Theory of mind: a new perspective on cluster headache—a cross-sectional study

Introduction Theory of mind (ToM) is the ability to attribute mental states of self and others, such as beliefs (cognitive ToM) and feelings (affective ToM). Based on the role of the hypothalamus in pain and social cognition, our aim is to determine whether ToM is impaired in patients with cluster headache (CH). Methods Cross-sectional study in which 31 episodic cluster headache (ECH) patients outside the bout and 20 matched controls carried out social cognition and executive function tasks. Patients were recruited from an outpatient Headache Unit. Results Patients performed worse than healthy controls at cognitive ToM ( t = 4.2, p < 0.001) task but not at affective ToM. Executive function was also impaired ( t = 4.8, p < 0.001) and higher scores at anxiety and depression questionnaires ( t = − 2.9, p = 0.006; t = − 3.6, p = 0.001) were reported. There was no correlation between ToM scores and executive function, anxiety and depression symptoms, or disease duration and severity. Discussion Our results suggest that ECH patients can perceive other people’s or selves’ feelings (affective ToM) but have more difficulties than healthy subjects at recognizing beliefs (cognitive ToM).