Abstract
While a significant proportion of the population suffer from migraine, the existing research literature does not provide a clear indication as to whether migraineurs experience objective cognitive deficits outside of acute migraine attacks. This meta-analysis was conducted to investigate which cognitive domains if any were affected by migraine, by synthesising the existing research quantitatively. The meta-analysis was prospectively registered with the PROSPERO International prospective register of systematic reviews (registration no.: CRD42019134138). A search of the electronic databases PubMed, Ovid MEDLINE, and PsycINFO was conducted for journal articles published between January 1980 and January 2020. Seventeen studies met the inclusion criteria, allowing for the calculation of pooled effect sizes between migraineurs (with and without aura) and healthy controls in the several cognitive domains. During the interictal period, migraineurs demonstrated a moderate, negative effect on complex attention immediate and delayed memory, spatial cognition, and executive functioning. This effect was not attributable to migraine history, attack frequency, or participant age. However, the lack of performance validity testing, and limited data on mood symptomatology and migraine medication use in the included studies may be confounds potentially overestimating the magnitude of effect. Comparison with a clinical control group, which may have accounted for some these extraneous variables, was unable to be conducted. Recommendations for comprehensive future neuropsychological research are provided.
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References
American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Araújo, C. M. D., Barbosa, I. G., Lemos, S. M. A., Domingues, R. B., & Teixeira, A. L. (2012). Cognitive impairment in migraine: A systematic review. Dementia & Neuropsychologia, 6(2), 74–79. https://doi.org/10.1590/S1980-57642012DN06020002
*Baschi, R., Monastero, R., Cosentino, G., Costa, V., Giglia, G., Fierro, B., & Brighina, F. (2019). Visuospatial learning is fostered in migraine: Evidence by a neuropsychological study. Neurological Sciences, 40(11), 2343–2348. https://doi.org/10.1007/s10072-019-03973-6
Bashir, A., Lipton, R. B., Ashina, S., & Ashina, M. (2013). Migraine and structural changes in the brain: A systematic review and meta-analysis. Neurology, 81(14), 1260–1268. https://doi.org/10.1212/WNL.0b013e3182a6cb32
Bell, B. D., Primeau, M., Sweet, J. J., & Lofland, K. R. (1999). Neuropsychological functioning in migraine headache, nonheadache chronic pain, and mild traumatic brain injury patients. Archives of Clinical Neuropsychology, 14(4), 389–399. https://doi.org/10.1016/S0887-6177(98)00020-1
Benedict, R. H., & Brandt, J. (1992). Limitation of the Mini-Mental State Examination for the detection of amnesia. Journal of Geriatric Psychiatry and Neurology, 5(4), 233–237. https://doi.org/10.1177/002383099200500409
Borenstein, M., Hedges, L. V., Higgins, J. P., & Rothstein, H. R. (2010). A basic introduction to fixed-effect and random-effects models for meta-analysis. Research Synthesis Methods, 1(2), 97–111. https://doi.org/10.1002/jrsm.12
*Calandre, E. P., Bembibre, J., Arnedo, M. L., & Becerra, D. (2002). Cognitive disturbances and regional cerebral blood flow abnormalities in migraine patients: Their relationship with the clinical manifestations of the illness. Cephalalgia, 22(4), 291–302. https://doi.org/10.1046/j.1468-2982.2002.00370.x
*Camarda, C., Monastero, R., Pipia, C., Recca, D., & Camarda, R. (2007). Interictal executive dysfunction in migraineurs without aura: Relationship with duration and intensity of attacks. Cephalalgia, 27(10), 1094–1100. https://doi.org/10.1111/j.1468-2982.2007.01394.x
Carnero-Pardo, C. (2014). Should the mini-mental state examination be retired? Neurología (english Edition), 29(8), 473–481. https://doi.org/10.1016/j.nrleng.2013.07.005
Cheung, M.W.-L. (2019). A guide to conducting a meta-analysis with non-independent effect sizes. Neuropsychology Review, 29(4), 387–396. https://doi.org/10.1007/s11065-019-09415-6
Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, New Jersey: L.
Daffner, K. R., Gale, S. A., Barrett, A. M., Boeve, B. F., Chatterjee, A., Coslett, H. B., & Lerner, A. J. (2015). Improving clinical cognitive testing: Report of the AAN Behavioral Neurology Section Workgroup. Neurology, 85(10), 910–918. https://doi.org/10.1212/WNL.0000000000001763
Davey, R. J., & Jamieson, S. (2004). The validity of using the mini mental state examination in NICE dementia guidelines. Journal of Neurology, Neurosurgery & Psychiatry, 75(2), 343–344.
