Cognitive Impairments Associated with Migraine
abstract & commentary
Source: Meyer JS, et al. Reversible cognitive decline accompanies migraine and cluster headache. Headache 2000;40: 638-646.
The definition of migraine has been based es-sentially on a description of the pain. Other signs and symptoms of the migraine syndrome have not been well appreciated. Cognitive disability during migraine has been underestimated and usually attributed to the overriding discomfort and/or other associated physical symptoms such as nausea, vomiting, photophobia, and phonophobia. However, migraine patients frequently report nonspecific cognitive symptoms such as "fuzziness" or "cloudiness," as well as specific problems with attention, memory, language, judgement, and problem solving persisting well after the head pain and other physical symptoms have past. Meyer and colleagues report the results of a prospective study to better assess the range and full effect of cognitive disability associated with migraine.
One hundred ninety-six subjects (136 women, 63 men, mean age 46) were included in the study. One hundred thirty-three had migraine without aura, 39 migraine with aura, 11 with periodic cluster, and 13 with chronic daily headache or transformed migraine. Subjects had otherwise normal neurologic profiles and normal neuro-imaging studies upon inclusion in the study. Subjects underwent neuropsychology testing with the Mini-Mental Status Exam (MMSE) combined with the Cognitive Capacity Screening Examination (CCSE) and the Hamilton Depression Rating Scale (HDRS). The tests were administered during clinic follow-up appointments accompanying both acute headache and headache-free periods. Mean neuropsych scores were stable across 10 clinic visits. The CCSE and MMSE scores decreased significantly (P < 0.0001) during acute headache periods, but returned to preheadache normative values on subsequent headache-free evaluations. The mean CCSE scores decreased by 4.8 for women and 3.6 for men. The mean score decreases in MMSE were 2.3 for women and 2.1 for men. The HDRS did not vary during headache periods. The cognitive decline did not vary among the various headache categories.
COMMENT by Jeffrey Reich, MD
The current study raises several interesting issues with regards to the full spectrum of migraine related disability. It is important to point out that cognitive changes in migraine appeared independent of mood change. Migraine sufferers are subject to cognitive impairments such as problems with attention, memory, concentration, thinking, calculation, problem solving, and judgement. The implications of this study suggest migraine to be a broader problem relating to diffuse cortical neuronal dysfunction. Further such investigations need to ameliorate the associated head pain so as to make sure the changes in cognition are not simply distractions related to the overwhelming pain. Improved cognitive responses to treatment were mentioned but remain another area to be further explored. (Dr. Reich is Assistant Professor of Neurology, New York Presbyterian Hospital Cornell Campus.)
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