Exploring social cognition in migraine: a narrative review

Background: Migraine is a neurological disorder that significantly impacts patients’ quality of life, with a growing global burden. This condition is characterized by recurrent headaches with symptoms like nausea and photophobia, with limited analysis of its cognitive effects, especially in social cognition. Methods: This narrative review investigates how migraine, especially in its chronic and medication-overuse forms, affects social cognition, focusing on domains such as Theory of Mind (ToM), emotion recognition, and empathy. Social cognition impairments in patients with migraine contribute to difficulties in maintaining relationships and effective communication, exacerbating the disorder’s emotional and social burden. Results: The reviewed literature shows that migraine is associated with a significant deficit in social cognition, particularly in chronic and medication-overuse headache (MOH). ToM deficits are frequently observed, as individuals with migraine struggle to attribute mental states to others, which impacts their ability to interpret social cues. Emotion recognition impairments, especially in recognizing subtle facial expressions, and difficulties with empathy are also reported, further complicating interpersonal interactions. Neuroimaging studies suggest that these cognitive deficits have a neural basis, with altered activation in areas involved in emotion processing. Alexithymia, often present in patients with migraine, is linked to these social cognitive difficulties, particularly affecting emotional awareness and empathy. Conclusions: These findings highlight the need for specific assessment tools and interventions aimed at improving social cognition in these patients. Such interventions could help improve the emotional and social impact of the disorder and improve overall patient outcomes. Future research should explore these mechanisms further and develop targeted therapies to support patients’ social and emotional well-being.