P103 | ALEXITHYMIA INCREASES THE RISK OF MIGRAINE CHRONIFICATION IN WOMEN WITHOUT DEPRESSION

E. Rota¹, E. Rubino², V. Batti², M. Trucco¹, S. Bottiroli^3|4, M. Cangelosi^3|4, A. Doretti⁵, F. Govone⁶, D. Ferrandi⁷, C. Lanni⁷, C. Cavestro⁸, M. Demaestri⁸, E. Canale⁹, V. Sciruicchio¹⁰, A. Di Gioia¹⁰, A. Passarini¹¹, I. Toldo¹², S. Di Antonio¹, A. Versace¹³, E. Cavagnetto¹, L. Savi², A. Battaggia¹⁴ | ¹Neurology Unit, San Giacomo Hospital, Novi Ligure, ASL AL, Italy; ²Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Italy; ³Department of Brain and Behavioral Sciences, University of Pavia, Italy; ⁴IRCCS Mondino Foundation, Pavia, Italy; ⁵Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milano, Italy; ⁶Neurology Unit, Regina Montis Regalis Hospital, Mondovì, ASL CN1, Italy; ⁷Neurology Unit, San Biagio e Arrigo Hospital, Alessandria, AOU AL, Italy; ⁸Headache Center, Alba, ASL CN2, Italy; ⁹Child Neuropsychiatry Unit, IRCCS Istituto G. Gaslini, Genoa, Italy; ¹⁰Children Epilepsy and EEG Center, Bari, Italy; ¹¹Child Neuropsychiatry Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy; ¹²Unit of Child Neurology and Neurophysiology, Women’s and Children’s Health Department University of Padova, Italy; ¹³Pediatric Headache Centre, Department of Pediatric Emergency, Regina Margherita Children’s Hospital, Turin, Italy; ¹⁴SVEMG – Scuola Veneta di Medicina Generale, Padova, Italy

Abstract

Background. Alexithymia is a psychological construct, characterized by a deficit in identifying and communicating feelings. Emerging data suggest a role for alexithymia in migraine, within a complex interplay with psychiatric comorbidities. This study was aimed to investigate the relationship between alexithymia and migraine chronification in females.
Methods. This was an observational, multicenter study, enrolling female patients with migraine. Each patient underwent a psychological assessment for alexithymia (TAS-20 scale), anxiety and mood comorbidities (STAI-Y1/STAI-Y2, BDI-II) and apathy (Starksteln’s Apathy scale, SAS-I). Data on headache frequency, intensity and medication use were recorded.A multivariable logistic regression model was fitted to evaluate the association between alexithymia (TAS-20 score) and the probability of chronic migraine. The model included BDI-II categories, the TAS-20 × BDI-II interaction term, STAI-Y2 and SAS-I score, age and education as covariates.
Results. The study included 507 participants. In the overall sample, 384 (75.74%) had episodic migraine, 31 (6.11%) had chronic migraine (CM), 43 (8.48%) CM with medication overuse headache (MOH), and 48 (9.47%) could not be classified (missing data).Alexithymia was identified in 207 patients (40.83%), depression in 206 (40.63%). Both variables had 34 missing observations (6.7%).In the logistic regression analysis performed on complete cases (n= 366), the association between alexithymia and chronic migraine was modified by depression severity. In patients with no or minimal depression, higher TAS-20 scores were associated with a higher probability of chronic migraine. The average marginal effect of TAS-20 was 1.74 percentage points for each one-point increase in TAS-20 among patients with BDI-II score 0–4, and 0.70 percentage points among subjects with BDI-II score 5–9. Conversely, the marginal effect of TAS-20 was not statistically significant among patients with a BDI-II score >10.These findings indicate a significant interaction between alexithymia and depression, with the association between TAS-20 and chronic migraine progressively attenuating as depression severity increases. Multiple imputation analysis on the whole sample confirmed this finding, with a milder modifier effect of depression.
Conclusions. These results indicate a role of alexithymia in increasing the risk of migraine chronification in women without clinically relevant depression. Moreover, a modifier effect for depression is suggested.