Memory and attention deficit in chronic migraine

Background. Memory and attention deficits are prevalent in the chronic pain population. There are multiple common mechanisms in chronic pain and cognitive impairment. However, the presence, prevalence and clinical burden of such impairment are frequently underestimated.

Objective: to evaluate subjective and objective cognitive deficits in patients with chronic migraine (CM).

Materials and methods. We recruited 53 subjects with CM and 22 genderand age-matched controls with low-frequency episodic migraine (a maximum of 4 headache days per month) aged 18–59. All patients filled in the HADS (Hospital Anxiety and Depression Scale) anxiety and depression scale and Pittsburg Sleep Quality Inventory (PSQI). Cognitive function was assessed with Montreal Cognitive Assessment (MoCA), Digital Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test (RAVLT) and the Perceived Deficits Questionnaire (PDQ-20).

Results. 56 % of patients with CM complained of memory problems. Decreased cognitive function was also observed during self-assessment using the PDQ-20 questionnaire. Objectively, we found a significant decrease in 90-second DSST results and RAVLT total recall and learning rates. 44 % of subjects with CM scored lower than 26 points on MoCA. Most frequently we found impairments in attention (75 %), memory/delayed recall (50 %), language (50 %) and executive function (37 %). Depression and sleep quality correlated with only several parameters of cognitive tests.

Conclusion. Subjective and objective cognitive deficits are prevalent in the CM population. Most often memory and attention are impaired. Cognitive complaints need to be carefully assessed, and treatment of such impairment may improve quality of life and decrease disability in CM.

1. Breivik H., Collett B., Ventafridda V. et al. Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. Eur J Pain 2006;10(4):287–333. DOI: 10.1016/j.ejpain.2005.06.009. PMID: 16095934.

2. Mazza S., Frot M., Rey A.E. A comprehensive literature review of chronic pain and memory. Prog Neuropsychopharmacol Biol Psychiatry 2017;17:30257–9. DOI: 10.1016/j.pnpbp.2017.08.006. PMID: 28797640.

3. Bell T., Trost Z., Buelow M.T. et al. Meta-analysis of cognitive performance in fibromyalgia. J Clin Exp Neuropsychol 2018;1:1–17. DOI: 10.1080/13803395.2017.1422699. PMID: 29388512.

4. Bertolucci P.H., de Oliveira F.F. Cognitive impairment in fibromyalgia. Curr Pain Headache Rep 2013;17(7):344. DOI: 10.1007/s11916-013-0344-9. PMID: 23709236.

5. Berryman C., Stanton T.R., Jane Bowering K. et al. Evidence for working memory deficits in chronic pain: a systematic review and meta-analysis. Pain 2013;154(8): 181–96. DOI: 10.1016/j.pain.2013.03.002. PMID: 23707355.

6. Moriarty O., McGuire B.E., Finn D.P. The effect of pain on cognitive function: a review of clinical and preclinical research. Prog Neurobiol 2011;93(3): 385–404. DOI: 10.1016/j.pneurobio.2011.01.002. PMID: 21216272.

7. Apkarian A.V., Baliki M.N., Farmer M.A. Predicting transition to chronic pain. Curr Opin Neurol 2013;26(4):360–7. DOI: 10.1097/WCO.0b013e32836336ad. PMID: 23823463.

8. Fallon N., Chiu Y., Nurmikko T. et al. Functional connectivity with the default mode network is altered in fibromyalgia patients. PLoS One 2016;11(7):1–12. DOI: 10.1371/journal.pone.0159198. PMID: 27442504.

9. Grilli M. Chronic pain and adult hippocampal neurogenesis: translational implications from preclinical studies. J Pain Res 2017;10:2281–6. DOI: 10.2147/JPR. S146399. PMID: 29033604.

