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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 39  |  Issue : 2  |  Page : 73-77

Does migraine negatively affect cognitive functions? Alexandria University Students Hospital experience


1 Alexandria University Students Hospital, Faculty of Medicine, Alexandria University, Alexandria, Egypt
2 Neurology and Psychiatry Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt

Date of Submission07-Sep-2017
Date of Acceptance31-Oct-2017
Date of Web Publication2-May-2018

Correspondence Address:
Hesham Sheshtawy
Neurology and Psychiatry Department, Faculty of Medicine, Alexandria University, Alexandria, 21525
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejpsy.ejpsy_29_17

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  Abstract 


Aim Studying the cognitive functions among Alexandria University Students Hospital patients, suffering from common migraine (either newly diagnosed or on regular treatment).
Patients and methods A total of three groups were studied: the newly diagnosed migraine group (group I, 20 patients), the chronic migraine group (group II, 20 patients), and the control group (group III, 20 patients). Their cognitive functions were compared using Wechsler Adult Intelligence Scale.
Results The mean total intelligence quotient (IQ) scores of chronic migraine group (106.65±4.18) and newly diagnosed migraine group (106.90±4.95) were significantly lower than that of control group (111.35±6.47) (P=0.007). There was no significant difference between mean IQ scores of chronic and newly diagnosed migraine groups. The mean score of newly diagnosed migraine (6.80±1.54) in digit backward subtest was significantly higher than that of chronic migraine group (5.70±1.49) and control group (5.70±2.13) (P<0.05).
Conclusion Patients with migraine have worse score than control in total IQ. However, this score is still within the normal limits. This difference may be related to the pain itself. This needs to be scientifically tested in further researches. On the contrary, newly diagnosed migraine group showed worse performance in working memory than chronic migraine group. No difference between chronic migraine patients and control. This denotes that adaptation can improve working memory of patients with migraine with the passage of time.

Keywords: cognition, intelligence quotient, migraine


How to cite this article:
Sharaf S, Hamdy M, El-Selmawy D, Sheshtawy H. Does migraine negatively affect cognitive functions? Alexandria University Students Hospital experience. Egypt J Psychiatr 2018;39:73-7

How to cite this URL:
Sharaf S, Hamdy M, El-Selmawy D, Sheshtawy H. Does migraine negatively affect cognitive functions? Alexandria University Students Hospital experience. Egypt J Psychiatr [serial online] 2018 [cited 2018 May 22];39:73-7. Available from: http://new.ejpsy.eg.net/text.asp?2018/39/2/73/231699




  Introduction Top


Migraine headaches are said to be genetically determined defect of cranial neurovascular function (Edmeads, 1984; Lance, 1993). The prevalence of migraine headaches is ∼18% in females and 6% in males older than 11 years (Lipton and Stewart, 1993). The age of onset is before 40 years in ∼90% of cases (Bartleson, 1984). Typically, migraine is a recurrent and extended episode of unilateral, pulsating, and moderate to severe headache. Cognitive symptoms may occur in the prodrome, aura, and/or headache phase of an attack (Bartleson, 1984; Merskey, 1986; Clifford Rose, 1988; Ardila and Sanchez, 1988).

Controversies exist regarding the effect of chronic migraine headache on cognitive performance. Some studies found negative effect of migraine on cognitive functions (Zeitlin and Oddy, 1984; Hooker and Raskin, 1986; D’Andrea et al., 1989; Bell et al., 1999; Le et al., 2000). Other studies did not find any effect (Burker et al., 1989; Mulder et al., 1999).

Mongini et al. (2005) pointed out a possible relationship between chronic migraine and dorsolateral and orbitofrontal prefrontal dysfunctions. This relationship was found to be partly independent of the patient’s psychological traits and psychiatric disorders. Schmitz et al. (2008) showed that migraineurs showed decreased frontal and parietal lobe grey matter density and executive dysfunction.


  Aim Top


This work aimed at studying the cognitive functions among patients experiencing common migraine who were on treatment and newly diagnosed patients at Alexandria University Students Hospital.


  Patients and methods Top


The current study was conducted on 40 patient with migraine recruited from Alexandria University Students Hospital Clinic. They were divided into two groups: 20 patients presenting with common migraine on treatment (group I) and 20 patients newly diagnosed with migraine (group II). The study also included a third group comprising 20 age-matched and sex-matched control persons who were recruited from Alexandria University Students Hospital (group III).

Patients with secondary headache, on polytherapy, with history of any disease affecting the cognition (e.g. multiple sclerosis, and mental retardation), and those on drugs affecting cognition (e.g. topiramate) were excluded.

Migraine diagnosis was established according to ICHD-3 (International Classification of Headache Disorders – third edition) criteria, (Headache Classification Committee of the International Headache Society, 1988). The frequency, the length, and the severity of migraine attacks were recorded. Patients’ data were compared with a control group of 20 healthy patients matched in age, sex, and educational level. Informed consent was taken from patients and control persons.

