Migraine and cognitive decline among women: prospective cohort study

In search of a neuropsychological profile for migraine: A scoping review

OBJECTIVE

Migraine is commonly overlooked by the general population and by professionals in research and clinical practice. Moreover, it is difficult to grasp the neuropsychological profile of migraineurs due to the cyclic nature of the disorder. With this in mind, a scoping review of the literature was conducted with the goal of characterizing cognitive domains associated with deficits in migraine.

METHODS

PubMed, PsychInfo, Scopus, EMBASE and OpenGrey databases were searched for studies published from 1st January 2006 to 30th November 2022. Following the review process, 52 eligible studies were included in the review.

RESULTS

Studies included in this review show mixed and sometimes contradictory findings. Overall, both visual and auditory perception appear to be impaired. Deficits on attention, many memory processes, visuospatial function and spatial navigation and on a wide range of executive functions (set-shifting and cognitive flexibility, decision-making and reasoning, working memory and prospective memory) complete a complex cognitive profile in migraine. Lack of consistency across studies in sample selection and sizes, lack of detailed links between cognitive deficits and specific migraine phases, or length and chronicity, inconsistencies on the role of aura in cognitive function; and heterogeneity and sometimes questionable reliability and validity of some of the cognitive measures used may affect the clarity and consistency of results observed.

CONCLUSION

Further research properly addressing the role of gender and age, migraine stage, length and chronicity of the condition, the effect of aura and comorbidities is needed, alongside increasing consistency across diverse neuropsychological assessment protocols.

SIGNIFICANCE

This review provides a comprehensive, up-to-date picture of the current status of knowledge in relation to the characterization of the complex cognitive profile of migraine. It offers detailed information of the existing research gaps and challenges to improve the cognitive characterization of migraine across its different stages and leads clinicians to carefully consider the selection of relevant cognitive tasks, in order to grasp more accurately the patient's cognitive profile; an assessment that should be an integral part of any protocol developed for the clinical assessment and subsequent treatment planning for migraine.

Preventive treatment can reverse cognitive impairment in chronic migraine

Objective

To study the impact of chronic migraine (CM) on the cognition and quality of life (QoL) of patients in the interictal period, and to analyse the degree of reversibility of any observed alterations following the use of preventive treatment.

Background

CM is a highly disabling disease, and migraineurs often have associated comorbidities, such as subjective memory problems, that are involved in the development of cognitive impairment. Our hypotheses are that patients suffering from chronic migraine experience objective cognitive alterations that are not only due to the pain that they suffer or their current emotional state. Furthermore, preventive treatment should be capable of reversing, or at least reducing, the impact of CM on the cognition and QoL of migraineurs.

Methods

The cognition and QoL of 50 control subjects and 46 patients with CM were assessed using a battery of tests, prior to the use of preventive treatment based on botulinum toxin or oral drugs and after 3 months of this treatment.

Results

Compared with controls, patients with CM had lower scores on the assessment of cognitive performance (Rey-Osterrieth Complex Figure test [ROCF] (p<0.05), Trail Making Test [TMT] B) (p < 0.05) and QoL (p < 0.05). Three months after the use of preventive treatment, improvement was observed in all cognitive parameters (p < 0.05) and QoL (p < 0.05), except the ROCF copy task (p = 0.79). No statistically significant differences were observed when these outcomes were compared based on treatment.

Conclusions

This study confirms poor cognitive performance that is not explained by migraine pain itself, as it occurs in the interictal period, irrespective of the patient’s emotional status. Our findings show that these effects are reversible in some cases with preventive treatment of CM, reaffirming the important impact of this condition on the QoL of these patients, and the need to establish preventive treatment guidelines.

Association between migraine and cognitive impairment

Background

Previous studies revealed inconsistent results regarding association between migraine and cognitive impairment. In addition, previous studies found inconsistent results regarding the association between migraine and risk of dementia. Thus, the study aimed to make a meta-analysis exploring comparison result in different types of cognitive function between migraine patients and non-migraine subjects. In addition, meta-analysis was made to explore the association between migraine and risk of dementia.

Methods

Articles published before June 2022 were searched in the following databases: PubMed, Web of Science, SCOPUS, EMBASE, EBSCO, PROQUEST, ScienceDirect and Cochrane Database of Systematic Reviews. Results were computed using STATA 12.0 software.

