Cognitive impairment in patients with migraine: causes, principles of effective prevention and treatment

Cognitive impairment (CI) is common in patients with migraine; its causes and pathogenesis continue to be discussed. Some authors consider that migraine proper does not lead to decreased cognitive functions, neuroimaging changes in the brain white matter are asymptomatic in migraine; and CI in patients with this condition is caused by comorbidities (depression, anxiety disorder) and/or concurrent cerebrovascular and neurodegenerative diseases. Other authors report the pathogenetic role of migraine in the development of CI and the importance of the frequency of headache attacks and neuroimaging changes in the brain matter in migraine. The paper reviews clinical trials dealing with the prevalence, causes, and pathogenesis of CI in patients with migraine. It sets forth the current principles of prevention and treatment of CI in patients with this condition.

1. Stovner LJ, Hagen K, Jensen R, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007 Mar;27(3): 193-210.

2. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012 Dec 15; 380(9859):2163-96. doi: 10.1016/S0140-6736(12)61729-2.

3. Stovner LJ, Zwart JA, Hagen K, et al. Epidemiology of headache in Europe. Eur J Neurol. 2006 Apr;13(4):333-45.

4. Yu S, Liu R, Zhao G, et al. The prevalence and burden of primary headaches in China: a population-based door-to-door survey. Headache. 2012 Apr;52(4):582-91.

5. Burch RC, Loder S, Loder E, et al. The prevalence and burden of migraine and severe headache in the United States: updated statistics from government health surveillance studies. Headache. 2015 Jan;55(1):21-34.

6. doi: 10.1111/head.12482.

7. Ayzenberg I, Katsarava Z, Sborowski A, et al. The prevalence of primary headache disorders in Russia: A countrywide survey. Cephalalgia. 2012 Apr;32(5):373-81. doi: 10.1177/ 0333102412438977. Epub 2012 Mar 6.

8. Foti M, Lo Buono V, Corallo F, et al. Neuropsychological assessment in migraine patients: a descriptive review on cognitive implications. Neurol Sci. 2017 Apr;38(4):553-562. doi: 10.1007/s10072-017-2814-z. Epub 2017 Jan 18.

9. De Araujo CM, Barbosa IG, Lemos SMA, et al. Cognitive impairment in migraine: A systematic review. Dement Neuropsychol. 2012 Apr-Jun;6(2):74-79. doi: 10.1590/S1980-57642012DN06020002.

10. Kurth T, Gaziano JM, Cook NR, et al. Migraine and risk of cardiovascular disease in women. JAMA. 2006 Jul 19;296(3):283-91.

11. Kurth T, Kase CS, Schurks M, et al. Migraine and risk of haemorrhagic stroke in women: prospective cohort study. BMJ. 2010 Aug 24;341:c3659. doi: 10.1136/ bmj.c3659.

12. Schurks M, Rist PM, Bigal ME, et al. Migraine and cardiovascular disease: systematic review and meta-analysis. BMJ. 2009 Oct 27; 339:b3914. doi: 10.1136/bmj.b3914.

13. Bigal ME, Lipton RB. The epidemiology, burden, and comorbidities of migraine. Neurol Clin. 2009 May;27(2):321-34. doi: 10.1016/j.ncl.2008.11.011.

14. Ott A, Breteler MM, van Harskamp F, et al. Incidence and risk of dementia. The Rotterdam Study. Am J Epidemiol. 1998 Mar 15;147(6):574-80.

15. Miche JP. Is It Possible to Delay or Prevent Age-Related Cognitive Decline? Korean J Fam Med. 2016 Sep;37(5):263-6. doi: 10.4082/kjfm. 2016.37.5.263. Epub 2016 Sep 21.

16. Kruit MC, van Buchem MA, Hofman PA, et al. Migraine as a risk factor for subclinical brain lesions. JAMA. 2004 Jan 28;291(4):427-34.

17. Kurth T, Mohamed S, Maillard P, et al. Headache, migraine, and structural brain lesions and function: the population-based EVA MRI study. BMJ. 2011 Jan 18;342:c7357. doi: 10.1136/bmj.c7357.

18. Scher AI, Gudmundsson LS, Sigurdsson S, et al. Migraine headache in middle age and late-life brain infarcts. JAMA. 2009 Jun 24;301(24):2563-70. doi: 10.1001/jama. 2009.932.

19. Vermeer SE, Prins ND, den Heijer T, et al. Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med. 2003 Mar 27;348(13):1215-22.

20. Costa A, Sansalone A, Squillace A, et al. Self-referred cognitive impairment in migraine patients. J Headache Pain. 2015 Dec;16 (Suppl 1):A149. doi: 10.1186/1129-2377-16-S1-A149.