Cognitive functions for patients and control groups were tested using Wechsler Adult Intelligence Scale (WAIS) (Wechsler, 1981). In patients, the evaluation was always performed during headache-free intervals. The assessment was usually carried out in a single session whose mean duration varied from 60 to 90 min.

Statistical analysis

Data were fed to the computer and analyzed using IBM SPSS software package (Armonk, NY: IBM Corp.), version 20.0. Qualitative data were described using number and percent. Quantitative data were described using minimum and maximum, mean and SD. Comparison between different groups regarding categorical variables was tested using χ2-test. When more than 20% of the cells have expected count less than 5, correction for χ2 was conducted using Fisher’s exact test or Monte Carlo correction. For normally distributed data, comparison between two independent populations was done using independent t-test. Correlations between two ordinal variables were assessed using Spearman’s coefficients. Receiver operating characteristic curve was plotted to analyze a recommended cutoff score for the Arabic version EAT-26 using psychiatric assessment as gold standard. The area under the receiver operating characteristic curve denotes the diagnostic performance of the test. Area more than 50% gives acceptable performance, and area ∼100% is the best performance for the test. Reliability statistics was assessed using Cronbach’s α test. Validity statistics was assessed using Pearson’s coefficient. Significance of the obtained results was judged at the 5% level (Kotz et al., 2006; Kirkpatrick and Feeney, 2013).

Ethical considerations

The study was approved by the Ethics Committee of the Faculty of Medicine, Alexandria University, and the researchers complied with the international ethical guidelines for research. Every participant was informed about the objectives of the study and their verbal consent was obtained, and confidentiality was assured.


  Results Top


In group I (chronic migraine), there were three (15%) male and 17 (85%) female patients. In group II (newly diagnosed), there were eight (40%) male and 12 (60%) female patients. In group III (control), there were six (30%) male and 14 (70%) female persons. The differences between groups were not statistically significant.

The range of the age among the three studied groups was 18–25 years. In the group I cases, the mean age was 20.65±1.76 years; in the group II cases, the mean age was 20.5±1.85 years; and in the group III control, the mean was 21.3±2.13 years. The differences between groups were not statistically significant.

The mean total intelligence quotient (IQ) scores of chronic migraine group (106.65±4.18) and newly diagnosed migraine group (106.90±4.95) were significantly lower than that of control group (111.35±6.47) (P=0.007). Moreover, the mean total IQ scores for both chronic and newly diagnosed groups (when combined, 106.78±4.53) were significantly lower than that of control group (111.35±6.47) (P=0.010) ([Table 1]).
Table 1 Comparison between the three studied groups according to total, performance, and verbal intelligence quotient

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However, the mean scores of performance IQ and verbal IQ of patient groups, either separated or combined, were insignificantly lower than that of control groups. Moreover, there was no significant difference between mean IQ scores of chronic and newly diagnosed migraine groups ([Table 1]).

The mean score of newly diagnosed migraine (6.80±1.54) in digit backward subtest was significantly higher than that of chronic migraine group (5.70±1.49) and control group (5.70±2.13) (P<0.05). The mean score of combined patient groups with each other in digit backward subtest (6.25±1.60) showed insignificant difference than that of control group. Otherwise, there were no statistically significant differences between scores of WAIS subtests of the studied groups ([Table 2]).
Table 2 Comparison between the three studied groups according to Wechsler Intelligence Scale subtests

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  Discussion Top


The mean scores of performance IQ and verbal IQ of patients groups, either separated or combined, were insignificantly lower than that of control groups. This insignificant difference was transformed to significant difference when total IQ was calculated. The mean score of total IQ of patient groups was significantly lower than that of control group. However, the mean total IQ scores of patient groups were within the normal limits (Wechsler, 1981). This means that migraine can negatively affect the cognition, but this impairment is not severe enough to cause functional impairment.

The working memory of the newly diagnosed migraine group (measured by digit backward subtest of WAIS) was significantly worse than that of chronic migraine group and control group. This difference can mean that the working memory is transiently impaired at the start of migraine attacks. With the passage of time, adaptation can occur in the brains of patients with migraine, leading to normalization of working memory again.

The previous result is in concordant with Zeitlin and Oddy (1984), who compared 19 patients with migraine and 19 healthy patients. They concluded that migraineurs showed lower cognitive scores than patients in the control group.

Moreover, Hooker and Raskin (1986), evaluated the neuropsychological performance of patients with migraine in comparison with control patients. The patients’ performance was worse than controls.

D’Andrea et al. (1989) studied memory function in 20 children experiencing common migraine and in 20 healthy children. They noted that patients experienced more from impairment in both short-term and in long-term memory than the healthy children.

Finally, Le Pira et al. (2000) examined cognitive abilities in 15 patients experiencing migraine with aura, 16 patients experiencing migraine without aura and 14 healthy controls, and they detected defects in both verbal and visual memory in both groups of patients.

