## 5 Discussion
### Comparison of the Results with Existing Literature  
In contrast to the present study, data from a meta-analysis on alexithymia show differences between people with migraine and healthy subjects. The results of the present study cannot reproduce the differences shown by [PERSON] et al. (2024). It should be noted, however, that the studies examined in this presentation of the meta-analysis all show a high risk of bias, and the results must, therefore, be viewed critically from this perspective [39]. The lack of differences in the area of psychological components is surprising, as large-scale reviews indicate an increased occurrence of these phenomena [64; 65], and studies indicate the effectiveness of psychological interventions in the management of migraine [66]. To improve this study, it may be advisable to tighten the inclusion criteria for the healthy group by using multidimensional questionnaires, such as the DASS, to better filter and compare participants without psychological abnormalities. This approach could also be applied more generally to participant selection. If one considers this aspect from a therapeutic clinical point of view, the so-called Orebro Musculoskeletal Screening Questionnaire (OMSQ) is often used in other persistent musculoskeletal syndromes, such as back pain, and screening is subsequently continued with more specific unidimensional questionnaires in the case of abnormalities. As mentioned, this would have added clinical value from a therapeutic point of view [67; 68]. The assessment of central sensitization using CSI is not standard in migraine studies. However, intervention studies, in particular, are increasingly using this tool to capture another objectifiable outcome parameter, in addition to limitations with and due to headache frequency or medication use [69]. In detecting possible overlap with other pain syndromes, such as restless leg syndrome, craniomandibular dysfunction, or cranial autonomic symptoms associated with migraine (e.g., runny nose, tearing, and nasal congestion), this questionnaire can indicate the underlying pathomechanism [70; 71; 72]. Nevertheless, the CSI might be more helpful in detecting psychological hypervigilance than the increased responsiveness of nociceptive neurons [55]. [PERSON] and [PERSON] (2021) examined LAT of hand and neck movements in patients with episodic migraine over 30 days, recording accuracy and speed of examination and differences in individual pain phases. They found correlations between the headache phases and worsening accuracy but not speed [26]. However, the lack of case-number calculation suggests an insufficient number of subjects, like the present study. Larger studies with more test persons and clearer inclusion and exclusion criteria are needed to obtain meaningful results. The study of facial emotion recognition in musculoskeletal manifestations is currently limited to syndromes such as low back pain (_LBP_) [59] and syndromes affecting the orofacial region, such as craniomandibular dysfunction [73] or (chronic) orofacial pain [11; 12; 57]. A comprehensive review [74] showed that FER has been investigated in psychological studies of healthy subjects and studies of psychiatric and neurological disorders, such as somatoform pain disorder [58], eating disorders [60], and Parkinson's syndrome [75]. This review concluded that alexithymia could be responsible for deficits in the context of FER, which, in turn, can occur in clinical disorders. The authors described previous studies showing that the correlation of impairment in FER with high scores in alexithymia testing may be partly due to depression and anxiety. In addition, behavioral and neuroimaging studies suggest that alexithymia is associated with processing deficits at the perceptual level [74]. More specifically, FER processing might be particularly impaired in correlation with marked alexithymia when the images are presented briefly and/or the image is degraded.