Debette, S., & Markus, H. S. (2010). The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: Systematic review and meta-analysis. BMJ, 341, c3666. https://doi.org/10.1136/bmj.c3666
Deloitte Access Economics (2018). Migraine in Australia Whitepaper. Retrieved from https://www2.deloitte.com/au/en/pages/economics/articles/migraine-australia-whitepaper.html
Diener, H. C., Holle, D., Solbach, K., & Gaul, C. (2016). Medication-overuse headache: Risk factors, pathophysiology and management. Nature Reviews Neurology, 12(10), 575. https://doi.org/10.1038/nrneurol.2016.124
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ, 315(7109), 629–634. https://doi.org/10.1136/bmj.315.7109.629
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–198. https://doi.org/10.1016/0022-3956(75)90026-6
Foti, M., Buono, V. L., Corallo, F., Palmeri, R., Bramanti, P., & Marino, S. (2017). Neuropsychological assessment in migraine patients: A descriptive review on cognitive implications. Neurological Sciences, 38(4), 553–562. https://doi.org/10.1007/s10072-017-2814-z
Friedman, A. P., Finley, K. H., & Graham, J. R. (1962). Ad hoc committee on classification of headache. JAMA, 179(717), 7.
Galli, A., Di Fiore, P., D’Arrigo, G., Uggetti, C., Squarza, S., Leone, M., & Frediani, F. (2017). Migraine with aura white matter lesions: Preliminary data on clinical aspects. Neurological Sciences, 38(1), 7–10. https://doi.org/10.1007/s10072-017-2917-6
*Gil-Gouveia, R., Oliveira, A. G., & Martins, I. P. (2016). Sequential brief neuropsychological evaluation of migraineurs is identical to controls. Acta Neurologica Scandinavica, 134(3), 197–204. https://doi.org/10.1111/ane.12530
*Han, M., Hou, X., Xu, S., Hong, Y., Chen, J., Ma, Y., & Liu, X. (2019). Selective attention network impairment during the interictal period of migraine without aura. Journal of Clinical Neuroscience, 60, 73–78. https://doi.org/10.1016/j.jocn.2018.10.002
Headache Classification Committee of the International Headache Society (IHS). (2018). The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 38(1), 1–211. https://doi.org/10.1177/0333102417738202
Higgins, J. P., & Green, S. (2011). Cochrane handbook for systematic reviews of interventions (Vol. 4). John Wiley & Sons.
Higgins, J. P., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analyses. BMJ, 327(7414), 557–560. https://doi.org/10.1136/bmj.327.7414.557
*Hooker, W. D., & Raskin, N. H. (1986). Neuropsychologic alterations in classic and common migraine. Archives of Neurology, 43(7), 709–712. https://doi.org/10.1001/archneur.1986.00520070065020
*Huang, X., Zhang, D., Chen, Y., Wang, P., Mao, C., Miao, Z., & Yin, X. (2019). Altered functional connectivity of the red nucleus and substantia nigra in migraine without aura. The Journal of Headache and Pain, 20(1), 1–10. https://doi.org/10.1186/s10194-019-1058-0
Institute for Health Metrics and Evaluation (IHME). (2018). Findings from the Global Burden of Disease Study 2017. Retrieved from http://www.healthdata.org/policy-report/findings-global-burden-disease-study-2017
Jewsbury, P. A., Bowden, S. C., & Duff, K. (2017). The Cattell–Horn–Carroll model of cognition for clinical assessment. Journal of Psychoeducational Assessment, 35(6), 547–567. https://doi.org/10.1177/0734282916651360
Kurth, T., Mohamed, S., Maillard, P., Zhu, Y. C., Chabriat, H., Mazoyer, B., ... & Tzourio, C. (2011). Headache, migraine, and structural brain lesions and function: Population based Epidemiology of Vascular Ageing-MRI study. BMJ, 342. https://doi.org/10.1136/bmj.c7357
Lee, S. H., Kang, Y., & Cho, S. J. (2017). Subjective cognitive decline in patients with migraine and its relationship with depression, anxiety, and sleep quality. The Journal of Headache and Pain, 18(1), 77. https://doi.org/10.1186/s10194-017-0779-1
*Leijdekkers, M. L., Passchier, J., Goudswaard, P., Menges, L. J., & Orlebeke, J. F. (1990). Migraine patients cognitively impaired?. Headache: The Journal of Head and Face Pain, 30(6), 352–358. https://doi.org/10.1111/j.1526-4610.1990.hed3006352.x
*Le Pira, F., Reggio, E., Quattrocchi, G., Sanfilippo, C., Maci, T., Cavallaro, T., & Zappia, M. (2014). Executive dysfunctions in migraine with and without aura: what is the role of white matter lesions?. Headache: The Journal of Head and Face Pain, 54(1), 125–130. https://doi.org/10.1111/head.12158
*Le Pira, F., Zappala, G., Giuffrida, S., Lo Bartolo, M. L., Reggio, E., Morana, R., & Lanaia, F. (2000). Memory disturbances in migraine with and without aura: A strategy problem? Cephalalgia, 20(5), 475–478. https://doi.org/10.1046/j.1468-2982.2000.00074.x
Lezak, M., Howieson, D., Bigler, E., & Tranel, D. (2012). Neuropsychological assessment (5th ed.): New York: Oxford University Press.