Results

Meta-analysis showed lower general cognitive function and language function in migraine group, compared to no migraine group (general cognitive function: standard mean difference (SMD) = − 0.40, 95% CI = − 0.66 to − 0.15; language: SMD = − 0.14, 95% confidence interval (CI) = − 0.27 to − 0.00), whereas the study showed no significant difference in visuospatial function, attention, executive function and memory between migraine group and no migraine group (visuospatial function: SMD = − 0.23, 95% CI = − 0.53 to 0.08; attention: SMD = − 0.01, 95% CI = − 0.10 to 0.08; executive function: SMD = − 0.05, 95% CI = − 0.16 to 0.05; memory: SMD = − 0.14, 95% CI = − 0.30 to 0.03). In addition, the meta-analysis showed a significant association between migraine and risk of dementia (odds ratio (OR)/relative risk (RR) = 1.30, 95% CI = 1.11 to 1.52).

Conclusions

In conclusion, the meta-analysis demonstrated lower general cognitive function and language function in migraine. In addition, migraine is associated with an increased risk of all-cause dementia, VaD and AD. These results suggest a significant association between migraine and cognitive impairment. Because of the association between migraine and cognitive impairment, neurological physician should be vigilant and effectively intervene in migraineurs with high risk factors of cognitive impairment to prevent the development of cognitive impairment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s10194-022-01462-4.

Migraine, Cognitive Decline, and Dementia in Older Adults: A Population-Based Study

Background: The potential impact of migraine on cognitive aging among older adults remains controversial. Objective: To examine the relationship of migraine and subtypes with cognitive decline and dementia in an older Swedish population. Methods: This population-based study included 3069 participants (age≥60) from the Swedish National study on Aging and Care in Kungsholmen, Stockholm. Baseline examination was conducted in 2001–2004, and participants were followed every 3 or 6 years until 2013–2016. Data were collected through face-to-face interviews, clinical examinations, laboratory tests, and linkage with registers. Global cognitive function was measured with the Mini-Mental State Examination (MMSE). Dementia was diagnosed according to the DSM-IV criteria. Migraine and subtypes were defined following the international classification system. Data were analyzed using logistic regression, Cox regression, and linear mixed-effects models. Results: At baseline, 305 participants were defined with non-migraine headache and 352 with migraine. The cross-sectional analysis showed that the multivariable-adjusted odds ratio (95% confidence interval) of prevalent dementia was 0.49 (0.20–1.21) for migraine and 0.66 (0.26–1.66) for migraine without aura. The longitudinal analysis showed that the multivariable-adjusted hazard ratios of incident dementia associated with migraine and subtypes ranged 0.68–0.89 (p > 0.05). Furthermore, migraine and subtypes were not significantly associated with either baseline MMSE score or MMSE changes during follow-ups (p > 0.05). The nonsignificant associations did not vary substantially by age, APOE ɛ4 allele, cerebrovascular disease, and antimigraine treatment (p for interactions > 0.05). Conclusion: This study shows no evidence supporting the associations of migraine and its subtypes with cognitive decline and dementia among older adults.

Cognitive Impairment in Primary and Secondary Headache Disorders

Purpose of Review

To critically evaluate the recent literature on cognitive impairment and headache.

Recent Findings

Neurocognitive symptoms are prevalent, debilitating, and occur often with both primary and secondary headache disorders.

Summary

This is a “narrative review of the current literature in PubMed on cognitive function and headache.” Migraine is associated with cognitive impairment years before a migraine diagnosis. In young and middle-aged adults, migraine is associated with deficits in attention, executive function, processing speed, and memory. It is unlikely that migraine is associated with dementia. Although methodologically difficult to assess, there does not seem to be an association between tension-type headache and cognitive dysfunction. In early to midlife, cluster headache seems to be associated with executive dysfunction. Several secondary headache syndromes relevant to clinicians managing headache disorders are associated with poorer cognitive performance or distinctive cognitive patterns, including those attributed to chronic cerebral or systemic vascular disorders, trauma, and derangements of intracranial pressure and volume, including frontotemporal brain sagging syndrome.

Is there a link between headache and cognitive disorders? A systematic review

BACKGROUND

The overall prevalence of headaches decreases with age; however headaches remain frequent in aged individuals who are also affected by other disorders such as cognitive decline. Despite the high frequency of both conditions in these persons, the association between headaches and cognitive decline is underexplored, underdiagnosed and poorly understood.

OBJECTIVE

In the present article, we aim to provide a comprehensive review of existing data concerning the link between headache and cognitive decline.

