Chronic migraine patients show cognitive impairment in an extended neuropsychological assessment

Ferreira, Karen S.; Teixeira, Caroliny T.; Cáfaro, Carolina; Oliver, Gabriela Z.; Carvalho, Gabriela L. P.; Carvalho, Larissa A. S. D.; Silva, Brenda G.; Haes, Fernanda B. B.; Ciciarelli, Marcelo C.

doi:10.1590/0004-282X20180085

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Article • Arq. Neuro-Psiquiatr. 76 (9) • Sept 2018 • https://doi.org/10.1590/0004-282X20180085 copy

Chronic migraine patients show cognitive impairment in an extended neuropsychological assessment

Pacientes com migrânea crônica apresentam déficits cognitivos em uma avaliação neuropsicológica estendida

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The objective of the present study was to assess the presence of cognitive deficits in patients with chronic migraine, and to assess the main factors that trigger cognitive disorders, such as comorbidities or the use of medications.

Methods:

Chronic migraine and control groups were interviewed in a case-control study. The frequency and intensity of the headache, medication used and associated comorbidities were determined. All patients were submitted to an extended neuropsychological assessment.

Results:

The chronic migraine group (n = 30) had a worse performance in the Montreal Cognitive Assessment Test (p = 0.00), Verbal Fluency (p = 0.00), Stroop (p = 0.00), Clock Drawing Test (p = 0.00), Digit Span (p = 0.00) and Matrix Reasoning (p = 0.01). After statistical adjustment by linear regression, migraine continued to be the only relevant factor in the poorer performance in the Montreal Cognitive Assessment, Verbal Fluency, Clock Drawing and Stroop tests.

Conclusion:

Patients with chronic migraine have cognitive deficits in multiple tasks, regardless of the presence of comorbidities or the use of medications.

Keywords:
headache; migraine disorders; cognitive dysfunction

Variable	CM / n = 30	CG / n = 30	p-value
Mean age	33.7 (SD ± 11.2)	33.7 (SD ± 9.7)	0.79
Gender	29 (96.7%) women	29 (96.7%) women	1.0
Marital status	15 (50%) married	11 (36.7%) married	0.37
High school educational level	10 (33.3%)	10 (33.3%)	0.64
Higher education	20 (66.7%)	20 (66.7%)

Characteristics	Frequency – mean (± SD)
Pulsatile	19 (63.3%)
Nausea	26 (86.6%)
Photophobia	27 (90%)
Phonophobia	24 (80%)
Aura	1 (3.3%)
Use of topiramate	15 (50%)
Disruption of activities	30 (100%)
Absenteeism from work	22 (73.3%)
Mean headache intensity*	8.5 (SD 1.9)
Total time of migraine pain (in years)	14.7 (SD 11.3)
Frequency (days/month)	12.0 (SD 9.2)

Test	CM n = 30	CG n = 30	p-value
MoCA^* * MoCA: Montreal Cognitive Assessment;	24.4	26.7	0.00
Verbal Fluency	13.7	19.1	0.00
Clock Drawing Test	2.2	2.7	0.00
Stroop Test (1)^* ***** seconds.	14.3	11.6	0.00
Stroop Test (2)^* ***** seconds.	17.9	14.3	0.01
Stroop Test (3)^* ***** seconds.	24.5	18.8	0.00
RAVLT	49.5	50.8	0.70
WAIS-III Matrix Reasoning	17.8	18.9	0.01
Color Trail Test 1^* ***** seconds.	47.7	45.3	0.38
Color Trail Test 2^* ***** seconds.	92.8	79.7	0.24
WAIS-III Digit Span	13.0	15.8	0.00
WAIS-III Vocabulary	35.1	37.4	0.23
Beck Depression Inventory	10.2	6.8	0.01
Beck Anxiety Inventory	11.9	6.2	0.01

Model		Unstandardized coefficients B	Std error	p-value	95%CI for B
Chronic migraine		2.26	0.66	0.00	0.94–3.59
Depressive disorder		-1.20	0.91	0.19	-3.03–0.61
Generalized anxiety disorder		0.28	0.83	0.73	-1.38–1.95
Nonrepairing sleep		-0.47	0.77	0.54	-2.02–1.07
Second model with the addition of topiramate
	Chronic migraine	2.47	0.76	0.00	0.92–4.01
	Use of topiramate	-0.45	0.86	0.60	-2.20–1.28
	Depressive disorder	-1.18	0.91	0.20	-3.02–0.65
	Generalized anxiety disorder	0.22	0.85	0.79	-1.47–1.92
	Nonrepairing sleep	-0.37	0.79	0.63	-1.98–1.22

Test	Migraine	Use of topiramate	Major depressive disorder	Generalized anxiety disorder	Nonrepairing sleep
Verbal fluency	0.00^* * p-values.	0.40	0.10	0.11	0.62
Clock drawing test	0.00	0.48	0.48	0.99	0.55
Stroop test (1)	0.06	0.06	0.12	0.80	0.28
Stroop test (2)	0.01	0.23	0.88	0.08	0.06
Stroop test (3)	0.03	0.43	0.75	0.08	0.08
RAVLT	0.41	0.34	0.98	0.92	0.59
WAIS-III: Matrix reasoning	0.11	0.35	0.01	0.65	0.59
Color trail test	0.92	0.91	0.12	0.97	0.30
WAIS-III: Digit span	0.16	0.05	0.43	0.46	0.03
WAIS-III: Vocabulary	0.27	0.05	0.16	0.04	0.27

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[1] Correspondence: Karen S. Ferreira; Departamento de Neurologia, Centro Universitário Barão de Mauá; Rua Ramos de Azevedo, 423; 14090-180 Ribeirão Preto SP, Brasil. E-mail: karen.ferreira@baraodemaua.br