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Cognitive Dysfunction and Migraine

It will come as no surprise to any Migraineur reading this that Migraine attacks are frequently associated with cognitive and mental symptoms. Patients often find these symptoms to be some of the most significant contributors to Migraine attack-related disability.

Patients report experiencing issues with concentration, attention, planning, judgment, initiative, processing speed, language and memory. Unfortunately, the treatment medications available to Migraineurs typically do not relieve these symptoms.

However, despite the frequency with which patients report these symptoms, this does not necessarily mean Migraineurs are experiencing cognitive dysfunction during an attack. A research study presented at the 2013 International Headache Congress in June attempted to scientifically evaluate what patients so frequently deal with during their Migraine attacks.

Researchers have attempted to study this issue in the past, but these studies had significant limits. Most had small sample sizes, did not control for medication use, depression and other comorbid psychiatric conditions or aura. None controlled for something called the practice or learning effect bias that commonly results from repeated psychological testing. Five of seven existing published studies documented some cognitive dysfunction, such as speed of processing, attention and learning.


To avoid the limitations of past studies, the researchers needed a population of young patients with episodic Migraine, no diagnosis of Medication Overuse Headache and no psychiatric comorbidities who were willing to come in for testing during an untreated Migraine attack. As you might expect, it took a long time to recruit patients that met these criteria.

Patients were evaluated by a trained neuropsychologist twice: When not experiencing a Migraine attack and during an active, untreated Migraine attack. To avoid the practice/learning bias half had their first evaluation during an attack-free period and the other half had their first evaluation during an attack. It took almost six years for the researchers to get the patients who were tested during a non-attack period through the second evaluation since it had to be conducted during an untreated Migraine attack.

The patients in the two groups were very similar demographically (age, education, quality of life, headache impact test (HIT), etc.). On average when evaluated during an attack, the patients were eighth hours into the Migraine attack and rated the attack as moderate. Finally, while a few patients were on preventive medications, only one patient was taking topiramate. A common side effect of topiramate is cognitive issues.

The data supports the idea that cognitive function globally diminishes during a Migraine attack in patients with Migraine without aura. These researchers believe this is probably due to the Migraine attack itself.

On every measure taken by the researchers, patient scores were on average lower during a Migraine attack. This includes language, memory, learning and executive functions. But the data failed to achieve statistical significance except on one test (the California Verbal Language Test).

The patients experienced more anxiety when they were evaluated during an attack than when evaluated during a non attack period. The researchers do not believe this explains the observed differences in cognitive functioning.

Some brain functions are impacted more than others. The executive and learning functions of patients changed the most during a Migraine attack in this study. Executive functions are what allows us to use our past experiences to make decisions about present actions.

It is possible these findings represent reversible changes that accompany the attack in patients living with Migraine without Aura and do not continue to burden the patient long term. However, functional imaging and neurophysiological studies support the existence of brain changes in patients with Migraine without Aura. We don’t yet know if there is a long term impact associated with the cognitive changes observed.

But another unanswered question is whether these cognitive issues are specific to Migraine. Could they be present in other Headache Disorders or in other conditions associated with pain?

Unfortunately, there are no equivalent studies on other conditions associated with acute pain to help determine if these results are specific to Migraine. But the researchers are working to recruit a control group of post-operative orthopedic patients with acute pain to learn more.

Reference:

Raquel Gil-Gouvela. “Cognitive Dysfunction During a Migraine Attack – Study on Migraine without Aura.” International Headache Congress. June 2013.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • Hstarks0
    2 years ago

    Just realized most of the posts were written in 2014/2015. Hope someone is still reading mine!

  • LeilaniRL
    2 years ago

    I am!

  • Kayakerjo
    5 years ago

    Cognitive impairments are definitely my most restrictive migraine symptoms. They don’t seem to correlate with my pain level or my level of sensitivity to light,sound, etc. Usually I start losing words when speaking and my task – switching ability first then i move onto losing decision making ability, memory, and ability to read and write well, then finally feel like I can’t think at all. I don’t trust myself to do my job once I’m past the first stage. And often medication doesn’t help. I just to sleep and wait for things to pass. Thankfully controlling my diet and taking magnesium have reduced the frequency and severity of my migraines.

  • cindyd
    5 years ago

    This is so pertinent to chronic migraine sufferers. I have this so bad at times that I just want to cry. I work in an extremely stressful and busy place and have very high energy bosses . . .they are very good to me but sometimes when they ask me something and are in a hurry I feel like I have a deer in the headlights look because either I can’t remember or it takes me time to process what they want. I feel so stupid sometimes that I could just cry. Sometimes even organizing things that used to be so simple for me to prioritize and get done are so frustrating that I’d like to just go home and pull the covers over my head. I appreciate this column so much for all of the good information and helping us to all realize we are not alone and that our symptoms are not because we are lazy or stupid . . . it is a medical issue.