METHODS

We undertook a systematic literature review to report articles that focus on headaches (including all types of headaches) and neurocognitive disorders of degenerative causes.

RESULTS

Only 9 studies have explored the association between headaches and neurocognitive decline. Methods were highly variable from population-based study to short series of patients using either database or questionnaire during consultation. Studies focusing on Familial Alzheimer's Disease revealed a very high prevalence of headaches in mutation carrier patients compared to non-carrier patients.

CONCLUSION

The association between headaches and cognitive decline is underexplored. Future studies are needed to address the pathophysiological mechanisms to improve the treatment of these underestimated headaches.

White Matter Lesions in Migraine

Migraine, the third most common disease worldwide, is a well-known independent risk factor for subclinical focal deep white matter lesions (WMLs), even in young and otherwise healthy individuals with no cardiovascular risk factors. These WMLs are more commonly seen in migraine patients with transient neurologic symptoms preceding their headaches, the so-called aura, and those with a high attack frequency. The pathophysiology of migraine-related deep white matter hyperintensities remains poorly understood despite their prevalence. Characteristic differences in their distribution related to chronic small vessel ischemic disease compared with that of common periventricular WMLs in the elderly suggest a different underlying mechanism. Both ischemic and inflammatory mechanisms have been proposed, as there is increased cerebral vulnerability to ischemia in migraineurs, whereas there is also evidence of blood-brain barrier disruption with associated release of proinflammatory substances during migraine attacks. An enhanced susceptibility to spreading depolarization, the electrophysiological event underlying migraine, may be the mechanism that causes repetitive episodes of cerebral hypoperfusion and neuroinflammation during migraine attacks. WMLs can negatively affect both physical and cognitive function, underscoring the public health importance of migraine, and suggesting that migraine is an important contributor to neurologic deficits in the general population.

Persistent pain and cognitive decline in older adults: a systematic review and meta-analysis from longitudinal studies

Both persistent pain and cognitive decline prevalence increase with advancing age and are associated with functional decline. However, the association of pain and cognitive decline has not been evaluated yet by a systematic assessment of longitudinal studies. We aimed to assess the association of persistent pain as a risk factor for cognitive decline in community older adults, using data from longitudinal studies in a systematic review and meta-analysis. Publications were identified using a systematic search on PubMed, EMBASE, and Cochrane Library databases from inception to June 2019. Because heterogeneity across studies was high, we used random-effects meta-analysis to calculate the pooled relative risk (RR) for the association between persistent pain and cognitive decline incidence. We investigated sources of heterogeneity among studies using meta-regression and stratified analyses. We included 10 prospective longitudinal studies with 57,495 participants with a mean age at the baseline ranging from 61.8 to 88.4 years and mean follow-up times ranging from 2.75 to 11.8 years. Persistent pain at baseline was not associated with the development of cognitive decline during the follow-up (pooled RR = 1.05, 95% confidence interval = 0.92-1.21). In sensitivity analyses, only length of follow-up time ≤4.5 years was associated with a higher risk of cognitive impairment (pooled RR = 1.19, 95% confidence interval = 1.10-1.28). Persistent pain was not associated with the incidence of cognitive decline.

Migraine Headache and Risk of Dementia in the Atherosclerosis Risk in Communities Neurocognitive Study

OBJECTIVE

We aimed to assess the association between migraine headache and incident dementia.

BACKGROUND

Migraine is a risk factor for white matter hyperintensities and ischemic stroke, which are both associated with increased risk of dementia. However, it is unknown whether migraine is independently associated with dementia.

METHODS

History of migraine was ascertained via questionnaire. Adjudicated cases of dementia were identified using cognitive tests, neuropsychological exams, and clinician review of suspected cases. Incident dementia was identified using adjudicated cases, follow-up calls, and surveillance of hospital and death codes. We assessed hazards of incident dementia by migraine status. Sex differences were also examined and stratified results were presented.

RESULTS

Analysis included 12,495 White and African American participants ages 51-70 with a median follow-up time of 21 years. Prevalence of dementia was 18.5% (1821/9955) among those with no migraine history, 15.8% (196/1243) among those with severe non-migraine heading, and 16.7% (233/1397) among migraineurs. There was no association between migraine and incident dementia [hazard ratio: 1.04 (0.91, 1.20)]. There was also no statistically significant interaction between sex and migraine status on risk of dementia.

CONCLUSION

Despite evidence of brain abnormalities in migraineurs, there was no association between migraine and incident dementia in this prospective cohort.

