WASHINGTON – Women with a high burden of episodic migraine don’t appear to have any related cognitive impairment.
A small prospective study has found that women with as many as 10 migraines per month scored well within the normal range on tests of learning and memory, efficiency and attention, and processing speed, Jill Jesurum, Ph.D., reported in a poster at the annual meeting of the American Headache Society.
"This is very good news for women with migraine," said Dr. Jesurum, scientific director of the Swedish Heart and Vascular Institute at the Swedish Medical Center, Seattle. "I see migraine patients in my own clinic, and many are very worried because they feel they have some type of cognitive problems from their migraines."
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She presented a subanalysis of the CAMP (Comorbidities Associated With Migraine and Patent Foramen Ovale) study. The ongoing study aims to assess cognitive impairment and other comorbidities in at least 40 patients with migraine aura and a large patent foramen ovale, compared with migraineurs who do not have the heart defect.
Dr. Jesurum’s substudy comprised 28 women with a high migraine burden. The subjects’ mean age was 35 years. They had experienced migraines for a mean 19 years, with a mean of eight migraines each month. The MIDAS (Migraine Disability Assessment Test) and HIT-6 (Headache Impact Test–6) both showed that these women experienced severe disability with their migraines, with a mean MIDAS score of 40 and a mean HIT-6 score of 64. Depression and anxiety were minimal and moderate, according to mean test scores.
The women underwent a battery of cognitive testing during a headache-free period; they had no headache symptoms and no alcohol or opioid use during the 24 hours before the testing. The analysis controlled for antiepileptic agents as well as the use of NSAIDs and anticoagulant or antiplatelet drugs. A neuropsychologist who was blinded to the headache ratings administered and scored the tests.
"What we found was very encouraging," Dr. Jesurum said in an interview. "These women with a very high migraine burden were functioning at a high cognitive level during their headache-free periods. All of them scored within 1 standard deviation in all of the tests."
A subanalysis of the data showed no significant relationships between cognitive function scores and monthly migraine frequency. However, Dr. Jesurum noted, "When we looked at migraine burden and disability as measured by the HIT-6 and the MIDAS, we did see many significant inverse relationships between migraine burden, disability and cognitive function. The higher the migraine burden and the higher the disability, the lower the cognitive functions were, but that relationship was not significant when [we looked] at monthly migraine frequency."
This may reflect the perceived intensity of migraines, she said. "One woman might have two migraines a month, but if they totally wreck her life and she can’t work or take care of her children, that may negatively impact her cognitive function. On the other hand, another may have 5 or even 10 migraines a month, but if she’s able to treat them adequately and go about her daily life, they may not affect her cognitive function."
Because the study was so small did not have a comparator, it must be regarded as exploratory, Dr. Jesurum noted. Also, the women were generally very well educated, with 54% having at least a bachelor’s degree.
"The results may not be generalizable to other areas or populations with a different educational level, but it still is a very encouraging initial observation," she said.
The research was supported by grants from Coherex Medical, the John L. Locke Jr. Charitable Trust, NMT Medical, and the National Headache Foundation. Neither Dr. Jesurum not her coinvestigators had any relevant financial disclosures.