Aynur Özge
Massimiliano Valeriani
Derya Uluduz
Vincenzo Guidetti6- 1Department of Neurology, Mersin University, Mersin, Türkiye
- 2Global Migraine and Pain Society, Istanbul, Türkiye
- 3Bambino Gesù Children's Hospital (Istituti di Ricovero e Cura a Carattere Scientifico), Rome, Italy
- 4Developmental Neurology Unit, Rome, Italy
- 5Brain 360 Neurology Center, Istanbul, Türkiye
- 6Unit of Child and Adolescent Neuropsychiatry, Sant'Andrea University Hospital, Sapienza, Rome, Italy
Editorial on the Research Topic
Cognitive schemas in primary headache disorders
Headache disorders are prevalent among individuals of all age groups and have a significant impact on their overall quality of life and functioning. The cognitive schemas approach to understanding these disorders suggests that specific patterns of thinking, attitudes, and beliefs can perpetuate or worsen primary headaches. Recent studies have also identified a link between cognitive schema dysfunction and the development and persistence of primary headache disorders in adults. This approach is especially relevant in children and adolescents, where cognitive development and psychological factors may contribute to headache pathology (1).
Furthermore, recent research has revealed the role of frontostriatal dysfunction in the development and maintenance of headache disorders, including their association with common psychiatric comorbidities (2, 3). The frontostriatal network plays a critical role in regulating pain perception and emotional processing, and dysfunction within this network may contribute to the onset and continuation of primary headaches in young individuals (2, 4, 5).
Moreover, individuals with chronic headache disorders, such as migraines and tension-type headaches, have reported disturbances in their body schema (6). Schemas, which are the fundamental structures of cognition, have not received sufficient attention. Body schema refers to an individual's perception and awareness of their own body, and disruptions in body schema may contribute to chronic pain conditions, including headache disorders. Previous studies have examined early maladaptive schemas (EMSs) and the clinical characteristics of migraines in adolescents. Female adolescent migraineurs demonstrated significantly elevated scores for EMSs related to emotional deprivation, abandonment/instability, defectiveness/shame (disconnection/rejection domain), dependence/incompetence, vulnerability to harm/illness, failure (in impaired autonomy/performance domain), and negativity/pessimism (in hypervigilance/inhibition domain). Conversely, male migraineurs had significantly elevated scores only in insufficient self-control/self-discipline (in impaired limits domain). The type of migraine and current psychopathology did not significantly affect EMS domains, while a history of sexual abuse significantly influenced certain EMSs. Consequently, body schema therapy has been proposed as a potential treatment option, particularly for female migraine sufferers and those with chronic headache disorders (5, 6) (Güler Aksu et al.).
To effectively manage primary headache disorders, a multidisciplinary approach is recommended, which encompasses lifestyle adjustments, pharmacological interventions, and behavioral interventions such as cognitive-behavioral therapy (CBT) and body schema therapy. CBT has proven to be an effective behavioral intervention for managing primary headache disorders in adults (4), while body schema therapy has shown promising outcomes in improving pain perception, disability, and quality of life among individuals with chronic pain conditions (7, 8). CBT has also demonstrated efficacy as a behavioral intervention for managing primary headache disorders in children and adolescents (9). These interventions typically involve identifying and challenging negative cognitive schemas and maladaptive coping strategies, enhancing emotion regulation and stress management skills, and implementing relaxation techniques (8, 9).
Additionally, recent studies have underscored the potential of neuromodulation techniques, such as transcranial magnetic stimulation (TMS), in the management of primary headache disorders. TMS can modulate the activity of the frontostriatal network, thereby reducing pain severity (10).
