Skip to main content

Volume 16 Supplement 1

1st Joint ANIRCEF-SISC Congress

  • Poster presentation
  • Open access
  • Published:

P008. Alexithymia and chronic migraine with medication overuse: what relationship?


Alexithymia is a personality trait characterized by the inability to identify and express emotions. Neuroimaging studies showed specific neural correlates in alexithymic subjects [1] and pathological scores of alexithymia in several chronic pain populations and in episodic migraine [2, 3]. There is also evidence of a positive association between alexithymia, depression, and anxiety in migraine patients. So far, no study has evaluated alexithymia in medication-overuse headache patients (MOH) (progressed by migraine) versus episodic migraine patients (MIG). The present study was aimed to evaluate whether MOH individuals differ from MIG as regards alexithymia scores and to investigate the association of alexithymia with headache characteristics.

Materials and methods

We recruited 99 patients suffering from MOH (n=54; 81.5% female; age: 41.6±10.9) evolved from migraine (chronic migraine + MOH) or MIG (n=45; 71.6% female; age: 41.0±9.3) at the Headache Centre of the “Mondino” Institute of Pavia. Diagnosis in the 2 groups was operationally defined according to the ICHD-IIIβ criteria. Patients were evaluated using the Toronto Alexithymia Scale (TAS-20), which uses a five-point Likert response scale and has a three-factor structure consisting of: (1) Difficulty in identifying feelings, (2) Difficulty in describing feeling, and (3) Externally oriented thinking. Demographic and clinical information were collected as well.


According to multiple binary logistic regression analysis, MIG and MOH patients were comparable in terms of demographic characteristics, whereas they differed for some characteristics of illness (age of migraine onset, duration of illness, frequency of headache), disability and QoL, as well as for depression levels. MOH patients scored higher than MIG on two of the three alexithymia facets, which were those concerning difficulties in identifying (MOH = 19.1±6.7, MIG = 13.8±6.7, p < 0.001) and describing feelings (MOH = 14.4±4.5, MIG = 11.6±4.8, p = 0.003). Groups were instead comparable in terms of externally oriented thinking (MOH = 18.6±4.2, MIG = 18.0±4.1, p = 0.50). Significant correlations resulted between alexithymia and illness characteristics (e.g., headache frequency, perceived disability, and QoL).


Our results show a specific alexithymic profile in our MOH population. These findings suggest that alexithymia could represent a risk factor in the transformation from episodic migraine into the chronic subtype with medication overuse. Early and appropriate interventions aimed at improving emotional awareness and expression could then represent a further preventive measure to avoid drug-induced headache.

Written informed consent to publish was obtained from the patient(s).

Conflicts of interests



  1. Pouga L, Berthoz S, de Gelder B, Grezes J: Individual differences in socioaffective skills influence the neural bases of fear processing: the case of alexithymia. Hum Brain Mapp. 2010, 31 (10): 1469-1481. 10.1002/hbm.20953.

    Article  PubMed  Google Scholar 

  2. Shibata M, Ninomiya T, Jensen MP, Anno K, Yonemoto K, Makino S, et al: Alexithymia is associated with greater risk of chronic pain and negative affect and with lower life satisfaction in a general population: the Hisayama Study. PLos One. 2014, 9 (3): e90984-10.1371/journal.pone.0090984.

    Article  PubMed Central  PubMed  Google Scholar 

  3. de Andrade Vieira RV, Vieira DC, Gomes WB, Gauer G: Alexithymia and its impact on quality of life in a group of Brazilian women with migraine without aura. J Headache Pain. 2013, 14: 18-10.1186/1129-2377-14-18.

    Article  Google Scholar 

Download references


This research was supported by a Grant of the Ministry of Health to the Mondino Institute (Current Research 2013-2015).

Author information

Authors and Affiliations


Corresponding author

Correspondence to Sara Bottiroli.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bottiroli, S., Galli, F., Viana, M. et al. P008. Alexithymia and chronic migraine with medication overuse: what relationship?. J Headache Pain 16 (Suppl 1), A150 (2015).

Download citation

  • Published:

  • DOI: