Interictal and Ictal Cognitive Performance in Episodic and Chronic Migraine

BACKGROUND: Cognitive dysfunction is a disabling feature of migraine, affecting attention, memory, and executive functions. Differences between episodic and chronic migraine, as well as between interictal and ictal periods, remain unclear. We aimed to compare interictal cognitive performance in episodic and chronic migraine with healthy controls and to evaluate intra-individual changes during attacks. METHODS: In this cross-sectional study with within-subject repeated measures, migraine patients (32 EM, 32 CM) and 30 matched healthy controls underwent standardized cognitive testing (Mini Mental State Examination, Clock Drawing Test, Stroop Test, Digit Span Forward/Backward Tests) assessing attention, short-term and working memory, and executive function along with Beck Depression Inventory. Migraine cohorts were evaluated interictally (≥ 72 h attack-free) and again within the first 3 h of an untreated spontaneous migraine attack. RESULTS: Interictally, CM patients demonstrated significant impairments in attention, short-term memory, and working memory compared to healthy controls. EM patients, however, showed no cognitive dysfunction except for working memory. During migraine attacks, all cognitive domains deteriorated significantly in both groups. The magnitude of cognitive decline during an attack did not differ between EM and CM. Attack severity was associated with greater cognitive decline during attacks in the general migraine group, but this association was more pronounced in EM than in CM. CONCLUSIONS: Migraine is a neurobiological disorder with cognitive consequences that extend beyond pain. Our findings highlight the importance of incorporating cognitive assessment into routine migraine management and reveal the need for longitudinal studies to elucidate the underlying mechanisms of cognitive dysfunction in migraine.