*Lo Buono, V., Bonanno, L., Corallo, F., Palmeri, R., Allone, C., Lo Presti, R., & Marino, S. (2019). Cognitive functions and psychological symptoms in migraine: A study on patients with and without aura. International Journal of Neuroscience, 129(6), 588–592. https://doi.org/10.1080/00207454.2018.1554658
*Lo Buono, V., Bonanno, L., Corallo, F., Pisani, L. R., Presti, R. L., Grugno, R., & Marino, S. (2017). Functional connectivity and cognitive impairment in migraine with and without aura. The Journal of Headache and Pain, 18(1), 72. https://doi.org/10.1186/s10194-017-0782-6
Martelli, M. F., Zasler, N. D., Bender, M. C., & Nicholson, K. (2004). Psychological, neuropsychological, and medical considerations in assessment and management of pain. The Journal of Head Trauma Rehabilitation, 19(1), 10–28. https://doi.org/10.1097/00001199-200401000-00003
McGrew, K. S. (2005). The Cattell-Horn-Carroll theory of cognitive abilities. In D. P. Flanagan & P. L. Harrison (Eds.), Contemporary intellectual assessment: Theories, tests, and issues (2nd ed., pp. 136–181). Guilford Press.
*Milovan, D. L. (2005). Neuropsychological functioning of migraine patients with-and without aura, and cerebral hemisphere laterality (Doctoral dissertation, Concordia University).
Mitchell, A. (2009). A meta-analysis of the accuracy of the mini-mental state examination in the detection of dementia and mild cognitive impairment. Journal of Psychiatric Research, 43(4), 411–431. https://doi.org/10.1016/j.jpsychires.2008.04.014
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Annals of Internal Medicine, 151(4), 264–269. https://doi.org/10.7326/0003-4819-151-4-200908180-00135
Moola, S., Munn, Z., Tufanaru, C., Aromataris, E., Sears, K., Sfetcu, R., ... & Mu, P. F. (2017). Chapter 7: Systematic reviews of etiology and risk. Joanna Briggs Institute Reviewer's Manual. The Joanna Briggs Institute, 2019–05.
Mulder, E. J. C. M., Linssen, W. H. J. P., Passchier, J., Orlebeke, J. F., & De Geus, E. J. C. (1999). Interictal and postictal cognitive changes in migraine. Cephalalgia, 19(6), 557–565. https://doi.org/10.1046/j.1468-2982.1999.019006557.x
National Health and Medical Research Council (2019). Assessing Risk of Bias. Retrieved from https://nhmrc.gov.au/guidelinesforguidelines/develop/assessing-risk-bias
Nieuwenhuis-Mark, R. E. (2010). The death knoll for the MMSE: Has it outlived its purpose? Journal of Geriatric Psychiatry and Neurology, 23(3), 151–157. https://doi.org/10.1177/0891988710363714
O’Bryant, S. E., Marcus, D. A., Rains, J. C., & Penzien, D. B. (2005). Neuropsychology of migraine: Present status and future directions. Expert Review of Neurotherapeutics, 5(3), 363–370. https://doi.org/10.1586/14737175.5.3.363
Prado, C. E., & Crowe, S. F. (2019). Corticosteroids and Cognition: A Meta-Analysis. Neuropsychology Review, 1–25. https://doi.org/10.1007/s11065-019-09405-8
Prado, C. E., Watt, S., & Crowe, S. F. (2018). A meta-analysis of the effects of antidepressants on cognitive functioning in depressed and non-depressed samples. Neuropsychology Review, 28(1), 32–72. https://doi.org/10.1007/s11065-018-9369-5
Rist, P. M., & Kurth, T. (2013). Migraine and cognitive decline: A topical review. Headache: The Journal of Head and Face Pain, 53(4), 589–598. https://doi.org/10.1111/head.12046
Rosenthal, R. (1979). The file drawer problem and tolerance for null results. Psychological Bulletin, 86(3), 638. https://doi.org/10.1037/0033-2909.86.3.638
Sacco, S., Ricci, S., & Carolei, A. (2012). Migraine and vascular diseases: A review of the evidence and potential implications for management. Cephalalgia, 32(10), 785–795. https://doi.org/10.1177/0333102412451361
*Santangelo, G., Russo, A., Tessitore, A., Garramone, F., Silvestro, M., Della Mura, M. R., & Tedeschi, G. (2018). Prospective memory is dysfunctional in migraine without aura. Cephalalgia, 38(12), 1825–1832. https://doi.org/10.1177/0333102418758280
*Santangelo, G., Russo, A., Trojano, L., Falco, F., Marcuccio, L., Siciliano, M., & Tedeschi, G. (2016). Cognitive dysfunctions and psychological symptoms in migraine without aura: A cross-sectional study. The Journal of Headache and Pain, 17(1), 76. https://doi.org/10.1186/s10194-016-0667-0
Stovner, L. J., Hagen, K., Jensen, R., Katsarava, Z., Lipton, R. B., Scher, A. I., & Zwart, J. A. (2007). The global burden of headache: A documentation of headache prevalence and disability worldwide. Cephalalgia, 27(3), 193–210. https://doi.org/10.1111/j.1468-2982.2007.01288.x
Strauss, E., Sherman, E. M., & Spreen, O. (2006). A compendium of neuropsychological tests: Administration, norms, and commentary: American Chemical Society.
