Assessment of cognitive dysfunction during migraine attacks: a systematic review

Abstract

Patients consistently report cognitive impairment during migraine attacks, yet the documentation of such dysfunction by neuropsychological evaluation has lacked similar consistency. This incongruence may be due to discrepant study designs, assessment tools and small samples sizes. To search for evidence of decline in cognitive functions during a migraine attack, compared to headache-free performance. The secondary objective was to determine if the eventual decline had a consistent neuropsychological pattern. Systematic review of the medical literature using PubMed and Cochrane library databases without limitations or restrictions from inception to March 2014, using the search terms "migraine", "cognition", "neuropsychological". We included studies in episodic migraine that had a neuropsychological evaluation performed during an attack. From 1,023 titles screened, a total of 10 articles met criteria for inclusion and were fully reviewed. Only five of these studies, comprising a total of 163 individuals, had enough data to allow an appraisal of the study question. All five studies were positive in documenting some type of reversible cognitive impairment during the migraine attack. The pattern of cognitive impairment most often documented was of executive dysfunction, but the presence of bias induced by the choice of tests and of small samples prevents this finding from being conclusive. This review supports the existence of reversible cognitive dysfunction during the migraine attack, corroborating patients' subjective descriptions. Further work is needed to establish the pattern of cognitive dysfunction, their underling pathophysiological mechanisms and the impact of these symptoms in migraine-associated disability.

The Spectrum of Vestibular Migraine: Clinical Features, Triggers, and Examination Findings

“…The large proportion with ictal aural symptoms agrees with the frequency (up to 69%), usually tinnitus, reported by others . Reversible cognitive dysfunction, reported by some of our patients, is a known feature of migraine attacks . Fatigue (13.7% of our patients) was also observed in another VM study …”

“…4,10,13,17,18,[20][21][22]27,31 Reversible cognitive dysfunction, reported by some of our patients, is a known feature of migraine attacks. 32 Fatigue (13.7% of our patients) was also observed in another VM study. 22 Vestibular symptoms were not limited to VM attacks, but also occurred interictally.…”

Clinical Utility of the Mig‐SCog

“…Bearing in mind that subjective cognitive complaints correlate with objective deficits in neuropsychological tests in the general population, our findings corroborate previous documentation of reversible pre‐frontal and executive difficulties during migraine attacks . Several executive measurements – such as Trail B and Wisconsin, alternate finger tapping, visual‐spatial SWITCH task, and in the Boston Scanning Test and Controlled Oral Word Association Test (but not in Trail B) – documented a decline in migraineurs compared to controls.…”

Subjective cognitive complaints and migraine characteristics: A cross‐sectional study

“…Migraine is a common brain disorder with a strong vascular involvement that is characterized by recurrent severe headache and may be accompanied by light sensitivity or gastrointestinal discomfort. In clinical practice, patients with migraine commonly complain of cognitive impairment . The prevalence of migraine is higher among patients with silent brain lesions .…”

“…In clinical practice, patients with migraine commonly complain of cognitive impairment. 1,2 The prevalence of migraine is higher among patients with silent brain lesions. 3 Sgaramella et al 4 reported that patients with migraine perform worse on prospective memory tests than those without migraine.…”