1. 2016;19;E137-E150Subjective Cognitive Symptoms During a Migraine Attack: A Prospective Study of a Clinic-Based Sample
   Prospective Evaluation
   Isabel Pavão Martins, MD, PhD, António G. Oliveira, MD, PhD, and Raquel Gil-Gouveia, MD.

BACKGROUND: A migraine attack aggregates a range of different symptoms, besides pain, that contribute to attack-related disability. Cognitive dysfunction is an unacknowledged part of the migraine attack.

OBJECTIVE: To provide a profile of the frequency and character of migraine attack-related cognitive symptoms occurring during the headache phase of the attack.

STUDY DESIGN: Cross-sectional survey.

SETTING: Clinical-based sample of episodic migraine patients.

METHODS: Sequential patients were screened about the occurrence of cognitive symptoms during migraine attacks using an open-ended question followed by a self-fulfilled symptom checklist.

RESULTS: Of 165 migraine patients (15 men, age average 37.3 ± 10.7 years), 89.7% described cognitive symptoms during the headache phase of the migraine attack. On average 2.5 ± 1.6 symptoms were reported per patient, uninfluenced by demographic or disease-related variables. The most common spontaneous symptoms related to executive functions, such as poor ability to concentrate (37%), difficulty in reasoning (25%), and thinking (23%). The pattern of responses on the symptoms checklist corroborated with those reported spontaneously and quantitative scores of the checklist were higher in patients with spontaneous symptoms.

LIMITATIONS: Open-ended questions tend to overestimate frequency; data accuracy may be influenced by the population chosen (clinical-based, some using prophylactic treatment).

CONCLUSIONS: This study detailed the frequency and characteristics of migraine attack-related subjective cognitive symptoms and found its frequency to be similar to reports of other migraine defining symptoms (ex. nausea, photophobia) in recent clinical series. Patients’ reports were consistent and dominated by complaints of attention difficulties, diminished cognitive efficiency, and processing speed impairment.