Cognitive aging in migraine sufferers is associated with more subjective complaints but similar age-related decline: a 5-year longitudinal study

Objectives and background

The effect of headache on cognitive performance is controversial, due to conflicting results obtained from studies in clinical or population settings. We aimed to understand if migraine and other headaches modify the rates of decline on different cognitive measures, during a 5-year interval.

Design and method

A cohort of community dwelling adults (> 50 years) with migraine (MH), non-migraine headaches (NMH) and controls without headache (WoH), was assessed by a comprehensive neuropsychological battery with tests of memory, language and executive functions, repeated 5 years apart. Change in performance between baseline and reevaluation was compared between groups, and controlled for age, gender, literacy and depressive symptoms.

Results

A total of 275 participants (78.5% WoH, 12.7% MH, 8.7% NMH) were reevaluated (average age 70.40 + 8.34 years, 64% females). Cognitive decline or dementia occurred in 11.4%, with a similar proportion among the three groups. Although MH participants had significantly more subjective cognitive complaints (p = 0.030, 95%CI:]-3.929,-0.014[), both MH and NMH subjects showed an age-associated decline identical to controls. Furthermore, migraine features (disease and attack duration, frequency and aura) were unrelated with cognitive performance.

Conclusion

Migraine and non-migraine headache are not associated with increasing risk of dementia or cognitive decline at an older age although subjects with migraine have more cognitive complaints. Longer longitudinal studies are necessary to understand if this pattern persists for more than 5 years.

Cognition and Cognitive Impairment in Migraine

BACKGROUND

Migraine is a complex neurological disorder that affects a significant percentage of the human species, from all geographic areas and cultures. Cognitive symptoms and dysfunctions are interim and disabling components of this disorder and may be related to the brain processes underlying the pathophysiology. Yet they are often undervalued by clinicians. In this review, we present the different types of cognitive dysfunctions associated with migraine and the mechanisms that are potentially causing them.

FINDINGS

While reversible attack-related cognitive dysfunction seems extremely consistent and likely related to functional cortical and subcortical brain changes occurring during attacks, interictal cognitive dysfunction is less consistent and might become more relevant as attack frequency and disease complexity increase. Migraine traits do not seem a predisposition to long-term cognitive decline. Cognitive dysfunction is a frequent manifestation of migraine attacks and may be specific to this disorder; it is important to understand if it could be useful in migraine diagnosis. Attack-related cognitive dysfunction is clinically relevant and contributes to disability, so it should be perceived as a therapeutic target. While there is no evidence to support that migraine increases the risk of long-term or persistent cognitive dysfunction, the fact that it occurs during the attacks and may persist in subjects with frequent or complicated attacks should prompt the understanding of the mechanisms related to its pathophysiology for it may also clarify the processes underlying migraine.

Brain functional connectivity in headache disorders: A narrative review of MRI investigations

Resting-state functional magnetic resonance imaging (rs-fMRI) is used to interrogate the functional connectivity and network organization amongst brain regions. Functional connectivity is determined by measuring the extent of synchronization in the spontaneous fluctuations of blood oxygenation level dependent (BOLD) signal. Here, we review current rs-fMRI studies in headache disorders including migraine, trigeminal autonomic cephalalgias, and medication overuse headache. We discuss (1) brain network alterations that are shared amongst the different headache disorders and (2) network abnormalities distinct to each headache disorder. In order to focus the section on migraine, the headache disorder that has been most extensively studied, we chose to include articles that interrogated functional connectivity: (i) during the attack phase; (ii) in migraine patients with aura compared to migraine patients without aura; and (iii) of regions within limbic, sensory, motor, executive and default mode networks and those which participate in multisensory integration. The results of this review show that headache disorders are associated with atypical functional connectivity of regions associated with pain processing as well as atypical functional connectivity of multiple core resting state networks such as the salience, sensorimotor, executive, attention, limbic, visual, and default mode networks.

Cognitive dysfunction and migraine

Cognitive dysfunction has recently gained attention as a significant problem among migraine sufferers. All of the clinical studies show poor cognitive performance during migraine attacks, though, the interictal data are conflicting. Migraineurs show impaired cognitive function interictally in most of the clinic-based studies. Population-based studies did not reveal a difference in cognitive functions between migraineurs and controls. The specific cognitive domains involved are information processing speed, basic attention, executive functions, verbal and non-verbal memory and verbal skills. Neurophysiological, imaging and pharmacological studies support clinical symptoms of cognitive impairment in migraine. Longitudinal studies do not suggest progressive cognitive decline over time in migraine patients. Preventive medications and comorbid disorders such as depression and anxiety can impact cognitive function, but cannot fully explain the cognitive impairment in migraine. In contrast to migraine, tension type or cluster headache are not associated with cognitive impairment, at least during headache-free periods.