This Research Topic seeks to provide a comprehensive understanding of cognitive schemas, frontostriatal dysfunction, and their potential roles in the development and persistence of primary headache disorders among children and adolescents. The contributions within this volume explore the application of CBT, neuromodulation techniques, and other behavioral interventions in managing primary headache disorders. Furthermore, they emphasize the significance of adopting a personalized approach to the management of primary headache disorders in adults. This approach involves identifying individual cognitive and body schema disturbances that contribute to headache pathology and tailoring treatment interventions accordingly. Moreover, recent studies have highlighted the importance of patient education and self-management strategies for the long-term management of primary headache disorders in adults (4, 10).
We trust that this Editorial provides readers with a comprehensive overview of the latest research on cognitive schemas, frontostriatal dysfunction, and primary headache disorders, as well as insights into the potential of multidisciplinary management approaches. We extend our sincere gratitude to the contributing authors for their valuable insights and efforts in compiling this collection of articles.
Author contributions
AÖ submitted the paper. All authors contributed to the article and approved the submitted version.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note
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References
1. Powers SW, Kashikar-Zuck SM, Allen JR, LeCates SL, Slater SK, Zafar M, et al. Cognitive behavioral therapy plus amitriptyline for chronic migraine in children and adolescents: a randomized clinical trial. JAMA. (2013) 310:2622–30. doi: 10.1001/jama.2013.282533
2. Coppola G, Petolicchio B, Di Renzo A, Tinelli E, Di Lorenzo C, Parisi V, et al. Cerebral gray matter volume in patients with chronic migraine: correlations with clinical features. J Headache Pain. (2017) 18:115. doi: 10.1186/s10194-017-0825-z
3. Alimoradi Z, Zarabadipour S, Arrato NA, Griffiths MD, Andersen BL, Bahrami N. The relationship between cognitive schemas activated in sexual context and early maladaptive schemas among married women of childbearing age. BMC Psychol. (2022) 10:131. doi: 10.1186/s40359-022-00829-1
4. Ozge A, Genç H, Aksu GG, Uludüz D. Migraine and frontostriatal circuit disorders: what have we learned until now? Neurol Sci Neurophysiol. (2021) 38:81–9. doi: 10.4103/nsn.nsn_9_21
5. Moseley GL. Graded motor imagery for pathologic pain: a randomized controlled trial. Neurology. (2006) 67:2129–34. doi: 10.1212/01.wnl.0000249112.56935.32
6. Paschali M, Lazaridou A, Vilsmark ES, Lee J, Berry M, Grahl A, et al. The “self” in pain: high levels of schema-enmeshment worsen fibromyalgia impact. BMC Musculoskelet Disord. (2021) 22:871. doi: 10.1186/s12891-021-04740-5
7. Schwedt TJ. Multisensory integration in migraine. Curr Opin Neurol. (2013) 26:248–53. doi: 10.1097/WCO.0b013e328360edb1
8. Onur OS, Ertem DH, Karsidag C, Uluduz D, Ozge A, Siva A, et al. An open/pilot trial of cognitive behavioral therapy in Turkish patients with refractory chronic migraine. Cogn Neurodyn. (2019) 13:183–9. doi: 10.1007/s11571-019-09519-y
9. Nicholson RA, Buse DC, Andrasik F, Lipton RB. Nonpharmacologic treatments for migraine and tension-type headache: how to choose and when to use. Curr Treat Options Neurol. (2011) 13:28–40. doi: 10.1007/s11940-010-0102-9
Keywords: cognitive schemas, frontostriatal dysfunction, migraine, cognitive behavioral therapy (CBT), migraine management
Citation: Özge A, Valeriani M, Uluduz D and Guidetti V (2023) Editorial: Cognitive schemas in primary headache disorders. Front. Neurol. 14:1240559. doi: 10.3389/fneur.2023.1240559
Received: 15 June 2023; Accepted: 04 July 2023;
Published: 12 July 2023.
Edited and reviewed by: Elisa Rubino, University Hospital of the City of Health and Science of Turin, Italy
Copyright © 2023 Özge, Valeriani, Uluduz and Guidetti. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Aynur Özge, YXludXJvemdlJiN4MDAwNDA7Z21haWwuY29t