21. Парфенов ВА, Захаров ВВ, Преображенская ИС. Когнитивные расстройства. Москва: Ремедиум; 2014. 192 с. [Parfenov VA, Zakharov VV, Preobrazhenskaya IS. Kognitivnye rasstroistva [Cognitive disorders]. Moscow: Remedium; 2014. 192 p.]

22. Balaban C, Jacob RG, Furman J. Neurologic bases for comorbidity of balance disorders, anxiety disorders and migraine: neurotherapeutic implications. Expert Rev Neurother. 2011 Mar;11(3):379-94. doi: 10.1586/ern.11.19.

23. Bigal ME, Kurth T, Santanello N, et al. Migraine and cardiovascular disease: a population-based study. Neurology. 2010 Feb 23;74(8):628-35. doi: 10.1212/WNL. 0b013e3181d0cc8b. Epub 2010 Feb 10.

24. Vetvik KG, MacGregor. Sex differences in the epidemiology, clinical features, and pathophysiology of migraine. Lancet Neurol. 2017 Jan;16(1):76-87. doi: 10.1016/S1474-4422(16)30293-9. Epub 2016 Nov 9.

25. Pavese N, Canapicchi R, Nuti A, et al. White matter MRI hyperintensities in a hundred and twenty-nine consecutive migraine patients. Cephalalgia. 1994 Oct;14(5):342-5.

26. Swartz RH, Kern RZ. Migraine is associated with magnetic resonance imaging white matter abnor-malities: A meta-analysis. Arch Neurol. 2004 Sep;61(9):1366-8.

27. Fazekas F, Koch M, Schmidt R, et al. The prevalence of cerebral damage varies with migraine type: A MRI study. Headache. 1992 Jun;32(6):287-91.

28. Lipton RB, Pan J. Is migraine a progressive brain disease? JAMA. 2004 Jan 28;291(4):493-4.

29. Schmitz N, Arkink EB, Mulder M, et al. Frontal lobe structure and executive function in migraine patients. Neurosci Lett. 2017 Jul 13; 653:92-96. doi: 10.1016/j.neulet.2017.05.041. Epub 2017 May 24.

30. Erdеlyi-Bоtor S, Aradi M, Kamson DO, et al. Changes of Migraine-Related White Matter Hyperintensities After 3 Years: A Longitudinal MRI Study. Headache. 2015 Jan;55(1):55-70. doi: 10.1111/head.12459. Epub 2014 Oct 16.

31. Baars MA, van Boxtel MP, Jolles J. Migraine does not affect cognitive decline: results from the Maastricht aging study. Headache. 2010 Feb;50(2):176-84.

32. doi: 10.1111/j.1526-4610.2009.01572.x. Epub 2009 Nov 17.

33. Kalaydjian A, Zandi PP, Swartz KL, et al. How migraines impact cognitive function: findings from the Baltimore ECA. Neurology. 2007 Apr 24;68(17):1417-24.

34. Rist PM, Dufouil C, Glymour MM, et al. Migraine and cognitive decline in the population-based EVA study. Cephalalgia. 2011 Sep; 31(12):1291-300. doi: 10.1177/033310241 1417466. Epub 2011 Aug 4.

35. Rist PM, Kang JH, Buring JE, et al. Migraine and cognitive decline among women: prospective cohort study. BMJ. 2012 Aug 8; 345:e5027. doi: 10.1136/bmj.e5027.

36. Corder EH, Saunders AM, Strittmatter WJ, et al. Gene dose of apolipoprotein E type 4 allele and the risk of Alzheimer's disease in late onset families. Science. 1993 Aug 13;261(5123): 921-3.

37. Schurks M, Rist PM, Kurth T. MTHFR 677C>T and ACE D/I polymorphisms in migraine: a systematic review and meta-analysis. Headache. 2010 Apr;50(4): 588-99. doi: 10.1111/j.1526-4610.2009.01570.x. Epub 2009 Nov 17.

38. Evers S, Afra J, Frese A, et al. EFNS guideline on the drug treatment of migraine – report of an EFNS task force. Eur J Neurol. 2006 Jun; 13(6):560-72.

39. Lainez MJ, Freitag FG, Pfeil J, et al. Time course of adverse events most commonly associated with topiramate for migraine prevention. Eur J Neurol. 2007 Aug;14(8):900-6.

40. Faralli M, Longari F, Crognoletti M, et al. Anamnestic factors and functional aspects in the selection of patients with migrainous vertigo. Eur Arch Otorhinolaryngol. 2010 Jul;267(7): 1157-62. doi: 10.1007/s00405-009-1164-8. Epub 2009 Nov 28.

41. Wang N, Huang HL, Zhou HY, et al. Cognitive impairment and quality of life in patients with migraine-associated vertigo. Eur Rev Med Pharmacol Sci. 2016 Dec;20(23): 4913-4917.