  • livinglife
    2 years ago

    You are not alone cindyd, I’ve gone down to a part time job since I also get disability. Thank you Jesus! But it is still tough, I use to be a manager of a bank & now I’m what they call a CSR.. It’s really tough sometimes on my self esteem when I think what I used to do and now what I barely can do. I Just have no memory when it comes to work items, I try to write things down. It just takes so long to grasp new duties. I too feel so dumb. I just think our brains have been rewired in a bad way with taking all the meds & having chronic migraines all the time. I have gotten a new nasal spray that doesn’t have the side effects & works pretty fast so life has been better, except my brain will never be the same….

  • Beth
    5 years ago

    Thanks for this blog!! The other day I and hubby were grocery shopping. I usually have no problem with remembering a long list. This day I had written a list. I was walking around the store in a fog. He kept questioning me and actually got mad. He just doesn’t understand! I also feel extremely sensitive and emotional while in the fog. I cry at the drop of a hat.

  • lk26
    6 years ago

    My migraines were episodic for 20yrs then gradually become chronic, now having constant pain at some degree. With the increase of pain so went my mind! I have been a nurse for 30yrs & worked different settings & I was very good in all settings and was even “crowned” the Queen of Organization! Now my once orderly household is so far from pre-chronic pain. Now all my cognitive processes are affected, most recently my speech, more so when pain is at a high level. Started with difficulty getting words from brain to mouth, very short term memory and poor concentration

  • lk26
    6 years ago

    Sorry I hit the wrong key before I finished. Starting after Christmas (2013), I am stuttering, struggling to even get appropiate words out, all with a “mental fog”. All symptoms increased with increased pain. Sadly it feels comforting to find out that I am not losing my mind and am not alone! I will be seeing my Neuro next week to discuss the problem & possible treatments. This new symptoms is making my hestincy to go out in public and/or speak on the phone. Our “family” here is very comforting.

  • George
    6 years ago

    “Ditto” to most of the experiences you good people have described.

    The article doesn’t say whether any of the researchers have thought to control their studies for cognitive dysfunction as symptoms of merely being overly distracted (by headache pain).

    That’s what I’ve assumed has been going on for me until reading the comments to this blog entry.

    The times when I’m super-sharp are rare and short-lived (but so are days without headaches, making it hard to identify any distinct prodrome phase). But in those sharp, manic times, I do feel more “like myself” than I do the other 99.8% of the time.

    The cognitive dysfunction described sounds a lot like my experience of AD[H]D. The battery of tests that resulted in my AD[H]D diagnosis triggered a migraine (as intense concentration and eye strain usually does). I’d lived with untreated chronic headache pain for so long that I didn’t even think to mention it. My partner thought it was important to say something, but the doctor didn’t know of any connection and just shrugged it off.

    I’ve always had days, sometimes weeks, that I’ve described as “I couldn’t think my way out of a paper bag.” I hadn’t thought of it before, but I don’t know if I’ve ever had an episode that didn’t include substantial headache pain. I’ve managed to compensate and get by all my academic and work career. After learning about AD[H]D I’ve had many moments of “Maybe I’m NOT lazy or stupid or crazy or incompetent after all!” At the moment, I’m somewhat encouraged that maybe if I could just manage to get the migraines managed, maybe the cognitive story would improve as well.

  • arden
    6 years ago

    Yeah, migraineurs know about crazy. But does anyone recognize the super cognitive phase when we are (they might call it “manic”) very aware and sensitive with the mind going lickity split before the melt down? This is the fun before the fall when memories flood the stage and thinking is a high wire act. I always try to slow down when I find myself hurdling down this slippery slope towards dysfunction.

  • Hstarks0
    2 years ago

    I had a few of these highs before. Once my VP told me that I was “possessed by the ghost of Ernest Hemingway” when I wrote exceptional emails for him to send to specific affiliates in HR. I also know the times when it’s a struggle to express myself, end up writing something cryptic or stay up at night in the hope of perfecting it. I have had times when I felt confident, super-philosophical, smiled a lot….and in the same day or period, get hit with dizzy spells, nausea, visual aura of migraine and had my husband take me home. The roller-coasters had been so obvious but I had kept pushing myself. Slowing down and recognizing the warning signs – that’s great advice! I have been on Depakote since and seem to be dull and foggy most of the time. Actually I spent the last hour writing this post.

  • kateymac
    6 years ago

    To Arden:
    YES! I started recognizing this, what I see as a “prodromal symptom”, only within the last 8 yrs or so. I get a rush of energy, ideas, & intellectual sharpness. Well, I feel sharp, but I’m all over the place, topic-wise. It really is similar to some manic symptoms. I become excessively talkative, overwhelming whomever I’m with. I often do massive sections of house cleaning within 30 minutes, breathless & sweaty because I’m in NO shape to move like that after 12 yrs of daily migraine.

    Then the energy drains out of me like a leaky hose, I have to sit, and a beast of a migraine comes on.

    In recent years I’ve grown better at catching myself in the middle of it, slowing down, and getting ready in case the migraine happens anyway, which it usually does. I think that’s because the hyper behavior is part of what is already a phase of an already-happening migraine, – the prodromal phase. But I’m not sure. At least the awareness helps me take meds earlier, which sometimes aborts it OR sometimes decreases the LEVEL of pain.

