Abstract text (incl. figure legends and references)

Objective: The diagnosis of migraines and tension-type headaches is based on phenotypic characteristics. We currently do not know any marker in the nervous system along which we could separate the two diseases. The emotional processing of migraineurs has been proved to be altered in comparison with that of people without headaches. We wondered whether alterations would also be present when comparing migraineurs to subjects with tension-type headaches.

Methods: 45 episodic migraine (41 females) and 34 episodic tension-type headache subjects (24 females) performed an implicit face emotion processing fMRI task. After preprocessing raw images, individual contrast maps were created and used in a full factorial design to detect between-group differences in association with the average monthly headache frequency. The initial significance threshold was p<0.001 but only results surviving family-wise error correction (pFWE<0.05) were considered statistically significant. Both preprocessing procedure and statistical analysis of fMRI scans were performed in SPM12.

Results: At the sight of sad faces, migraine subjects showed less activation in the left supplementary motor area compared to tension-type headache subjects in association with the average monthly headache frequency (pFWE<0.05, voxel threshold=0).

Conclusion: Although both headache disorders are associated with negative mood, neural responses yielded to a negative emotion were different in migraine and tension-type headache subjects having similar headache frequency. Since the affected cortical region plays a role in emotional processing and cognitive control, we can speculate that the difference in its reaction might contribute to the differences in processing the affective component of pain.

Funding: 2017-1.2.1-NKP-2017-00002; KTIA_NAP_13-2- 2015-0001; 2020-4.1.1.-TKP2020; TKP2021-EGA-25; 2019-2.1.7-ERA-NET-2020-00005, and ÚNKP-20-3-II-SE-51.