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Positive Facial Expression for Pain Modulation in Patients with Chronic Migraine †

Center for Studies in Communication Sciences Luigi Anolli, Department of Human Sciences for Education Riccardo Massa, University of Milano-Bicocca, 20126 Milan, Italy
Scientific-Disciplinary Sector M-PSI/01 General Psychology, Giustino Fortunato University, 82100 Benevento, Italy
Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
Author to whom correspondence should be addressed.
Presented at the 2nd International Electronic Conference on Brain Sciences, 15–30 July 2021. Available online:
Med. Sci. Forum 2022, 8(1), 11;
Published: 14 July 2021
(This article belongs to the Proceedings of The 2nd International Electronic Conference on Brain Sciences)


Background: Migraine is one of the most prevalent neurological disorders worldwide [1]. A large number of studies suggest that migraines are associated with the mental state of the patients, and especially with negative emotions [2]. One option to regulate negative emotions or the negative affective state in chronic migraine patients is by using visual feedback techniques that may visually induce analgesia [3]. In fact, it is known that the observation of facial expressions effectively modulates pain perception during social interactions [4]. Aim: To investigate whether exposure to different visual feedback conditions (facial expressions) may modulate pain perception, assessed by the 1 to 100 cm visual analogue scale in chronic migraine patients. Methods: To this aim, 38 female chronic migraine patients were recruited at the IRCCS C. Mondino Foundation. Chronic migraine patients eligible for detoxification in our institution during the pain attack period (pain between 3 and 7 in the visual analogue scale) were included. Participants were exposed to a 1 × 4 within-subject study design, where they had to observe different visual stimuli (positive face, neutral face, negative face, and control (white screen)), presented three times in a randomized order (each condition lasted 40 s). After the observation of each visual condition, pain ratings with a 0 to 100 VAS and identification scores in a Likert scale from −3 (no identification at all) to 3 (total identification) were assessed. Results: The results show a significant difference in pain ratings between the positive (32.44 ± 31) the negative (38.61 ± 29.74) (z = −4.46, p < 0.0001), and the neutral facial expression (37.15 ± 28.36) (z = 3.41, p < 0.001). Participants identified more with the neutral face condition compared with the negative face condition (z = 3.32, p < 0.05). Overall, the patients identified more with the three emotional face conditions than with the white screen control condition. Conclusions: A positive emotional face feedback is a stimulus strong enough to modulate pain perception via the mediation of emotion regulation for positive emotions. This study paves the way for the integration of new cognitive–behavioural training based on the adoption of visual placebo analgesia to further control pain perception in chronic migraine patients.

Supplementary Materials

The poster presentation can be downloaded at:


This study was supported by a grant from the Italian Ministry of Health to C. Mondino National Neurological Institute (Current Research 2020).

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found below: [Zenodo; Reservation 10.5281/zenodo.4808069].

Conflicts of Interest

The authors declare no conflict of interest.


  1. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet (London, England) 2016, 388, 1545–1602. [Google Scholar] [CrossRef]
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MDPI and ACS Style

Matamala-Gomez, M.; Bottiroli, S.; Sances, G.; Allena, M.; De Icco, R.; Guaschino, E.; Sandrini, G.; Tassorelli, C. Positive Facial Expression for Pain Modulation in Patients with Chronic Migraine. Med. Sci. Forum 2022, 8, 11.

AMA Style

Matamala-Gomez M, Bottiroli S, Sances G, Allena M, De Icco R, Guaschino E, Sandrini G, Tassorelli C. Positive Facial Expression for Pain Modulation in Patients with Chronic Migraine. Medical Sciences Forum. 2022; 8(1):11.

Chicago/Turabian Style

Matamala-Gomez, Marta, Sara Bottiroli, Grazia Sances, Marta Allena, Roberto De Icco, Elena Guaschino, Giorgio Sandrini, and Cristina Tassorelli. 2022. "Positive Facial Expression for Pain Modulation in Patients with Chronic Migraine" Medical Sciences Forum 8, no. 1: 11.

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