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Thinking through the pain of migraine
Cognitive symptoms are a part of the migraine syndrome and cognitive dysfunction is part of the attack pathophysiology that contributes to disability summarized Dr Gil-Gouveia Hospital da Luz, Lisbon, Portugal speaking at #AHSAM21. While chronicity and comorbidities influence the cognitive performance of people living with migraine, fortunately migraine is unlikely to be related to cognitive decline. Dr David Seminowicz, University of Maryland shared data showing that behavioral changes, specifically enhanced mindfulness-based stress reduction may be associated with visualized changes in cognitive brain networks resulting in increased cognitive efficiency.
Cognitive function and migraine
Dr Gil-Gouveia highlighted that cognitive symptoms are frequent in migraine and span the full spectrum of migraine phases from prodrome to postdrome. Cognitive symptoms reported by patients consistently relate to executive functions and correlate with disability.1-3
Cognitive symptoms are part of the migraine syndrome and cognitive dysfunction contributes to migraine disability
Cognitive impairment is related to chronic migraine and can be influenced by comorbidities. Cognitive impairment does not appear to have a defined neuropsychological profile and may be due to differences in brain processing in people with migraine. It may be possible to reverse cognitive impairment with adequate treatment.
While chronicity and comorbidities influence the cognitive performance of people living with migraine, cognitive decline is unlikely to be related to migraine.4,5 Reversible attack-related cognitive dysfunction seems extremely consistent and likely related to functional cortical and subcortical brain changes occurring during attacks; interictal cognitive dysfunction is less consistent and might become more relevant as attack frequency and disease complexity increase.6
Cognitive decline is unlikely to be related to migraine
Cognitive interference impacts function
Results from a Migraine Clinical Outcome Assessment System (MiCOAS) study that aimed to capture patient perspectives on migraine-related cognitive changes during and between migraine attacks were also reported at #AHSAM21.7 This study found that cognitive interference is a common burden for people with migraine disease that occurs both during and between migraine attacks and impacts function. This highlights the importance of assessing cognitive-related outcomes in the migraine population.
“I will still have brain fog for days following a migraine headache”
Cognitive strategies and migraine
Dr David Seminowicz, University of Maryland shared data showing that, in people with migraine, enhanced mindfulness-based stress reduction (MBSR+) may be associated with visualized changes in cognitive brain networks resulting in increased cognitive efficiency. A study in people with episodic migraine (N=98) also showed that MBSR+ can offer outcomes comparable to standard migraine preventives, with significantly greater reduction in migraine frequency as compared with stress management for headache (p=0.04 after 10–20 weeks).8 The effectiveness of enhanced MBSR+ was greater than that previously observed for standard MBSR.9,10
Enhanced mindfulness-based stress reduction can offer outcomes comparable to standard migraine preventives
Dr Seminowicz concluded that future directions include understanding the mechanism of mindfulness, predicting treatment response,11 and determining if mindful breathing and savouring-induced corticostriatal activation in the brain is associated with improvement in chronic pain outcomes.
Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.
References
- Gil-Gouveia R, et al. J Neurol. 2015;262(3):654–665.
- Gil-Gouveia R, et al. Pain Physician. 2016;19(1):E137–E150.
- Gil-Gouveia R, et al. Cephalalgia. 2016;36(5):422–430.
- Rist PM, et al. BMJ. 2012;345:e5027.
- Palm-Meinders IH, et al. JAMA. 2012;308(18):1889–1897.
- Gil-Gouveia R and Martins IP. Curr Pain Headache Rep. 2019;23(11):84.
- Gerstein MT, et al. Headache. 2021; 61 (Suppl 1):50; OR-17.
- Seminowicz DA, et al. Pain. 2020 161(8):1837–1846.
- Wells RE, et al. JAMA Intern Med. 2021;181(3):317–328.
- Wells RE, et al. Expert Rev Neurother. 2020; 20(3): 207–225.
- Krimmel SR, et al. bioRxiv 2021;2021.03.31.437905: doi: 10.1101/2021.03.31.437905