  • HorseAndCarriage
    6 years ago

    Back in high school, I was diagnosed with a memory-based learning disability. This was far preceding my silent migraine diagnosis, which only happened two years and eight months ago. I wonder if the memory issues are actually part of my migraines (which are triggered by light) instead of being a learning disability? I hate forgetting words and especially people’s names! I also have that problem where you have a hard time recognizing people, so it can be hard to follow certain shows and movies, plus trying to find somebody I know in a crowded public place is difficult. Does anybody else with migraine have that? (I forget what the condition is called, LOL!)

    P.S. Diana (author), I think you meant to say “topiramate”, not “topamirate”. 🙂 I was on the stuff for half of last year.

  • Nene
    3 years ago

    I have the same issue with names and recognizing people in a crowd – even those I know well. Also, following the characters in a movie! You are the first person I’ve heard who also has that. It’s very difficult in my work where knowing names is important.
    Another big issue I have is – all my “filters” go down – in a meeting or talking with others I will say inappropriate things, say “what I really think”, be kind of negative, etc. All things I would be careful about in “non-migraine” mode. It’s like my “normal” filters are off. This has caused me some issues where I’ve had to apologize for what just tumbled out of my brain. So frustrating!

  • AngelinaB79
    6 years ago

    Amber T, Thank you for commenting below. There is no way I could have put it in better words… Its like it could have been me writing about myself.
    The blog post kinda hurt my head to try and understand. My life has gone in the same way as you and it makes life so frustrating. To lose the you that made you you… The cognitive issues migraines and comorbid symptoms bring is unbelievable and so life changing.
    Blessings Angel’ xx

  • Amber T.
    6 years ago

    Thank you for writing this! I have been diagnosed with migraines for 13 years (though I had them longer). I have had chronic daily migraines for 8 years (not from over use of medicines), that aren’t controlled by medications. Probably 9 months ago I really started realizing that my memory wasn’t what it use to be (which use to be very good) Since then symptoms have become a lot worse. Not being able to find words when I speak, forgeting what I was doing in the middle of doing it, and too me the worst is, easily becoming overwhelmed when there is too much going on. When that happens litterly everything just shuts down and have given me what I would describe as a panic attack if to overwhelming.
    I talk to my neurologist 3 months ago (he also has a degree in psychology) I thought it was caused by one of medications. He told me people who fall into the same category as I do also report the same thing. He said hypothalamus actually shrinks but is reversible if your daily pain is removed or lessened (I don’t see this happening for me)
    Family and friends who have known me before all of this happened remember the me that had a great memory, was a multitasking expert and could handle anything that came my way. I have tried to explain to some but people look at me as rude not staying in contact like I use to, or lazy because maybe I only completed one task in a day even though I had to complete 10. This isn’t widely published, so I can see the disbelief in some of their eyes. Don’t realize I have had to learn how to push through daily pain of 5-6, but it’s still pretty good pain so I avoid things that will make it worse, which is a pretty long list. I hear the frustration from some (including my kids) when I’ve had to cancel plans, AGAIN. I’ve lost quite a few friends because of this.
    To anyone beginning to feel this know your not going crazy like I did, don’t hide it from loved one’s tell them early so they understand, and lastly except or ask for help when you need it!

  • Hstarks0
    2 years ago

    Amber T, I noticed problems with my memory seven years ago after a concussion to my head. Migraine (the atypical kind wihout headaches…I forget the name) was diagnosed in 2016 after two visits to the ED. It sure feels better to know that there are others like me. I often forget the point I am trying to make mid-conversation and can’t process conversations in a movie or in actual group settings (I hear words but forget them right away). When I am reading a book, I have to go over a few times and even so, I cannot grasp the whole scene or sequence of events. I forget my destination when I pull out of my drive way many times. The forgetfulness seem to come more often than not. I am on Depacote which probably dulls me more. Since the migraine comes without headaches, I don’t know when it has hit. My husband pays attention now that he understands and looks out for me when I can’t even warn him that I am having an attack. So thanks for the reminder about not hiding it from loved ones. About completing one task a day….this is just what’s going on with me! Thanks for sharing your experience.

  • bluebird
    6 years ago

    I suggest that a survey of readers is done to discover how many folks actually experience a prodrome of increased activity prior to a phase of shut down, isolation and withdrawal from activity. Not only is it adaptive…like getting things done for the safety of one’s self, children and community…but it might help functional imaging researchers.

  • Louise Neville
    6 years ago

    Amber T, I just read your post and cried buckets, its like you’re describing me. Apart from I’ve had chronic daily for 18 years and don’t have kids. I kinda thought the memory was fading with age (I’m the ripe ole age of 34!!) And that I was somehow cracking up with what I call panic attacks. Only this morning I got overwhelmed because there wasn’t a clean bowl for my porridge! I have mostly 5-6 scores and the pain doesn’t have to be a 9-10 for my cognitive functions to suffer, so I read this blog post with interest. Thanks eveyone for sharing, Louise

  • Richard
    6 years ago

    Which factor was confirmed with a statistical significance? The article does not disclose this.

    Other factors not confirmed in this study as being statistically significant are discussed in the article as though they are factors to be discussed and considered.

    A larger study is needed.

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