Are Some Migraine Patients “Emotionally Blind”?

Are migraine patients “emotionally blind” – maybe also “emotionally mute”?

That may sound like an insult at first, but it isn’t. It’s a reference to your new word-of-the-day, alexithymia.

Alexithymia is a relatively new term, from Greek terms meaning not speaking heart – in other words, the inability to speak about “heart issues”, or emotions. More specifically, people struggling with alexithymia have difficulty identifying and explaining emotions, either in themselves or others.

Alexithymia is not generally diagnosed as a condition on its own. Instead, it is a common aspect of other conditions, such as depression, autism, or schizophrenia. Sometimes it’s considered to be a major deficit in one’s abilities. Other times it’s considered to be simply part of someone’s normal personality. Could there be a relationship between alexithymia and current isolation or our emphasis on “online relationships”?

But people with significant or severe alexithymia can have major problems. Imagine if you couldn’t recognize how your friend were feeling – you would be much more likely to make matters worse by what you said or did. Or imagine if you had a husband or wife who couldn’t express how they were feeling – you would never know if they really “empathized” with you, or really “cared”. You might respond by expressing your feelings even more, trying to get a response.

However alexithymia is categorized or described, researchers get especially interested if they see that it’s more common in people with other conditions, such as migraine. A recent study in France discussed some of the growing interest in migraine and alexithymia:

In literature, migraine is often associated with psychological factors such as anxiety, depression, and stress. The presence of alexithymia in migraine patients has also been reported increasingly frequently in recent years. Alexithymia — defined as difficulty in expressing feelings in words and in experiencing symbolic thought — seems to be related to the intensity and frequency of migraines, as well as how they are triggered and how disabling they are. Regardless of the severity of migraine, alexithymia appears to be a psychological characteristic of migraine patients.

Social and emotional cognition in patients with severe migraine consulting in a tertiary headache center: A preliminary study

This particular study, published last month, used various tests to see if patients with severe migraine had trouble with emotional understanding and communication. For example, there are faux pas tests, which see whether people understand how to act “appropriately” in various emotional situations. Social cognition & and emotional assessments have a variety of tests, including evaluation of the ability to understand facial expressions.

The severe migraine patients did seem to have a harder time with this emotional understanding than the control group, something that especially showed up in the faux pas test.

So why is it that some migraine patients may struggle with “emotional blindness”? Is it related to the biology of migraine? Perhaps just a reaction to regular pain – a defence mechanism to keep too many negative emotions from flooding in?

This was a small study, and just a small step forward in our understanding. In the long term, there may be something here that could help us better understand what migraine is. But in the short term, it may help us to better understand some migraine patients, and provide better treatment.

Do you think that you may experience alexithymia? How has it influenced your relationships, or your migraine treatment?

For more information, see:

• The Emotional Blindness of Alexithymia (Scientific American)
• Four decades of research on alexithymia: moving toward clinical applications (Frontiers in Psychology)