High levels of alexithymia as well as low scores on assertiveness have been described in patients with chronic pain and headache.

To determine alexithymia and assertiveness scores and to explore their association with headache impact, in primary chronic headache patients.

This study aims to advance knowledge of the emotional expressiveness in headache impact.

In a sample of 62 outpatients, we used the Toronto Alexithymia Scale (TAS-20), the Rathus Assertiveness Scale and the Headache Impact Test (HIT-6) and applied the Pearson correlation index.

77.4% of women, 36.3 years mean age. The most prevalent diagnoses are migraine combined with tension type headache (33.9%), migraine alone (32.3%) and tension-type headache alone (22.6%). Most of the patients have not any psychiatric comorbidity (77.8%). We observe a direct linear relationship and statistically significant difference, between the total impact of headache and the total score of alexithymia (r = 0.27 p = 0.03) and there is an inverse correlation between the impact of headache and the total score of the scale of assertiveness, not statistically significant (r = −0.004 p = 0.97).

Discriminated by diagnostic groups, we found that the association between assertiveness and headache impact remains only in patients with migraine alone, while that between alexithymia and headache impact is preserved in all subgroups.

Two indirect measures of the difficulties in emotional expressiveness such as alexithymia and assertiveness, show the expected association with headache impact. The sample size can influence some of the correlations not statistically significant.