Chronic migraine patients show cognitive impairment in an extended neuropsychological assessment

Neuropsychological and Neuropsychiatric Features of Chronic Migraine Patients during the Interictal Phase

This study aimed to examine the presence of neuropsychological deficits and their relationships with clinical, pharmacological, and neuropsychiatric characteristics in chronic migraine (CM) patients assessed during a headache-free period. We enrolled 39 CM patients (mean age: 45.4 years; male/female ratio: 3/36) and 20 age-, sex-, and education-matched healthy controls (HCs, mean age: 45.5 years; male/female ratio: 2/18) in a case-control study. All CM patients underwent a full and extensive clinical, neuropsychiatric, and neuropsychological evaluation to evaluate cognitive domains, including sustained attention (SA), information processing speed (IPS), visuospatial episodic memory, working memory (WM), and verbal fluency (VF), as well as depressive and anxiety symptoms. CM patients exhibited higher scores than HCs for all clinical and neuropsychiatric measures, but no differences were found in personality characteristics. Although more than half of the CM patients (54%) showed mild-to-severe neuropsychological impairment (NI), with the most frequent impairments occurring in short- and long-term verbal episodic memory and inhibitory control (in approximately 90% of these patients), almost half of the patients (46%) showed no NI. Moreover, the severity of NI was positively associated with the number of pharmacological treatments received. Remarkably, disease-related symptom severity and headache-related disability explained global neuropsychological performance in CM patients. The presence of cognitive and neuropsychiatric dysfunction during the interictal phase occurred in more than half of CM patients, increasing migraine-related disability and possibly exerting a negative impact on health-related quality of life and treatment adherence.

Executive functions in migraine patients: a systematic review with meta-analysis

Introduction: Migraine, a common neurological disease, is known to impact the quality of life of individuals with this condition.Methods: We performed a systematic review with meta-analysis to investigate the abnormalities associated with executive functions of migraineurs as compared with healthy controls. In addition, we investigated the differences between patients with and without aura.Results: A total of 25 studies were included in the systematic review and 19 in the meta-analysis. Meta-analysis was conducted using random effects models, with the unit of analysis as the standardised mean difference (calculated as Hedges'g). Patients with migraine had worse performance in the trail making test A (g = 0.40; 95% confidence interval [CI] 0.05-0.74; p = 0.0271) and B (g = 0.40; 95% CI 0.16-0.64; p = 0.0026), and digit span backward test (g = -0.20; 95% CI - 0.31, - 0.09; p = 0.0105). Subgroup analysis revealed no difference between migraine with and without aura.Conclusion: These results suggest that migraine patients may present worse performance for specific executive functional domains, including attention, working memory, and mental flexibility.

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.

Kognition und Kraftfahreignung bei chronischem Schmerzsyndrom

Kognitive Auffälligkeiten bei Patienten mit chronischen Schmerzen finden in wissenschaftlichen Untersuchungen zunehmend Beachtung. Die Folgen dieser kognitiven Störungen in Bezug auf die Schmerzbewältigung, die Alltagsgestaltung und die Kraftfahreignung werden in der klinischen Praxis jedoch kaum berücksichtigt, obwohl die Hälfte aller Patienten davon betroffen ist. Die vorliegende Arbeit fasst die aktuelle Studienlage zusammen und diskutiert Möglichkeiten der Integration in die klinische und therapeutische Versorgung.

Neuropsychological findings in migraine: a systematic review

ABSTRACT. Patients with migraine often experience cognitive dysfunction during a migraine attack, but they have also been reported to complain about cognitive impairment after an attack and during the interictal period. Objective: The aim of this study was to determine what neuropsychological test methods are used to assess cognitive functioning in migraine patients and to examine the neuropsychological findings in adult (≥18 years) migraineurs compared to adult (≥18 years) healthy controls (HC). Methods: A systematic review was conducted on the literature published between 2012 and the present. The search results were screened and additional studies identified in the lists of references in the selected articles. A total of 16 articles met the inclusion criteria. Results: The 16 articles included in the review compared chronic migraineurs (CM), migraineurs with (MwA) and without aura (MwoA), and migraineurs without aura classification (MIG) to HC. A total of 45 neuropsychological assessment methods were identified. CM and MwA were found to perform significantly worse than HC in executive function, attention, and visual functioning. Additionally, both MwA and MwoA performed significantly worse than HC in memory functions. CM and both MwA and MwoA also performed significantly worse than HC in general cognitive functioning. Surprisingly, MIG performed significantly better than HC in several cognitive domains, including executive, motor, and language functioning and general cognitive functioning. Conclusions: This systematic review mostly concurs with the results of an earlier systematic review on the topic from 2012, but with the important addition that different migraine diagnostic groups should be assessed separately.

