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

DOI: https://doi.org/10.1007/s10072-017-2814-z

Abstract-Summary Recent studies report that migraine patients have a cognitive decline associated to structural brain alterations.

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.

While cognitive deficits during the attack of migraine are now recognized, only

few studies confirmed the presence of cognitive impairment in migraine patients.

Future studies should determine if specific migraine characteristics, for example, attack frequency, may impact the association between migraine and cognitive decline.

Extended: Recent studies report that migraineurs have a cognitive decline [550]. All studies were conducted on 1479 migraineurs, 190 non-migraine headache

and 11,978 control subjects.

Future studies should determine if specific migraine characteristics, for example, attack frequency, may impact the association between migraine and cognitive decline.

Introduction The International Classification of Headache Disorders (ICHD) includes among the primary headache: (a) the tension-type headache; (b) migraine with aura; (c) migraine without aura [430].

Migraine without aura manifests by recurrent headache lasting 4–72 h. It is char- acterized by unilateral location, with moderate or severe intensity, associated with nausea, vomiting and heightened sensitivity to stimuli, such as light (photophobia), sound (phonophobia) and movement [551].

That structural brain lesions are associated with an increased risk of cognitive decline, it has been hypothesized that migraine may be a progressive brain disorder associated with an increased risk of cognitive impairment.

During migraine attacks patients reported feeling of distraction, difficulty to con- centrate at their usual speed, and they have difficulty in performing mental tasks and retrieving names.

4.8 Psycho-Behavioral Interventions

819

This descriptive review focused on studies that investigated the association

between migraine and cognitive function.

Methods Studies were identified by searching on PubMed (1969 (the first related published article)–January 2016) and Web of Science database (1995–January 2016).

The search terms were identified into title and abstract. Studies that examined the relationship between migraine and cognitive function were included, after they fulfilled the following criteria: (a) The sample population included migraine patients. (b) Studies specifically assessed the relationship between migraine and cognitive function. (c) The longitudinal studies to assess the effect of migraine in cognitive function. (d) We excluded case studies and migraine associated to other organic diseases.

Results All studies were conducted on 1479 migraineurs, 190 non-migraine headache and 11,978 control subjects.

Migraine patients (in particular migraine without aura) showed a cognitive

impairment in complex evaluating tests and in executive functions.

The comparison with the control groups showed a decrease in response time, attention and processing speed in migraineurs headaches, while non-migraine head- aches presented the worst performance in memory tests, with a tendency to confabulations.

The study conducted by Kalaydjian [552] evaluated the association between migraine history, memory and cognitive function in a population of middle-aged subjects.

Jelicic et al. [553] conducted a longitudinal study to assess two aspects of cogni- tive functions: (a) memory and (b) information processing speed in patients with and without migraine.

The authors investigated cognitive functions in 74 migraine patients with a long

clinical history and 74 control subjects.

No differences were observed between migraine patients and control subjects in

cognitive performance.

Discussion The results of the studies that have investigated cognitive impairment in migraine are discordant.

While cognitive deficits during the attack of migraine are now recognized [554],

only few studies confirmed the presence of cognitive impairment in migraine.

The factors that could contribute to these inconsistent results are probably due to methodological aspects or related to problems concerning the diagnosis [555], patient selection biases, different neuropsychological assessment [556], a lack of distinction between migraines patients with and without aura, the absence of matched control group and the sample size.

Especially in longitudinal studies, another factor that could alter the results may

be the dropout of patients [553, 556, 557].

820

4 Treatment

Conclusions Given the prevalence of migraine in the young population (especially among women), an association between migraine and cognitive impairment could have substantial public health implications.

Although some authors reported a cognitive impairment in patients with

migraine, others seem to not confirm these results.

Future studies should determine if specific migraine characteristics, for example, attack frequency, may impact the association between migraine and cognitive decline.

Acknowledgement A machine generated summary based on the work of Foti, Maria; Lo Buono, Viviana; Corallo, Francesco; Palmeri, Rosanna; Bramanti, Placido; Marino, Silvia. 2017 in Neurological Sciences.

Pain cognition in migraine: from basic neurophysiology to a behavioral paradigm