Cognitive impairment in patients with migraine: causes, principles of effective prevention and treatment

Cognitive impairment (CI) is common in patients with migraine; its causes and pathogenesis continue to be discussed. Some authors consider that migraine proper does not lead to decreased cognitive functions, neuroimaging changes in the brain white matter are asymptomatic in migraine; and CI in patients with this condition is caused by comorbidities (depression, anxiety disorder) and/or concurrent cerebrovascular and neurodegenerative diseases. Other authors report the pathogenetic role of migraine in the development of CI and the importance of the frequency of headache attacks and neuroimaging changes in the brain matter in migraine. The paper reviews clinical trials dealing with the prevalence, causes, and pathogenesis of CI in patients with migraine. It sets forth the current principles of prevention and treatment of CI in patients with this condition.

Definition of Balance and Cognition Related to Disability Levels in Vestibular Migraine Patients

Objective

To compare the balance and cognition of vestibular migraine (VM) patients with migraineurs without vertigo history and healthy subjects, and to examine the effects of disability level on these functions.

Material-method

The study consisted of 32 VM patients, 32 migraineurs and 31 healthy subjects with similar sex and age. Balance functions were assessed with Balance Evaluation Systems Test (BEST), dizziness and headache severity with Visual Analogue Scale (VAS), disability related to dizziness with Dizziness Handicap Inventory (DHI), cognition with Stroop test.

Results

There was no statistical significant difference among the three groups in terms of age, gender, height, weight, marital status and education levels (p>0.05). Headache severity was higher in migraineurs than vestibular migraineurs and healthy subjects, also dizziness severity was higher in vestibular migraineurs than migraineurs and healthy subjects (p<0.0167). The outcomes of BEST 4, 5, 6 and BEST-total were significantly impaired in VM patients than migraineurs and healthy subjects, and worse in migraineurs rather than healthy subjects (p<0.0167). Stroop effect of cognitive examination was worse in VM and migraine patients rather than healthy subjects (p<0.0167). There was no significantly difference between VM and migraineurs (p>0.0167). There was a negative correlation between Stroop effect and BEST-total in VM patients significantly (r=-0.509, p=0.003), and no significant correlation in migraineurs (p>0.05). Disability levels of VM patients were low in 38.7%, mild in 51.6% and severe in 9.7% related to DHI. There was no significant difference between balance and cognition function in terms of disability levels (p>0.05).

Conclusion

The balance and cognition in VM patients and migraineurs were impaired rather than healthy subjects. The patient groups differed from each other in terms of vertiginous complaints rather than cognition. Solving the functional limitations with further longitudinal examinations can facilitate the treatment. The appropriate physiotherapy programs and patient education methods can be planned for these various issues.

Differences in executive functions applied to memory processes in people with migraine: a cross-sectional study

The aim of this cross-sectional study was to identify differences in memory processes and the role of executive functions in memory, in people with migraine and in a control group. Neuropsychological evaluation was made in one session on 63 participants distributed into interictal migraine-with-aura (n = 24), interictal migraine-without-aura (n = 16) and control (n = 23) groups. ANOVAs on the individual tasks revealed statistically significant differences between groups on Rey-Osterrieth direct and percentile copy strategy and recall (both p < 0.001). Differences were identified between control and migraine groups in performance on the Rey-Osterrieth Complex Figure, but not on other memory tasks, suggesting the existence of brain dysfunctions in people with migraine affecting organizational and planning abilities that are necessary for visual memory.

