Cognitive dysfunction during mild to moderate migraine attacks: potential implications for presenteeism

BACKGROUND: Migraine-related presenteeism is a global concern, arising when individuals attend work during a headache attack, resulting in reduced performance. To clarify this issue, we investigated the effect of the presence and severity of headache attacks on cognitive function in patients with migraine. METHODS: We conducted a retrospective analysis of prospectively collected cohort data from April to December 2019, enrolling participants aged 18–80 years who met the ICHD-3 criteria for migraine. Participants were categorized into four groups based on headache (HA) intensity at the time of their clinic visit: no HA, mild, moderate, or severe. Cognitive function was assessed using the Digit Cancellation Test (D-CAT) and the Trail Making Test (TMT). Patients with severe HAs were excluded, as pain relief treatment was prioritized. Statistical comparisons were conducted across the remaining groups. RESULTS: A total of 259 patients were analyzed, including 125 without HAs (HA (−)) and 134 with HAs (HA (+)), of whom 79 were mild and 55 were moderate. The HA (+) group showed significantly lower D-CAT scores compared with the HA (−) group (p < 0.05), while TMT scores did not differ significantly between the two groups. Within the HA (+) group, no significant differences in D-CAT or TMT scores were observed between patients with mild and moderate HAs. Similarly, cognitive scores did not differ between migraine patients with and without aura. CONCLUSION: Migraine patients experiencing a headache attack had reduced cognitive function compared with HA-free migraine patients, and this dysfunction was independent of HA severity. These findings suggest that the presence of a headache attack itself – regardless of its severity – may impair cognitive function and have potential implications for work efficiency and presenteeism.