Neuropsychological correlates of theory of mind in chronic migraine

Objective: Theory of mind (ToM), the ability to understand other minds-that is, their beliefs, intentions (cognitive ToM), or emotions (affective ToM)-and its neuropsychological mechanisms in migraine have been poorly investigated. The aim of the study was to explore the deficit of cognitive and affective ToM and its possible associations with cognitive functioning in patients with chronic migraine (CM). Method: Forty participants with CM and 40 age-, education-, and sex-matched healthy controls (HC) underwent clinical assessment, cognitive (the ToM Pictures Sequencing Task and the Advanced Test of ToM) and affective ToM (the Reading the Mind in the Eyes Task and the Emotion Attribution Task) tasks, and a comprehensive neuropsychological battery. Results: Patients with CM significantly reported a lower performance on tasks assessing ToM compared to HC, with an impairment demonstrated for cognitive ToM. Moreover, patients with CM achieved significantly lower scores on tests assessing cognitive flexibility, planning, abstract reasoning, and long-term memory with respect to HC. ToM abilities were significantly related to migraine severity, executive, and memory functions in CM patients. Conclusions: The findings demonstrated that patients with CM present difficulties in inferring others' mental states, which would be related to clinical and cognitive functioning. The clinical importance of these findings, implications for clinical practice, and future research are discussed.