Neurocognitive Performance and Executive Functions Do Not Influence Conditioned Pain Modulation in Women with Migraine

<b>Introduction</b>: Migraine is featured by altered nociceptive processing and the presence of cognitive impairments. No study has previously investigated the influence of neurocognitive performance and executive functions in descending pain processing in this population. <b>Aim</b>: To assess the influence of neurocognitive processes and executive functions in conditioned pain modulation (CPM) activation in women with migraine. <b>Methods</b>: A cross-sectional case-control study including 140 women with migraine (50% chronic) and 70 control women was conducted. Clinical migraine features, neurocognitive processes (e.g., attention), and executive functions (memory, mental inhibition, speed of processing) were evaluated. Pressure pain thresholds (PPTs) were bilaterally assessed at the temporalis muscle, lateral epicondyle, and tibialis anterior muscle. Heat (HPT) and cold (CPT) pain thresholds were assessed at the frontalis (trigeminal area) muscle. Thus, CPM was evaluated with the cold pressor test paradigm by analyzing changes in mechanical/thermal stimuli after a conditioned stimulus. <b>Results</b>: Significant group*time interactions not associated with neurocognitive process/executive function, educational level, and employment status were found for PPTs at the temporalis muscle (Wilk's λ = 0.588, F[2,199] = 69.756, <i>p</i> < 0.001, n²p = 0.412, 1 - β = 0.999), lateral epicondyle (Wilk's λ = 0.674, F[2,200] = 48.331, <i>p</i> < 0.001, n²p = 0.326, 1 - β = 0.999), and tibialis anterior (Wilk's λ = 0.751, F[2,200] = 33.110, <i>p</i> < 0.001, n²p= 0.249, 1 - β = 0.999): PPTs were higher after the conditioned stimulus in all points in control women (increases ranging from 11% to 17%), whereas PPTs were lower after the conditioned stimulus in women with migraine (decrease from -7.5% to -0.1%) when compared with PPTs at baseline. Changes in HPT and CPT were small and not significant, ranging from 0.1% to 0.5%. <b>Conclusion</b>: This study revealed that women with episodic or chronic migraine showed CPM deficits particularly against mechanical stimuli when compared with pain-free women. Neurocognitive (e.g., attention) processes or executive functions (e.g., working memory, mental inhibition) did not modulate CPM activity in women with migraine.