Alexithymia, Metacognition, and Theory of Mind in Children and Preadolescents With Migraine Without Aura (MWoA): A Case-Control Study

Background: Some studies have demonstrated the high impact of headache and migraine in several areas of children and adolescents’ life. In recent years, there has been an increase in scientific interest in the relationship between migraine and emotional regulation, investigating the possible consequences of emotional dysregulation on physical and mental health. While some studies have been carried out on the relationship between alexithymia and headache or migraine (especially in adults), no data exist on relationship between Theory of Mind (TOM), metacognition, and alexithymia in children and adolescents with migraine. Methods: Children with diagnosis of migraine without aura (MWoA) (36 males and 34 females) were compared to a healthy control group (31 males and 39 females). The age range was from 8 to 13 years in both groups. All children completed the Alexithymia Questionnaire for Children (AQC) for the assessment of alexithymia levels and the Domain of Social Perception included in the NEPSY-II to evaluate levels of TOM. Metacognitive development was evaluated with Io e La Mia Mente for children aged between 8 and 10 years and with Metacognitions Questionnaire for Children (MCQ-C) for children from 11 to 13. Results: There were no differences between children with MWoA and the control group in metacognitive abilities; only in the subscale “Negative Meta Worrying” of MCQ-C girls scored higher than boys, regardless of the group they were part of. Also, in the NEPSY-II subscale there were no statistically significant differences between the two groups. Children with MWoA scored higher in the AQC subscales “Difficulty Identifying Feelings” and “Difficulty Describing Feelings” than controls. Moreover, children between 8 and 10 years statistically differed from older children in “Difficulty Identifying Feelings” and in Total Score. Conclusion: Our data suggest that children with MWoA have no metacognitive and TOM problems compared to a healthy group. The experimental group showed higher traits of alexithymia, confirming what suggested by other studies in the literature. Future research will have to focus on migraine with aura and tension-type headache to evaluate any differences with children with MWoA

BRIX3000® Papain Gel for Cavity Treatment in the Adult Patient

Tooth decay is a multifactorial disease. Fermentable sugar, host factors, and cariogenic microbial flora are several agents that influence dental structure. In literature, alternative protocols for treating cavities are always of interest in terms of reducing pain and preserving tissue. In this case report, the use of a new gel-based on papain, which has a chemical effect on bacteria and allows the consistency of the altered tissue to be modified, leads to a less traumatic removal of the infected tissue. In this case report, BRIX3000, a gel with papain as its main ingredient, was used to treat an interproximal cavity on an upper premolar of a 35-year-old man frightened of the turbine. After a clinical check of all the systematic conditions and a first view of the oral cavity, the protocol was explained to the patient, and informed consent was obtained. The protocol involved applying the papain gel directly to the cavity, and after 2.5–3 minutes, it was removed. The complete removal of the infected tissue was achieved in three steps. The patient reported no discomfort, and the cavity was completely treated and ready to be restored. In conclusion, BRIX3000 seems to be a good alternative to the turbine in cavity treatment, particularly in patients who have discomfort during traditional treatments and are frightened of the turbine

Metacognition and theory of mind in children with migraine and children with internalizing disorders

Mentalization, theory of mind (ToM) and metacognition are abilities that explain or predict behavior based on beliefs, intentions, or feelings attributed to the self or others, mental states and thoughts. Some studies have showed an impairment of these abilities in children and adolescents with several disorders, such as anxiety, depression, Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD). Moreover, some studies have hypothesized a relationship between a deficit on metacognition, TOM abilities and alexithymia. There are very few data on the relationship between ToM and metacognition in children and adolescents with migraine and there is no study comparing these children with those with internalizing disorders. Since the literature suggests that children with migraine have a high comorbidity with internalizing disorders, our hypothesis is that these problems may have in common persistent and maladaptive patterns of thinking which are related to maladaptive metacognitive beliefs. For these reasons we used the Domain of Social Perception included in the NEPSY-II to assess levels of ToM, Metacognitions Questionnaire for Children (MCQ-C) for metacognitive abilities and Alexithymia Questionnaire for Children (AQC) for alexithymia, both in children with migraine and children with internalizing disorders. These two group will be compared with a control group without any psychiatric or psychological disorders. We expect to find higher level of Alexithymia and a greater impairment on TOM and Metacognition in both clinical samples compared to the healthy group. Moreover, we expect a significative correlation between migraine characteristics (e.g. intensity, frequency, duration of the attacks etc.) and deficit on metacognition and ToM abilities and in alexithymia