Interoception in migraine is characterised by normal accuracy but altered sensibility and behaviour

Abstract

Abstract Migraine is typically precipitated by unaccustomed changes in one’s internal state and/or external environment. Migraine symptoms largely involve increased, noxious, awareness of bodily changes and external stimuli. Links have been proposed between migraine and interoception (sensing and interpreting internal states), but direct evidence is limited. Unmedicated, otherwise healthy, age-matched female participants were grouped by migraine tendency: control (no unprovoked headaches, n = 19); low-frequency ( < = 3 migraines/month, n = 20); high-frequency ( > = 4 migraines/month, n = 19). Interoception was assessed, interictally, with standardised questionnaires such as MAIA-2 and a widely used heartbeat counting task. The notable significant questionnaire-based difference was in the ‘noticing’, ‘not distracting’ domain of the MAIA-2; controls were least likely to continue activities despite experiencing physical discomfort, and high-frequency migraineurs most likely. Follow-up questioning clarified that this behaviour related predominantly to migraine-related symptoms. The heartbeat task found no differences in accuracy. Interoceptive accuracy scores were not reduced in migraine participants. Self-reported tendency to deliberately ignore physical discomfort, is associated with migraine frequency. Confidence (sensibility) showed a significant main effect of group. The low-frequency migraine group had the lowest confidence but interpretation of this finding requires further attention which could form a longitudinal study over the migraine cycle to distinguish causes from effects of migraine.