Addenbrooke's cognitive examination test for brief cognitive assessment of adolescents suffering from migraine with aura

The aim of this study was to assess the role of the Addenbrooke's cognitive examination test (ACE-R) in the evaluation of cognitive status in migraineurs interictally. A total of 44 adolescent patients and 44 healthy controls, matched by age and gender, have undergone ACE-R testing. Migraineurs were additionally questioned about migraine aura features and presence of higher cortical dysfunctions (HCD) during an aura. According to the questionnaire results, patients were subsequently divided into HCD and Non-HCD group. ACE-R scores of migraine patients were significantly lower than in healthy controls (93.68 ± 3.64 vs 96.91 ± 2.49; t = 4.852, p < 0.001). Also, subscores of memory and verbal fluency were significantly higher in the control population. There was no correlation of HCD occurrence with cognitive examination score, although Non-HCD subgroup achieved better score (93.13 ± 3.91 vs 94.29 ± 3.30; t = 1.053, p = 0.298). Findings have shown that migraineurs get lower ACE-R test scores, with a tendency to have a poorer outcome in more complex aura. Also, our study has revealed that the ACE-R test is an easily administered test for brief assessment of cognitive status in migraineurs. Future perspectives could be further evaluation of ACE-R test in larger sample size and the impact of migraine with aura on cognitive function in adolescents.

Neuropsychological assessment in migraine patients: a descriptive review on cognitive implications

Migraine is considered a disabling disorder with highly prevalence in population. Recent studies report that migraine patients have a cognitive decline associated to structural brain alterations. We search on PubMed and Web of Science databases and screening references of included studies and review articles for additional citations. From 519 studies identified, only 16 met the inclusion criteria. All studies were conducted on 1479 migraineurs (190 non-migraine headache and 11,978 controls subject) and examined the association between migraine and cognitive impairment. The results are discordant. Indeed, while cognitive deficits during the attack of migraine are now recognized, only few studies confirmed the presence of cognitive impairment in migraine patients. Given the prevalence of migraine in the population (especially among women), and the early age of the population, an association between migraine and cognitive impairment could have substantial public health implications. Future studies should determine if specific migraine characteristics, for example, attack frequency, may impact the association between migraine and cognitive decline.

Primary Headaches in an Elderly Population Seeking Medical Care for Cognitive Decline

OBJECTIVES

To assess the prevalence of specific headache disorders in a population older than 65 years seeking consultation due to memory problems or cognitive impairment.

METHODS

We verified the occurrence of headache symptoms and the impact of headaches on daily life. Headaches were classified as per the International Classification of Headache Disorders, 2nd edition (ICHD-2). All patients were screened with the Mini-Mental State Examination (MMSE), followed by the Selective Reminding Test and neuroimaging. Participants with severe cognitive impairment or dementia were excluded.

RESULTS

A total of 1,237 patients (51.6% women), with mean age of 75.6 years (SD = 6.9) were screened from January 2006 to December 2014. Of them, 302 (24.4%) patients suffered from headaches. Most common individual diagnoses were probable migraine (13.8%), episodic tension-type headache (3.4%), and episodic migraine (3.0%). Chronic migraine or probable chronic migraine happened in 3.5%, while chronic tension-type headache affected 0.6%. Most patients with headaches routinely used symptomatic medications (55.6%). Mean MMSE scores were similar in patients with or without headaches, or with different headache diagnoses.

CONCLUSIONS

Headache disorders overall, frequent headaches, and headaches requiring treatment are commonly seen in the elderly seeking care for cognitive decline and should be properly assessed and managed.

Increased Risk of Dementia in Patients with Tension-Type Headache: A Nationwide Retrospective Population-Based Cohort Study

PURPOSE

The association between primary headaches, including tension-type headache (TTH) as one of the most common primary headache disorders, and dementia remains controversial. In this nationwide, population-based, retrospective, cohort study, we explored the potential association between TTH and dementia and examined sex, age, and comorbidities as risk factors for dementia.

METHODS

Using the Taiwan National Health Insurance Research Database (NHIRD) claims data, the sample included 13908 subjects aged ≥20 years with newly-diagnosed TTH in 2000-2006. The non-TTH group included 55632 randomly selected sex- and age-matched TTH-free individuals. All subjects were followed until dementia diagnosis, death, or the end of 2011. Patients with dementia, including vascular and non-vascular (including Alzheimer's) subtypes, were identified using International Classification of Diseases Ninth Revision, Clinical Modification codes. Multivariate Cox proportional hazards regression models were used to assess the risk of dementia and dementia-associated risk factors, such as migraine and other medical comorbidities.

RESULTS

During the average follow-up of 8.14 years, the incidence density rates of dementia were 5.30 and 3.68/1,000 person-years in the TTH and non-TTH groups, respectively. Compared with the non-TTH group, the risks of dementia were 1.25 (95% confidence interval [CI], 1.11-1.42) and 1.13 (95% CI, 1.01-1.27) times higher in the women and >65-year-old TTH group, respectively. TTH patients with comorbidities had a higher risk of dementia. TTH patients had a greater risk of non-vascular dementia (hazard ratio, 1.21; 95% CI, 1.09-1.34) than the non-TTH group.

