Feeling like you can’t think clearly and unable to comprehend even simple topics of conversation, your mind is in a fog. Not being able to pay attention, find words you’ve known since you were two, or make rational decisions. Looking at words on a page and wishing you could follow their meaning, but knowing you won’t remember what you read anyway. These are all examples of cognitive dysfunction during a migraine attack.
A look at the research
People with migraine have reported for ages that their minds don’t work normally during attacks; some even find it to be more disabling than the pain. Research on the topic has been difficult and inconclusive, but quality studies exploring cognitive dysfunction and migraine attacks continue to mount. (Diana’s article from last year, Cognitive Dysfunction and Migraine, explores some of the issues researchers have encountered when studying this.)
A study published in the October 2014 issue of the journal Cephalalgia teaches us even more about cognitive dysfunction during migraine attacks. Participants with episodic migraine without aura were given a slew of cognitive tests during an untreated attack and when they were not in an attack. During the attack, they performed worse on the majority of the tests than they did when between migraine attacks, particularly in speed of reading words, learning verbally, and recalling verbal information in the short- and long-term. Difficulty recalling verbal information occurred whether participants were asked to list words spontaneously or were prompted with a definition first.
The role of pain
Difficulty thinking during a migraine attack is often attributed to the pain. While this study doesn’t solidify an answer to that question, researchers argue that cognitive dysfunction appears to less about the pain and more about the brain’s activity during the migraine. One reason for this is that cognitive dysfunction arises in the earliest stage of a migraine attack, even before the pain begins. Even when acute medications work for the pain, cognitive dysfunction can remain. Only learning and memory worsened with the severity of the pain; the other symptoms of cognitive dysfunction happened no matter what the pain levels. The pain also lingers in the migraine hangover, which follows the pain phase of the attack. A person can even have cognitive dysfunction if they have a migraine attack with no pain at all.
People with migraine, particularly frequent or chronic migraine, often worry that these difficulties thinking represent permanent changes in the brain. The research shows that cognitive dysfunction is reversible and does not last after all the stages of the migraine are over.
My experience is only one anecdote, not scientific research, but I identify with so much of what this study says. Cognitive dysfunction is not noticeably dependent on pain levels for me. I can have mild pain and severe cognitive dysfunction or horrible pain with no trouble thinking. The cognitive dysfunction could stem from my brain processing pain that I’m not feeling, but that’s hard for me to believe, especially given that I can sometimes think just fine even with severe pain.
After years of daily migraine, one of my biggest fears was that my intelligence was eroding permanently. Now that there’s space between my migraine attacks, I can see that the cognitive dysfunction is temporary. It’s such a relief. Migraine feels so violent. It seems like the brain couldn’t possibly undergo such assault and come out unscathed. It’s always nice when research can soothe those worries.