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.

Cognitive Dysfunction in Migraineurs

Background and Objectives: Migraines are one of the most common types of primary headaches in neurology. Many studies to date have investigated cognitive impairment in migraineurs, but the results are inconsistent. This study aimed to investigate the cognitive function of migraineurs and explore the influencing factors. Material and Methods: A total of 117 patients with primary headaches (87 with migraine and 30 with tension-type headache (TTH)) and 30 healthy controls were enrolled. General information and data on headache clinical characteristics, and assessments of headache-related disability, psychological symptoms, and cognitive function were collected for statistical analysis. Results: The Montreal Cognitive Assessment (MoCA) total score and the scores of visuospatial and executive functions, language, and delayed recall in the migraine and TTH groups were significantly lower than those in the healthy control group (all p < 0.05). The MoCA total score did not correlate with Headache impact test-6, Migraine Disability Assessment Questionnaire, Patient Health Questionnaire-9, or Generalized Anxiety Disorder Questionnaire-7 scores in migraineurs (all p > 0.0125). The multiple linear regression analysis showed that age and duration of attack had a major influence on the overall and various fields of cognition in migraineurs. Conclusion: The study confirmed the impairment of cognitive function in patients with migraine and TTH, and found that the duration of attack had an effect on cognitive function in migraineurs.

Attention Impairment During the Interictal State in Migraineurs without Aura: A Cross-Sectional Study

Background and Purpose

Migraine suffering is more than the onset of head pain. The broad non-painful clinical symptoms associated with migraine are not well recognized. Recent researches support that migraineurs suffer attention deficits, but these findings are not conclusive. The purpose of our study was to assess whether patients with migraine without aura (MwoA) during the interictal period have attention impairment and to identify the migraine characteristics related to attention deficits.

Methods

We enrolled subjects with MwoA during the interictal period and healthy controls matched for age, gender, and education level in this cross-sectional study. The attention network test (ANT) and a battery of neuropsychological tests, including the trail-making test (TMT), the digit span test (DST), and the Stroop test, were administered to the participants during the headache-free period.

Results

Forty-four subjects with MwoA (4 males, 40 females) and 20 controls matched for age, gender, and literacy education were included. Patients in MwoA were more anxious (P = 0.007) and depressed (P = 0.001) than healthy subjects. Significant differences between the two groups were detected in the executive network (P = 0.006) but not in the alerting and orienting networks of ANT. Mean reaction time of ANT in the MwoA group was significantly longer than that in the control group (P = 0.028). Patients showed worse performance on DST-forward (P < 0.001), DST-backward (P < 0.001), DS Total (P < 0.001), TMT-A (P < 0.001), TMT-B (P < 0.001) and TMT-d (P = 0.002). Differences found in executive functions between the two groups were unrelated to gender, age, literacy, anxiety, and depression. Multiple regression analysis revealed no relation between clinical characteristics of headache and scores on the executive function with MwoA.

Conclusion

Our study suggested that patients in MwoA present worse performances on the executive control of attention networks during the headache-free period, which appear not be associated with measures of migraine severity. Although more studies are needed in this area, our results could be useful to find specific neuropsychological biomarker for migraine pathophysiology.

The role of a potential biomarker in patients with migraine: review and new insights

Introduction: The search for an ideal biomarker for migraine has persisted for a long time. There is plentiful evidence of potential biomarkers for migraine found in cerebrospinal fluid, blood, and saliva.Areas covered: Herein, the authors highlight and discuss the most promising candidates in the literature. An electronic search was performed for studies published between 2010 and 2020 in MEDLINE, PubMed, and EMBASE, related to potential biomarkers in migraine patients, found in cerebrospinal fluid, saliva, and serum, focusing on biomarkers that can be related to treatment and clinical outcomes.Expert opinion: An ideal biomarker, or a panel of biomarkers, could revolutionize the way we address and propose treatments for this disease. Once severe presentations and phenotypes have been identified using a reliable biomarker, patients could be treated at earlier disease stages with more specific medications. The most important biomarkers with the most significant levels of evidence comprised calcitonin gene-related peptide (CGRP), glutamate, nerve growth factor, some inflammatory (CRP, TNF-α, interleukins) and oxidative stress markers. CGRP was associated with episodic, chronic migraine and response to treatment. Pituitary adenylate cyclase-activating polypeptide is an emerging neuropeptide involved in migraine diagnostics and severity. New genetic and epigenetic biomarkers will be candidates for future research.