Suhr, J. A., & Seng, E. K. (2012). Neuropsychological functioning in migraine: Clinical and research implications. Cephalalgia, 32(1), 39–54. https://doi.org/10.1177/0333102411430265
Suhr, J., & Spickard, B. (2007). Including measures of effort in neuropsychological assessment of pain-and fatigue-related medical disorders. In K. B. Boone (Ed.), Assessment of feigned cognitive impairment: A neuropsychological perspective (pp. 259–280). Guildford Press.
Swartz, R. H., & Kern, R. Z. (2004). Migraine is associated with magnetic resonance imaging white matter abnormalities: A meta-analysis. Archives of Neurology, 61(9), 1366–1368. https://doi.org/10.1001/archneur.61.9.1366
Tendal, B., Higgins, J. P., Jüni, P., Hróbjartsson, A., Trelle, S., Nüesch, E., & Gøtzsche, P. C. (2009). Disagreements in meta-analyses using outcomes measured on continuous or rating scales: Observer agreement study. BMJ, 339, b3128. https://doi.org/10.1136/bmj.b3128
Tombaugh, T. N., & McIntyre, N. J. (1992). The mini-mental state examination: A comprehensive review. Journal of the American Geriatrics Society, 40(9), 922–935. https://doi.org/10.1111/j.1532-5415.1992.tb01992.x
Trauninger, A., Leél-Őssy, E., Kamson, D. O., Pótó, L., Aradi, M., Kövér, F., & Pfund, Z. (2011). Risk factors of migraine-related brain white matter hyperintensities: An investigation of 186 patients. The Journal of Headache and Pain, 12(1), 97. https://doi.org/10.1007/s10194-011-0299-3
*Tunç, A., Tekeşin, A. K., Güngen, B. D., & Arda, E. (2018). Cognitive performance in young and middle-aged adults with migraine: Investigating the correlation with white matter hyperintensities and psychological symptoms. Neurologia i Neurochirurgia Polska, 52(4), 470–476. https://doi.org/10.1016/j.pjnns.2018.05.001
Vuralli, D., Ayata, C., & Bolay, H. (2018). Cognitive dysfunction and migraine. The Journal of Headache and Pain, 19(1), 109. https://doi.org/10.1016/0022-510X(69)90069-0
*Wang, N., Huang, H. L., Zhou, H., & Yu, C. Y. (2016). Cognitive impairment and quality of life in patients with migraine-associated vertigo. European Review for Medical Pharmacological Science, 20(23), 4913–4917.
World Federation of Neurology. (1969). Meeting of the Research Group on Migraine and Headache. Journal of the Neurological Sciences, 9, 202.
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Literature search strings used on online databases
PubMed
(Migraine OR Headache) AND Neuropsych*
(Migraine OR Headache) AND Cogniti*
Ovid MEDLINE/PsycINFO
(Migraine OR Headache) AND (Neuropsych* OR Cogniti*)
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Braganza, D.L., Fitzpatrick, L.E., Nguyen, M.L. et al. Interictal Cognitive Deficits in Migraine Sufferers: A Meta-Analysis. Neuropsychol Rev 32, 736–757 (2022). https://doi.org/10.1007/s11065-021-09516-1
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DOI: https://doi.org/10.1007/s11065-021-09516-1