On the contrary, the results of the current study showed inconsistent findings with that of Burker et al. (1989), Bell et al. (1999) and Mulder et al. (1999) All of these studies found similar results in patient and control groups.

The contradicting results can be related to the selection of the sample. The patients of the studies of Zeitlin and Oddy (1984), Hooker and Raskin, (1986), and D’Andrea et al. (1989) came from headache clinics (similar to the current study). On the contrary, those of Burker et al. (1989), Bell et al. (1999) and Mulder et al. (1999) were recruited from either the general population or students. Attending headache clinic regularly may reflect worse severity. Hence, lower scores may also be related to the severity of pain itself rather than definite brain pathology. This needs to be scientifically tested in further research.


  Conclusion Top


Patients with migraine have worse score than control regarding total IQ. However, this score is still within the normal limits. This difference may be related to the pain itself. This needs to be scientifically tested in further researches. On the contrary, newly diagnosed migraine showed worse performance in working memory than chronic migraine. No difference was present between patients with chronic migraine and control. This can denote that adaptation can improve working memory of patients with migraine with the passage of time.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ardila A, Sanchez E (1988). Neuropsychologic symptoms in the migraine syndrome. Cephalalgia 8:67–70.  Back to cited text no. 1
    
2.
Bartleson J (1984). Transient and persistent neurological manifestations of migraine. Stroke 15:383–386.  Back to cited text no. 2
    
3.
Bell BD, Primeau M, Sweet JJ, Lofland KR (1999). Neuropsychological functioning in migraine headache, nonheadache chronic pain, and mild traumatic brain injury patients. Arch Clin Neuropsychol 14:389–399.  Back to cited text no. 3
    
4.
Burker E, Hannay HJ, Halsey JH (1989). Neuropsychological functioning and personality characteristics of migrainous and nonmigrainous female college students. Neuropsychology 3:61.  Back to cited text no. 4
    
5.
Clifford Rose F (1988). Clinical characterisation of migraine. Basic mechanisms of headache. Amsterdam: Elsevier. pp. 3–8.  Back to cited text no. 5
    
6.
D’Andrea G, Nertempi P, Milone FF, Joseph R, Cananzi AR (1989). Personality and memory in childhood migraine. Cephalalgia 9:25–28.  Back to cited text no. 6
    
7.
Edmeads J (1984). Migraine: new views on an old theory. Can J Neurol Sci 11:363–364.  Back to cited text no. 7
    
8.
Hooker WD, Raskin NH (1986). Neuropsychologic alterations in classic and common migraine. Arch Neurol 43:709–712.  Back to cited text no. 8
    
9.
Kirkpatrick LA, Feeney BC (2013). A simple guide to IBM SPSS statistics for version 20.0. Belmont, CA: Wadsworth, Cengage Learning.  Back to cited text no. 9
    
10.
Kotz S, Balakrishnan N, Read CB, Vidakovic B (2006). Encyclopedia of statistical sciences. 2nd ed. Hoboken, NJ: Wiley-Interscience.  Back to cited text no. 10
    
11.
Lance J (1993). Current concepts of migraine pathogenesis. Neurology 43(Suppl 3):S11–S15.  Back to cited text no. 11
    
12.
Le Pira F, Zappala G, Giuffrida S, Bartolo ML, Reggio E, Morana R et al. (2000). Memory disturbances in migraine with and without aura: a strategy problem? Cephalalgia 20:475–478.  Back to cited text no. 12
    
13.
Lipton RB, Stewart WF (1993). Migraine in the United States: a review of epidemiology and health care use. Neurology 43(Suppl 3):S6–S10.  Back to cited text no. 13
    
14.
Merskey HE (1986). Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Pain 3:S1–S226.  Back to cited text no. 14
    
15.
Mongini F, Keller R, Deregibus A, Barblonga E, Mongini T (2005). Frontal lobe dysfunction in patients with chronic migraine: a clinical − neuropsychological study. Psychiatry Res 133:101–106.  Back to cited text no. 15
    
16.
Mulder E, Linssen W, Passchier J, Orlebeke J, Geus ED (1999). Interictal and postictal cognitive changes in migraine. Cephalalgia 19:557–565.  Back to cited text no. 16
    
17.
Schmitz N, Arkink AB, Mulder M, Rubia K, Admiral Behloul F, Schoonmann GG et al. (2008). Frontal lobe structure and executive function in migraine patients. Neurosci Lett 44:92–96.  Back to cited text no. 17
    
18.
Headache Classification Committee of the International Headache Society (1988). Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 8:1–96.  Back to cited text no. 18
    
19.
Wechsler D (1981). Wechsler Adult Intelligence Scale, revised. New York, NY: Psychological Corporation.  Back to cited text no. 19
    
20.
Zeitlin C, Oddy M (1984). Cognitive impairment in patients with severe migraine. Br J Clin Psychol 23:27–35.  Back to cited text no. 20
    



 
 
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  [Table 1], [Table 2]



 

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