10. Lam R.W., Kennedy S.H., Mclntyre R.S. et al. Cognitive dysfunction in majordepressive disorder: effects on psychosocial functioning and implications fortreatment. Can J Psychiatry 2014;59(12):649–54. DOI: 10.1177/070674371405901206. PMID: 25702365.

11. McIntyre R.S., Soczynska J.Z., Woldeyohannes H.O. et al. The impact ofcognitive impairment on perceived workforce performance: results from the International Mood Disorders Collaborative Project. Compr Psychiatry 2015;56:279–82. DOI: 10.1016/j.comppsych.2014.08.051. PMID: 25439523.

12. McIntyre R.S., Harrison J., Loft H. et al. The effects of vortioxetine on cognitive function in patients with major depressive disorder: a meta-analysis of three randomized controlled trials. Int J Neuropsychopharmacol 2016;19(10):1–9. DOI: 10.1093/ijnp/pyw055. PMID: 27312740.

13. Frampton J.E. Vortioxetine: a review in cognitive dysfunction in depression. Drugs 2016;76(17):1675–82. DOI: 10.1007/s40265-016-0655-3. PMID: 27807822.

14. Gil-Gouveia R., Martins I.P. Clinical description of attack-related cognitive symptoms in migraine: a systematic review. Cephalalgia 2017:1–16. DOI: 10.1177/0333102417728250. PMID: 28847155.

15. Huang L., Juan Dong H., Wang X. et al. Duration and frequency ofmigraines affect cognitive function: evidence from neuropsychological tests and event-related potentials. J Headache Pain 2017;18(1):54. DOI: 10.1186/s10194-017-0758-6. PMID: 28477306.

16. Santangelo G., Russo A., Trojano L. et al. Cognitive dysfunctions and psychological symptoms in migraine without aura: a cross-sectional study. J Headache Pain 2016;17(1):76. DOI: 10.1186/s10194-016-0667-0. PMID: 27568039.

17. Lawrence C., Roy A., Harikrishnan V. et al. Association between severity of depression and self-perceived cognitive difficulties among full-time employees. Prim Care Companion CNS Disord 2013;15(3):1–13. DOI: 10.4088/PCC.12m01469. PMID: 24171145.

18. Tesio V., Torta D.M., Colonna F. et al. Are fibromyalgia patients cognitively impaired? Objective and subjective neuropsychological evidence. Arthritis Care Res (Hoboken) 2015;67(1):143–50. DOI: 10.1002/acr.22403. PMID: 25047247.

19. Apkarian A.V., Sosa Y., Krauss B.R. et al. Chronic pain patients are impaired on an emotional decision-making task. Pain 2004;108(1–2):129–36. DOI: 10.1016/j.pain.2003.12.015. PMID: 15109516.

20. Nekovarova T., Yamamotova A., Vales K. et al. Common mechanisms of pain and depression: are antidepressants also analgesics? Front Behav Neurosci 2014;8:99. DOI:10.3389/fnbeh.2014.00099. PMID: 24723864.

21. Campbell L.C., Clauw D.J., Keefe F.J. Persistent pain and depression: a biopsychosocial perspective. Biol Psychiatry 2003;54(3):399–409. DOI: 10.1016/S00063223(03)00545-6. PMID: 12893114.

22. Pehrson A.L., Cremers T., Betry С. et al. Lu AA21004, a novel multimodal antidepressant, produces regionally selective increases of multiple neurotransmitters – a rat microdialysis and electrophysiology study. Eur Neuropsychopharmacol 2013;23(2):133–45. DOI: 10.1016/j.euro-neuro.2012.04.006. PMID: 22612991.

23. Baune B.T., Brignone M., Larsen K.G. A network meta-analysis comparing effects of various antidepressant classes on the digit symbol substitution test (DSST) as a measure of cognitive dysfunction in patients with major depressivedisorder. Int J Neuropsychopharmacol 2018;21(2):97–107. DOI: 10.1093/ijnp/pyx070. PMID: 29053849.