Cognitive Function and White Matter Lesions in Medication-Overuse Headache

Purpose

This study was designed to investigate the cognitive function and the white matter lesions (WMLs) and the relationship between them in medication-overuse headache (MOH) patients.

Methods

Subjects were enrolled and performed Montreal Cognitive Assessment (MoCA, Chinese-Beijing Version), Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD-24), and Pittsburgh Sleep Quality Index (PSQI) to evaluate the general cognitive function, anxiety, depression and sleep quality, and they were divided into three groups according to the MoCA scores: healthy controls, MOH with normal cognition group and MOH with cognitive impairment group. All the participants underwent MRI scans and images were obtained for WML evaluation with Fazekas scale.

Results

One hundred thirty-four participants were enrolled into this study, 46 of them for healthy controls, and 88 for MOH patients, 40 of the MOH patients for MOH with cognitive impairment group, and 48 for MOH with normal cognition group. MOH patients had significantly lower MoCA scores, including the scores of visuospatial and executive function, attention, and orientation, while they had significantly greater HAMA scores, HAMD-24 scores, PSQI scores, and deep white matter hyperintensity scores compared to healthy controls. And in MOH patients, the age, disease duration, monthly headache days, and periventricular white matter hyperintensity scores in patients with cognitive impairment were greater than those in patients with normal cognition. Moreover, the MoCA scores were negatively related to age, disease duration, monthly headache days, and Fazekas scale scores, and disease duration and monthly headache days were significant predictors of cognitive impairment in MOH patients.

Conclusion

MOH patients showed cognitive impairment and increased WML burden. And in MOH patients, cognitive function was negatively related to WML burden, and disease duration and monthly headache days were potential predictors of cognitive impairment. Prompt and effective treatment to stop the progression of the disease may alleviate cognitive impairment in MOH patients.

Headache - A Window to Dementia: An Unexpected Twist

Migraine and other types of headaches have several symptoms associated with them. The association between migraine and dementia has been considered. It is a topic of discussion and appears to be multifactorial. Dementia is a cluster of symptoms, with memory loss and cognitive dysfunction being the prominent symptoms. In this review, we discussed the association of headache and cognitive dysfunction in a broader context and how the practiced treatment of headaches may silently lead to dementia. We conducted a thorough literature search using PubMed as our main database. The articles exploring the association between headache (both migraine and non-migraine) and dementia were included. Some risk factors like migraine-induced stroke and inherent vascular diseases in migraine patients channeling to stroke and dementia were not considered. A total of 28 studies were included for review. All the reviewed studies put together showed an association between headache and cognitive dysfunction of any form. They showed that the frequency and duration of headache is a determinant for dementia. Few studies also focused on how treating headaches with certain drugs can lead to dementia. The reviewed published literature showed that headaches of any sort and their treatment are potentially linked to dementia. Not all headache patients will require medical treatment, as the benefit might outweigh the risk sometimes. It is interim to understand these facts and formulate a better protocol for treating headache patients. However, due to some discordant results, further studies are needed.

Patients with chronic migraine without history of medication overuse are characterized by a peculiar white matter fiber bundle profile

Background

We investigated intracerebral fiber bundles using a tract-based spatial statistics (TBSS) analysis of diffusion tensor imaging (DTI) data to verify microstructural integrity in patients with episodic (MO) and chronic migraine (CM).

Methods

We performed DTI in 19 patients with MO within interictal periods, 18 patients with CM without any history of drug abuse, and 18 healthy controls (HCs) using a 3 T magnetic resonance imaging scanner. We calculated diffusion metrics, including fractional anisotropy (FA), axial diffusion (AD), radial diffusion (RD), and mean diffusion (MD).

Results

TBSS revealed no significant differences in the FA, MD, RD, and AD maps between the MO and HC groups. In comparison to the HC group, the CM group exhibited widespread increased RD (bilateral superior [SCR] and posterior corona radiata [PCR], bilateral genu of the corpus callosum [CC], bilateral posterior limb of internal capsule [IC], bilateral superior longitudinal fasciculus [LF]) and MD values (tracts of the right SCR and PCR, right superior LF, and right splenium of the CC). In comparison to the MO group, the CM group showed decreased FA (bilateral SCR and PCR, bilateral body of CC, right superior LF, right forceps minor) and increased MD values (bilateral SCR and right PCR, right body of CC, right superior LF, right splenium of CC, and right posterior limb of IC).

Conclusion

Our results suggest that chronic migraine can be associated with the widespread disruption of normal white matter integrity in the brain.