B – 5 Detecting migraine prodrome cognitive changes using the Stroop test: Evidence from EMA testing

Abstract Objective Examine objective cognitive performance on the Stroop test during migraine prodrome (period preceding head pain onset) compared to ictal (period with head pain) and interictal phases (period without head pain). Method Adults with episodic migraine completed an electronic EMA (ecological momentary assessment) protocol (five times per day for 2-4 weeks, including at least 5 migraine attacks), including migraine diary and adapted Stroop. Hurdle mixed-effects models assessed Stroop performance across migraine phases (prodrome = 24 hours before head pain onset). Results Participants (N=19, median age = 34, IQR = 27, 39; 68.4% female; 84.2% White; mean years of education = 16.5 SD=2.5) who produced at least one correct response on the “Stroop Go” task (word naming) correctly responded to more items during the ictal phase (estimate=0.57, 95% CI [0.22, 0.92]) and interictal phase (estimate=0.46, 95% CI [0.13, 0.80]) vs. prodrome. Odds of responding correctly to at least one “Stroop NoGo” item (e.g., interference; OR=2.31, 95% CI [1.52, 3.51]) were higher and making at least one commission error (e.g, incorrect response; OR=.54 95% CI [0.35, 0.81]) were lower during the ictal phase vs. prodrome. Conclusion This is the first study to demonstrate objective cognitive deficits during migraine prodrome. Findings suggest that cognitive impairments in processing speed and inhibition may occur during migraine prodrome. The Stroop test may be particularly sensitive to early cognitive changes, as it assesses multiple cognitive domains. Further research with larger samples is needed to confirm and translate findings into interventions to help participants recognize and treat migraine attacks during prodrome.