## 5 Discussion
### Interpretation of the Results and Outlook  
The non-significant results between the two groups do not allow any interpretations or considerations of tendencies in a certain direction from a statistical point of view. Reasons for these results range from the group size not being reached to the still under-researched methods concerning LAT and FER. The testing of central sensitization using the German version [47] of the CSI questionnaire [76] provides the only statistically significant difference in the study of the two groups. The implementation of this questionnaire would be relevant in a scientific context, as well as in clinical practice, and interesting for possible treatment courses. Although primarily a screening tool, the CSI could be useful as a follow-up parameter during studies and treatments, providing clinical clues to other physical and psychological symptoms for a holistic approach to the patient's problems. The presentation of confounders also suggests that persistent central sensitization can be associated with various other syndromes. Among others, associations with clinical pictures such as restless leg syndrome and craniomandibular dysfunction, cranial autonomic syndromes, a general sensitivity to pain in subjects with episodic and chronic migraine are linked to the neurophysiological phenomenon of central sensitization in the literature [70; 71; 72; 77]. All too often, there is a danger of pathologizing a physiological phenomenon such as central sensitization and blaming it for a clinical problem [18]. This should be avoided, given current considerations with respect to the IASP concept of neoplastic pain [78] and the new ICD-11 classification of chronic primary pain as a diagnosis in its own right, in that it is defined not only by purely neurophysiological adaptations but also by the existence of functional and emotional impairments [79]. The most frequent additional musculoskeletal disorder in the migraine group (n = 10) is cervical spine-shoulder syndrome. These results go hand in hand with studies on the overlapping of headache syndromes and other complaints pertaining to the musculoskeletal system, particularly in the shoulder-neck region [80; 81; 82; 83]. Central sensitization seems to play an important role in the chronification of pain [84] and is also consistent with considerations of other described persistent syndromes, such as irritable bowel syndrome (n = 1) or chronic gastritis (n = 2). The use of the CSI questionnaire seems even more justified. In addition to the confounding factors of other symptoms, the difference in the highest level of education also stands out. While 100% of the participants in the healthy control group have a high school diploma (Matura) or a university degree, this applies to 69% of the migraine group. The other 31% of the migraine group have a primary school degree. Socio-economic and educational factors are discussed with respect to (chronic) migraine below. Migraine is indirectly proportionally more common in social classes with lower levels of education and income [85]. A higher score on the TAS-20 questionnaire for alexithymia traits seems to be weakly correlated with poorer recognition of the emotions of FEAR, SAD, HAPPY, SURPRISED, and ANGRY. Compared to the CG, these weak to moderate monotonic correlations could be detected for almost all basic emotions (except DISGUST), which would clinically justify screening for alexithymiaa in combination with FER. Subsequently, training could influence existing alexithymiaa. How this might affect the intensity or frequency of migraine cannot be inferred from existing data. This would require actual intervention studies with the mentioned parameters. On a psychological level, the calculation of monotonic correlations for the migraine group between the DASS questionnaire and facial emotion recognition showed a weak to moderately negative monotonic correlation only in the recognition of the emotion of FEAR.