CONCLUSION

TTH patients have a future risk of dementia, indicating a potentially linked disease pathophysiology that warrants further study. The association between TTH and dementia is greater in women, older adults, and with comorbidities. Clinicians should be aware of potential dementia comorbidity in TTH patients.

Abnormal Connectivity Within Executive Resting-State Network in Migraine With Aura

OBJECTIVE

To evaluate the executive control network connectivity integrity in patients with migraine with aura, in the interictal period, in comparison to patients with migraine without aura and healthy controls.

METHODS

Using resting-state functional magnetic resonance imaging, we compared executive control network functional connectivity in 20 patients with migraine with aura vs 20 sex and age-matched patients with migraine without aura and 20 healthy controls, and assessed the correlation between executive control network functional connectivity and clinical features of patients with migraine. We used voxel-based morphometry and diffusion tensor imaging to investigate potential structural or microstructural changes.

RESULTS

Neuropsychological data revealed no significant executive dysfunction in patients with migraine. Resting-state functional magnetic resonance imaging showed significant group differences in right middle frontal gyrus (Talairach coordinates x, y, z: +26, +2, +48) and dorsal anterior cingulate cortex (Talairach coordinates x, y, z: +6, +13, +49), indicating that these areas had a decreased component activity in both patients with migraine with and without aura when compared with healthy controls. Conversely, there were no significant differences in the executive control network functional connectivity between patients with migraine with and without aura (P < .05, cluster-level corrected). These functional abnormalities are independent of structural and microstructural changes and did not significantly correlate with clinical parameters.

CONCLUSIONS

Our data demonstrate a disrupted executive control network functional connectivity in patients with migraine with and without aura, in the interictal period. Although this functional phenomenon is present in the absence of clinically relevant executive deficits, it may reflect a vulnerability to executive high-demanding conditions of daily living activities in patients with migraine.

Headache as a predictor for dementia: The HUNT Study

BACKGROUND

The impact of headache on dementia is largely unknown. This study examined the association between headache and dementia using data from a large population-based study.

METHODS

This population-based study used data from the Nord-Trøndelag Health Surveys performed in 1995-1997 (HUNT2) and 2006-2008 (HUNT3). The reference group (controls) was participants aged ≥55 years who answered the headache questions in HUNT2 and later participated in HUNT3 (n = 15,601). The association with headache status in HUNT2 was investigated in sample of confirmed non-demented elderly evaluated with psychometric tests after HUNT3 (n = 96), and HUNT2 participants later diagnosed with dementia during 1997-2011 (n = 746). The association with headache was evaluated by logistical regression with adjustment for age, gender, level of education, comorbidity, smoking, and anxiety and depression.

RESULTS

Any headache was more likely to be reported in HUNT2 among those who later were included in the dementia registry (OR 1.24; 95 % CI 1.04-1.49) compared to the reference group, but less likely among the confirmed non-demented individuals (OR 0.62; 95 % CI 0.39-0.98). This relationship was even stronger for non-migrainous headache, whereas such association was not found for migraine.

CONCLUSIONS

Compared to the reference group, individuals with dementia were more likely to report non-previous migrainous headache in HUNT2, whereas a sample of confirmed non-demented were less likely to report previous non-migrainous headache.

Cognitive Impairment and Age-Related Vision Disorders: Their Possible Relationship and the Evaluation of the Use of Aspirin and Statins in a 65 Years-and-Over Sardinian Population

