Preventive treatment can reverse cognitive impairment in chronic migraine

Abstract

Objective To study the impact of chronic migraine (CM) on the cognition and quality of life (QoL) of patients in the interictal period, and to analyse the degree of reversibility of any observed alterations following the use of preventive treatment. Background CM is a highly disabling disease, and migraineurs often have associated comorbidities, such as subjective memory problems, that are involved in the development of cognitive impairment. Our hypotheses are that patients suffering from chronic migraine experience objective cognitive alterations that are not only due to the pain that they suffer or their current emotional state. Furthermore, preventive treatment should be capable of reversing, or at least reducing, the impact of CM on the cognition and QoL of migraineurs. Methods The cognition and QoL of 50 control subjects and 46 patients with CM were assessed using a battery of tests, prior to the use of preventive treatment based on botulinum toxin or oral drugs and after 3 months of this treatment. Results Compared with controls, patients with CM had lower scores on the assessment of cognitive performance (Rey-Osterrieth Complex Figure test [ROCF] (p<0.05) , Trail Making Test [TMT] B) ( p < 0.05) and QoL ( p < 0.05). Three months after the use of preventive treatment, improvement was observed in all cognitive parameters ( p < 0.05) and QoL ( p < 0.05), except the ROCF copy task ( p = 0.79). No statistically significant differences were observed when these outcomes were compared based on treatment. Conclusions This study confirms poor cognitive performance that is not explained by migraine pain itself, as it occurs in the interictal period, irrespective of the patient’s emotional status. Our findings show that these effects are reversible in some cases with preventive treatment of CM, reaffirming the important impact of this condition on the QoL of these patients, and the need to establish preventive treatment guidelines. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01486-w.

Improving the Cognitive Impact of Migraine: A Real-World Study on the Ability to Concentrate

“…is a result of migraine improvement. These results corroborate previous findings that showed an improvement in cognitive performance in chronic migraine in patients treated with botulinum toxin or oral preventives [16,17]. The latter was conduted on headache free days, with the goal of assessing the interictal cognitive performance in chronic migraine.…”

“…The latter was conduted on headache free days, with the goal of assessing the interictal cognitive performance in chronic migraine. In these studies patients underwent cognitive tests twice [17] or three times [16], within a follow up time of 3 months. However, the studies did not control for the learning effects associated with test repeated test administration.…”

“…Despite the recommendation to include non-headache features of migraine as possible outcomes of migraine in clinical trials, there is limited evidence regarding the benefit of current migraine treatments on patients´ cognitive complaints or performance [16][17][18]. Yet the improvement in cognitive symptoms is relevant because they have been shown to contribute to the disability of migraine attacks [19].…”

Real-world effectiveness and satisfaction with intravenous eptinezumab treatment in patients with chronic migraine: REVIEW, an observational, multi-site, US-based study

“…Remarkably, of the patients who said they had experienced brain fog, a large majority (86%) reported that they experienced some level of improvement in their brain fog after initiating eptinezumab treatment. To date, research evaluating the impact of preventive treatments on cognition are limited, with focus on traditional oral therapies and onabotulinumtoxinA [ 37 ]. These findings suggest that further research is needed to fully understand cognitive burden and the impact of preventive therapies.…”

Beyond Pain: The Effects of OnabotulinumtoxinA Therapy on Sensitization and Interictal Symptoms in Chronic Migraine

“…Chronic migraine (CM) represents a subclassification of migraine due to its deterioration and is defined as the presence of at least 15 headache days per month, of which at least 8 show migraine characteristics (or lead to anti-migraine acute drug intake) for at least 3 consecutive months [1]. The chronification (i.e., the increase in headache frequency leading to CM) of migraine, besides pain, leads to other consequences, such as an increased burden from associated symptoms, (e.g., nausea, photophobia, and phonophobia) and a greater incidence of comorbidities (e.g., cognitive symptoms, anxious and/or depressive symptoms, and medication overuse), which may cause disability even in migraine-free days (i.e., interictal phase) [2][3][4]. The increased incidence of such symptoms in CM compared to episodic migraine (EM) is reputed as an effect of central sensitization mechanisms [5].…”