42. Lampl C, Thomas H, Tassorelli C, et al. Headache, depression and anxiety: associations in the Eurolight project. J Headache Pain. 2016;17:59. doi: 10.1186/s10194-016-0649-2. Epub 2016 Jun 1.

43. Vos T, Barber RM, Bell B. et al. Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015 Aug 22;386(9995):743-800. doi: 10.1016/S0140-6736(15)60692-4. Epub 2015 Jun 7.

44. Steel Z, Marnane C, Iranpour C, et al. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980-2013. Int J Epidemiol. 2014 Apr;43(2):476-93. doi: 10.1093/ije/dyu038. Epub 2014 Mar 19.

45. Merikangas KR, Stevens DE, Angst J. Psychopathology and headache syndromes in the community. Headache. 1994 Sep;34(8): S17-22.

46. Breslau N, Andreski P. Migraine, personality, and psychiatric comorbidity. Headache. 1995 Jul-Aug;35(7):382-6.

47. Juang KD, Wang SJ, Fuh JL, et al. Comorbidity of depressive and anxiety disorders in chronic daily headache and its subtypes. Headache. 2000 Nov-Dec;40(10):818-23.

48. Lake AE 3rd, Rains JC, Penzien DB, Lipchik GL. Headache and psychiatric comorbidity: Historical context, clinical implications, and research relevance. Headache. 2005 May; 45(5):493-506.

49. Beghi E, Bussone G, D'Amico D, et al. Headache, anxiety and depressive disorders: the HADAS study. J Headache Pain. 2010 Apr;11(2):141-50. doi: 10.1007/s10194-010-0187-2. Epub 2010 Jan 27.

50. Головачева ВА, Парфенов ВА, Табеева ГР и др. Оптимизация ведения пациентов с хронической ежедневной головной болью. Журнал неврологии и психиатрии им. С.С. Корсакова. 2017;117(2):4-9. [Golovacheva VA, Parfenov VA, Tabeeva GR, et al. Optimization of management of patients with chronic daily headache. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2017;117(2):4-9. (In Russ.)].

51. Осипова ВВ, Вознесенская ТГ. Коморбидность мигрени: обзор литературы и подходы к изучению. Журнал неврологии и нейропсихиатрии им. С.С. Корсакова. 2007; 107(3):64-73. [Osipova VV, Voznesenskaya TG. Comorbidity of migraine: a review of the literature and approaches to the study. Zhurnal nevrologii i neiropsikhiatrii im. S.S. Korsakova. 2007;107(3):64-73. (In Russ.)].

52. Oedegaard KJ, Neckelmann D, Mykletun A, et al. Migraine with and without aura: association with depression and anxiety disorder in a population-based study. The HUNT study. Cephalalgia. 2006 Jan;26(1):1-6.

53. Breslau N, Schultz LR, Stewart WF, et al. Headache and major depression: is the association specific to migraine? Neurology. 2000 Jan 25;54(2):308-13.

54. Табеева ГР, Яхно НН. Мигрень. Москва: ГЭОТАР-Медиа; 2011. 624 с. [Tabeeva GR, Yakhno NN. Migren' [Migrane]. Moscow: GEOTAR-Media; 2011. 624 p.]

55. Hagen K, Linde M, Steiner TJ, et al. Risk factors for medication-overuse headache: an 11-year follow-up study. The Nord-Trondelag Health Studies. Pain. 2012Jan;153(1):56-61. doi: 10.1016/j.pain.2011.08.018. Epub 2011 Oct 22.

56. Zwart JA, Dyb G, Hagen K, et al. Depression and anxiety disorders associated with headache frequency. The Nord-Trondelag Health Study. Eur J Neurol. 2003 Mar;10(2): 147-52.

57. Яхно НН, Преображенская ИС, Захаров ВВ и др. Распространенность когнитивных нарушений при неврологических заболеваниях (анализ работы специализированного амбулаторного приема). Неврология, нейропсихиатрия, психосоматика. 2012;4(2):30–5. [Yakhno NN, Preobrazhenskaya IS, Zakharov VV, et al. Prevalence of cognitive impairments in neurological diseases: Analysis of the activities of a specialized outpatient reception office. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2012;4(2):30–5. (In Russ.)]. doi: 10.14412/ 2074-2711-2012-378

58. Conradi HJ, Ormel J, de Jonge P. Presence of individual (residual) symptoms during depressive episodes and periods of remission: a 3-year prospective study. Psychol Med. 2011 Jun;41(6):1165-74. doi: 10.1017/S003329 1710001911. Epub 2010 Oct 8.

59. McIntyre RS, Cha DS, Soczynska JK, et al. Cognitive deficits and functional outcomes in major depressive disorder: determinants, substrates, and treatment interventions. Depress Anxiety. 2013 Jun;30(6):515-27. doi: 10.1002/ da.22063. Epub 2013 Mar 6.

