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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2020; 78(03): 133-138
DOI: 10.1590/0004-282X20190159
Article

Cognitive impairment in chronic migraine: a cross-sectional study in a clinic-based sample

Comprometimento cognitivo na enxaqueca crônica: um estudo transversal em uma amostra clínica
Nina LATYSHEVA 
1   Sechenov University, Institute for Professional Education, Department of Neurology, Moscow, Russia.
2   Alexander Vein Headache Clinic, Moscow, Russia.
,
Elena FILATOVA 
1   Sechenov University, Institute for Professional Education, Department of Neurology, Moscow, Russia.
2   Alexander Vein Headache Clinic, Moscow, Russia.
,
Diana OSIPOVA 
1   Sechenov University, Institute for Professional Education, Department of Neurology, Moscow, Russia.
,
Alexey B. DANILOV 
1   Sechenov University, Institute for Professional Education, Department of Neurology, Moscow, Russia.
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Abstract

Cognitive impairment has been described in all phases of a migraine attack and interictally. However, the prevalence and phenotype of such impairment in chronic migraine (CM) have not yet been studied. Objectives: The aim of this study was to evaluate both the prevalence of the objective cognitive deficit in patients with CM and the factors underlying its etiology. Methods: 144 patients with CM and 44 age-matched patients with low-frequency episodic migraine (EM) (a maximum of 4 headache days per month) participated in this study. Neuropsychiatric characteristics were measured with the HADS Hospital Anxiety and Depression Scale. Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA), Digit Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test (RAVLT), and the Perceived Deficits Questionnaire (PDQ-20). Results: Compared to EM, CM subjects demonstrated higher subjective and objective cognitive impairment across all tests. CM patients had 4 times higher odds of achieving a RAVLT score in the lower quartile range compared to EM (Odds Ratio [OR] 3.8; 95% confidence interval [95%CI] 1.5–9.6; p=0.005). In the MoCA, CM patients demonstrated the most striking impairment in memory/delayed recall (65.3%), attention (46.5%), abstraction (30.6%), and language (27.1%). Chronic headache and level of education, but not gender, depression or anxiety, were independent predictors of cognitive impairment. Conclusions: Cognitive impairment is prevalent in the CM population during their mildest possible pain and may be caused by a central sensitization. Timely preventive treatment of EM is warranted.

Resumo

O comprometimento cognitivo foi descrito em todas as fases de um ataque de enxaqueca, de maneira intermitente. Entretanto, a prevalência e o fenótipo desse comprometimento na enxaqueca crônica (EC) não foram estudados. Objetivos: O objetivo deste estudo foi avaliar a prevalência do déficit cognitivo objetivo em pacientes com EC e fatores subjacentes à sua etiologia. Métodos: 144 pacientes com CM e 44 pacientes pareados por idade com enxaqueca episódica (EE) de baixa frequência (máximo de 4 dias de dor de cabeça por mês) foram incluídos. As características neuropsiquiátricas foram medidas pela Hospital Anxiety and Depression Scale (HADS). A função cognitiva foi avaliada por meio da Montreal Cognitive Assessment (MoCA), o Digit Symbol Substitution Test (DSST), o Rey Auditory Verbal Learning Test (RAVLT) e o Perceived Deficits Questionnaire (PDQ-20). Resultados: Em comparação com a EE, os indivíduos com EC demonstraram um comprometimento cognitivo subjetivo e objetivo maior em todos os testes. Os pacientes com CM tiveram 4 vezes mais chances de alcançar um escore RAVLT na faixa quartil inferior, em comparação com EE (Odds Ratio [OR] 3,8; intervalo de confiança de 95% [IC95%] 1,5–9,6; p=0,005). No MoCA, os pacientes com EC demonstraram o maior prejuízo na memória/atraso na recordação (65,3%), atenção (46,5%), abstração (30,6%) e linguagem (27,1%). Dor de cabeça crônica e nível de escolaridade, mas não o sexo, depressão ou ansiedade, foram preditores independentes de comprometimento cognitivo. Conclusões: O comprometimento cognitivo é prevalente na população com enxaqueca crônica mesmo durante uma dor muito leve e pode ser causado pela sensibilização central. O tratamento preventivo oportuno da enxaqueca episódica se faz necessário.

Keywords:

migraine - chronic migraine - cognition - memory - depression

Palavras-chave:

transtornos de enxaqueca - enxaqueca crônica - cognição - memória - depressão


Publication History

Received: 17 September 2019

Accepted: 30 September 2019

Article published online:
02 June 2023

© 2020. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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