La narrazione dell'esperienza di cefalea in età adulta: tra regolazione emotiva e adattamento psicosociale

ABSTRACT This doctoral dissertation investigates the role of narrative processes in the experience of primary headache in adult patients, with particular attention to psychosocial adaptation and emotional regulation. Migraine and tension-type headaches are the most common forms of primary headache, one of the main causes of disability globally. Although traditionally viewed as a condition with a predominantly biological component, the literature increasingly shows that the experience of headache cannot be reduced to its symptomatic dimension alone. It’s a multidimensional phenomenon in which biological, psychological, and relational factors are connected. Several studies have documented that primary headache is associated with high levels of psychological distress and dysfunction in emotional regulation and cognitive processes, modulating perceived pain intensity and disability. However, these processes have been primarily investigated from a clinical perspective, while the subjective dimension through which patients construct, redefine, and reprocess the experience of illness has been relatively underexplored. Recent treatment approaches, which integrate pharmacological interventions with non-pharmacological therapies, reflect the condition's complexity. In this framework, expressive writing (EW) can be conceptualized as a narrative instrument that supports meaning-making processes and facilitates emotional processing. Although psychological aspects, the subjective and narrative aspects of illness are still unexplored. The present study aims to address this gap by integrating a narrative intervention into a mixed-methods design. This quasi-experimental study aimed to: (1) quantitatively assess the effects of expressive writing, compared to a neutral writing condition, at the intrapsychic level (2) qualitatively explore the impact of headache on social life and family relationships, at the psychosocial level; and (3) exploratorily examine the contribution of narrative medicine as a theoretical and clinical framework for understanding and integrating patient’s illness narratives. Participants were recruited at the IRCCS "Carlo Besta" Neurological Institute in Milan between July 2023 and July 2024. 95 of the 126 patients, with tension-type headache or migraine (episodic and chronic), were randomly assigned to either the experimental condition (Expressive Writing) or the control condition (Neutral Writing). 56 participants who completed the study protocol at baseline and follow-up were included in the final sample. Participants completed the protocol independently online at home. Participants completed the writing task at baseline (T0), as well as self-report instruments including the Migraine Disability Assessment Scale, the Migraine-Specific Quality of Life Questionnaire, the Depression Anxiety Stress Scales-21, the Emotion Regulation Questionnaire and the Pain Catastrophizing Scale, and also an open-ended question. They were contacted again three months later (T1) to complete the online surveys without repeating the writing assignment. The findings demonstrated that the EW group exhibited a slight enhancement in quality of life, a reduction in psychological distress, and statistically significant increases in emotional regulation and pain catastrophizing. The results revealed recurring themes of disrupted identity, everyday functioning restrictions, relational distress, and progressive attempts to incorporate headaches into personal narratives. Overall, the study emphasizes the clinical benefit of incorporating narrative medicine into patient-centered, biopsychosocial therapy models and supports the applicability of story-based therapies in primary headache care.