60. Вознесенская ТГ. Депрессия при сосудистых заболеваниях головного мозга. Медицинский совет. 2012;(4):12–6. [Voznesenskaya TG. Depression in vascular diseases of the brain. Meditsinskii sovet. 2012;(4): 12–6. (In Russ.)].

61. Sapolsky RN. Depression, antidepressants, and the shrinking hippocampus. Proc Natl Acad Sci U S A. 2001 Oct 23;98(22):12320-2.

62. Harvey PO, Fossati P, Pochon JB, et al. Cognitive control and brain resources in major depression: an fMRI study using the n-back task. Neuroimage. 2005 Jul 1;26(3):860-9. Epub 2005 Apr 8.

63. Fitzgerald PB, Laird AR, Maller J, Daskalakis ZJ. A meta-analytic study of changes in brain activation in depression. Hum Brain Mapp. 2008 Jun;29(6):683-95.

64. Matsuo K, Glahn DC, Peluso MA, et al. Prefrontal hyperactivation during working memory task in untreated individuals with major depressive disorder. Mol Psychiatry. 2007 Feb;12(2):158-66. Epub 2006 Sep 19.

65. Meusel LA, Hall GB, Fougere P, et al. Neural correlates of cognitive remediation in patients with mood disorders. Psychiatry Res. 2013 Nov 30;214(2):142-52. doi: 10.1016/j. pscychresns.2013.06.007. Epub 2013 Aug 30.

66. Bras M, Dordevic V, Gregurek R, Bulajic M. Neurobiological and clinical relationship between psychiatric disorders and chronic pain. Psychiatr Danub. 2010 Jun;22(2):221-6.

67. Shelton CI. Diagnosis and management of anxiety disorders. J Am Osteopath Assoc. 2004 Mar;104(3 Suppl 1):S2-5.

68. Hoffelt C, Zwack A. Assessment and management of chronic pain in patients with depression and anxiety. Mental Health Clinician. 2014;4(3):146-52.

69. Chuang CS1, Lin CL, Lin MC, et al. Migraine and risk of dementia: a nationwide retrospective cohort study. Neuroepidemiology. 2013;41(3-4):139-45. doi: 10.1159/000353559. Epub 2013 Jul 30.

70. Gaist D, Garde E, Blaabjerg M, et al. Migraine with aura and risk of silent brain infarcts and white matter hyperintensities: an MRI study. Brain. 2016;139(7):2015-2023. doi:10.1093/brain/aww099.

71. Spalice A, Del Balzo F, Papetti L, et al. Stroke and migraine is there a possible comorbidity? Italian Journal of Pediatrics. 2016;42:41. doi:10.1186/s13052-016-0253-8.

72. Парфенов ВА. Дисциркуляторная энцефалопатия и сосудистые когнитивные расстройства. Москва: ИМА-ПРЕСС; 2017. 128 с. [Parfenov VA. Distsirkulyatornaya entsefalopatiya i sosudistye kognitivnye rasstroistva [Dyscirculatory encephalopathy and vascular cognitive disorders]. Moscow: IMA-PRESS; 2017. 128 p.]

73. Evers S, Afra J, Frese A, et al. EFNS guideline on the drug treatment of migraine – revised report of an EFNS task force. Eur J Neurol. 2009 Sep;16(9):968-81. doi: 10.1111/j.1468-1331.2009.02748.x.

74. Campbell JK, Penzien DB, Wall EM. Evidence-based guidelines for migraine headaches: behavioral and psychological treatments. www.aan.com/public

75. Castelnuovo G, Giusti EM, Manzoni GM, et al. Psychological treatments and psychotherapies in the neurorehabilitation of pain: evidences and recommendations from the Italian consensus conference on pain in neurorehabilitation. Front Psychol. 2016 Feb 19;7:115. doi: 10.3389/fpsyg.2016.00115. eCollection 2016.

76. Rosen NL. Psychological issues in the evaluation and treatment of tension-type headache. Curr Pain Headache Rep. 2012 Dec; 16(6):545-53. doi: 10.1007/s11916-012-0301-z.

77. Wells RE, Burch R, Paulsen RH, et al. Meditation for migraines: a pilot randomized controlled trial. Headache. 2014 Oct;54(9): 1484-95. doi: 10.1111/head.12420. Epub 2014 Jul 18.

78. Day MA, Thorn BE, Ward LC, et al. Mindfulness-based cognitive therapy for the treatment of headache pain: a pilot study. Clin J Pain. 2014 Feb;30(2):152-61. doi: 10.1097/ AJP.0b013e318287a1dc.

79. Day MA, Thorn BE. Mindfulness-based cognitive therapy for headache pain: An evaluation of the long-term maintenance of effects. Complement Ther Med. 2017 Aug;33:94-98. doi: 10.1016/j.ctim.2017.06.009. Epub 2017 Jul 1.