Neurological disorders (Alzheimer’s disease, vascular and mixed dementia) and visual loss (cataract, age-related macular degeneration, glaucoma, and diabetic retinopathy) are among the most common conditions that afflict people of at least 65 years of age. An increasing body of evidence is emerging, which demonstrates that memory and vision impairment are closely, significantly, and positively linked and that statins and aspirin may lessen the risk of developing age-related visual and neurological problems. However, clinical studies have produced contradictory results. Thus, the intent of the present study was to reliably establish whether a relationship exist between various types of dementia and age-related vision disorders, and to establish whether statins and aspirin may or may not have beneficial effects on these two types of disorders. We found that participants with dementia and/or vision problems were more likely to be depressed and displayed worse functional ability in basic and instrumental activities of daily living than controls. Mini mental state examination scores were significantly lower in patients with vision disorders compared to subjects without vision disorders. A closer association with macular degeneration was found in subjects with Alzheimer’s disease than in subjects without dementia or with vascular dementia, mixed dementia, or other types of age-related vision disorders. When we considered the associations between different types of dementia and vision disorders and the use of statins and aspirin, we found a significant positive association between Alzheimer’s disease and statins on their own or in combination with aspirin, indicating that these two drugs do not appear to reduce the risk of Alzheimer’s disease or improve its clinical evolution and may, on the contrary, favor its development. No significant association in statin use alone, aspirin use alone, or the combination of these was found in subjects without vision disorders but with dementia, and, similarly, none in subjects with vision disorders but without dementia. Overall, these results confirm the general impression so far; namely, that macular degeneration may contribute to cognitive disorders (Alzheimer’s disease in particular). In addition, they also suggest that, while statin and aspirin use may undoubtedly have some protective effects, they do not appear to be magic pills against the development of cognitive impairment or vision disorders in the elderly.

Headache as a risk factor for dementia: A prospective population-based study

Background

Headache has not been established as a risk factor for dementia. The aim of this study was to determine whether any headache was associated with subsequent development of vascular dementia (VaD), Alzheimer’s disease (AD) or other types of dementia.

Methods

This prospective population-based cohort study used baseline data from the Nord-Trøndelag Health Study (HUNT 2) performed during 1995–1997 and, from the same Norwegian county, a register of cases diagnosed with dementia during 1997–2010. Participants aged ≥20 years who responded to headache questions in HUNT 2 were categorized (headache free; with any headache; with migraine; with nonmigrainous headache). Hazard ratios (HRs) for later inclusion in the dementia register were estimated using Cox regression analysis.

Results

Of 51,383 participants providing headache data in HUNT 2, 378 appeared in the dementia register during the follow-up period. Compared to those who were headache free, participants with any headache had increased risk of VaD ( n = 63) (multivariate-adjusted HR = 2.3, 95% CI 1.4–3.8, p = 0.002) and of mixed dementia (VaD and AD ( n = 52)) (adjusted HR = 2.0, 95% CI 1.1–3.5, p = 0.018). There was no association between any headache and later development of AD ( n = 180).

Conclusion

In this prospective population-based cohort study, any headache was a risk factor for development of VaD.

Migraine and risk of dementia: a nationwide retrospective cohort study

OBJECTIVE

Migraines are one of the most common neurological disorders. Dementia is a neurodegenerative disease characterized by slow progressive memory loss and cognitive dysfunction. This retrospective cohort study investigates the association between migraines and dementia using a nationwide population-based database in Taiwan.

METHODS

We retrieved the data analyzed in this study from the National Health Insurance Research database (NHIRD) in Taiwan. We used multivariate Cox proportion-hazards regression models to assess the effects of migraines on the risk of dementia after adjusting for sociodemographic characteristics and comorbidities.

RESULTS

The migraine cohort had a higher prevalence of diabetes, hypertension, coronary artery disease, head injury and depression at baseline (p < 0.0001). After adjusting the covariates, migraine patients had a 1.33-fold higher risk of developing dementia [hazard ratio (HR) 1.33, 95% confidence interval (CI) 1.22-1.46]. The sex-specific incidence rate of dementia was higher in men than in women in both cohorts, with an HR of 1.09 (95% CI 1.00-1.18) for men compared to women. Kaplan-Meier analysis shows that the cumulative incidence of dementia was 1.48% greater in the migraine cohort than in the nonmigraine cohort (log-rank test, p < 0.0001).

CONCLUSIONS

This study shows that migraines are associated with a future higher risk of dementia after adjusting for comorbidities. Specifically, the association between migraine and dementia is greater in young adults than in older adults.

Migraine and cognitive decline: a topical review

Migraine has been linked with an increased risk of stroke and an increased prevalence of clinically silent brain lesions and white-matter hyperintensities. As it is known that stroke and structural brain lesions are associated with an increased risk of cognitive decline, it has been hypothesized that migraine may be a progressive brain disorder and associated with an increased risk of cognitive impairment. Given the prevalence of migraine in the population, especially among women, and the aging of the population, an association between migraine and cognitive impairment would have substantial public health implications. In this review, we will summarize the existing evidence evaluating the association between migraine and cognitive function. Additionally, we will discuss methodological issues in migraine and cognitive function assessment and elaborate on study design strategies to address this important question.