Migraine and mental performance: good or bad?

People with migraine process sensory input differently

With sensory response on permanent overdrive, the nervous system of people with migraine is constantly on ‘high alert’. If stimulus processing is too fast or continues for too long, the nerves may run out of energy and get out of control. Pain-triggering neurotransmitters are released and a pounding migraine headache sets in. Heightened stimulus processing is a trait shared by luminaries like Pablo Picasso, Richard Wagner, and Marie Curie, all of whom had migraine.

Does migraine affect our ability to think?

Scientists who study this use the terms "cognition" and "cognitive abilities." These terms are a short way of saying “all the processes associated with thinking and perception and their results”. There is now an extensive body of research on a variety of topics related to cognition, including recent studies on whether people with migraine experience impaired cognitive function during attacks.

Other research questions include whether impairment can also occur between attacks, and whether a lifetime of migraine can hasten cognitive decline as you age.

Hard to research

These are questions that interest people with migraine as much as scientists. But the evidence is still inconclusive, as a look at the latest research shows. A major reason is because research questions like these are heavily based on subjective perception and people’s own personal experience. Research into the possible effects of migraine on cognition relies on the personal statements and impressions of people with migraine. Migraineurs may be asked whether they notice any bad effects on their mental performance during or between attacks.

The results are not based on neutral and reliable test systems but indicate the personal perceptions and (often) the emotions of the individual subjects. The impairments in themselves are no less relevant for the individuals concerned, because personal perception of cognitive impairment can add significantly to a person’s disease burden. Nevertheless, research in these areas walks a tightrope between scientific accuracy and reproducibility on the one hand and patients’ subjective perceptions on the other hand.

How does a migraine attack affect mental performance?

A comprehensive review published in 2019 evaluated the results of studies investigating the potential impact on cognition during the various stages of a migraine attack. Cognitive issues seem to be a warning sign that an attack is on the way. Speech and reading difficulties and poor concentration are common. Low mood and anxiety are also reported. Speech problems and poor concentration may become manifest when an attack strikes. Patients notice effects such as slowed thinking, confused thinking or retardation of thought processes. They also report feeling tired, lethargic, having no energy, or feeling depressed. According to the study, the symptoms usually subside as the attack ends.

What about between attacks?

In episodic migraine (not more than 14 migraine days per month; less frequent or only occasional migraine), cognition returns to normal between attacks in most people. However, increased sensitivity to light may persist because of the altered stimulus processing. There are also reports of altered pain processing.

In chronic migraine (15 or more migraine days per month; very frequent migraine), recovery periods between attacks are typically shorter. Brain scans show that the hyperexcitability of certain areas in the brain does not go away completely between attacks. In very severe cases, it may be permanent. Another possible consequence is chronic activation of the trigeminal nerve, resulting in permanently altered pain processing. This in turn can affect cognition and the way your nervous system processes emotions.

Attack frequency and duration have an impact

A 2017 study investigating the connection between cognitive impairment and the duration and frequency of migraine attacks found that the higher attack frequency associated with chronic migraine has negative impacts on cognition in migraineurs. This research identified major effects on language, memory, executive function (your cognitive control system that helps you stay organized and pay attention), calculation and orientation. Additional investigations (EEG: electroencephalogram) show that nerve signals may be processed and transmitted more slowly. The researchers think these observations are clearly linked to attack duration. Effects in some areas (executive function and numeracy) are also linked to attack frequency.

Lasting harm is unlikely

Most studies over the past ten years see no evidence of a connection between lifelong migraine and cognitive decline as you age (these studies were conducted in subjects over 65 or over 50 years of age, depending on the study design). So with all the serious limitations migraine brings, there is one consolation: while migraine sufferers may experience significant impairments – some of which are cognitive - they do not seem to worsen the cognitive effects of aging.