Cognitive dysfunction during mild to moderate migraine attacks: potential implications for presenteeism

Migraine-related presenteeism is a global concern, arising when individuals attend work during a headache attack, resulting in reduced performance. To clarify this issue, we investigated the effect of the presence and severity of headache attacks on cognitive function in patients with migraine. We conducted a retrospective analysis of prospectively collected cohort data from April to December 2019, enrolling participants aged 18–80 years who met the ICHD-3 criteria for migraine. Participants were categorized into four groups based on headache (HA) intensity at the time of their clinic visit: no HA, mild, moderate, or severe. Cognitive function was assessed using the Digit Cancellation Test (D-CAT) and the Trail Making Test (TMT). Patients with severe HAs were excluded, as pain relief treatment was prioritized. Statistical comparisons were conducted across the remaining groups. A total of 259 patients were analyzed, including 125 without HAs (HA (−)) and 134 with HAs (HA (+)), of whom 79 were mild and 55 were moderate. The HA (+) group showed significantly lower D-CAT scores compared with the HA (−) group (p < 0.05), while TMT scores did not differ significantly between the two groups. Within the HA (+) group, no significant differences in D-CAT or TMT scores were observed between patients with mild and moderate HAs. Similarly, cognitive scores did not differ between migraine patients with and without aura. Migraine patients experiencing a headache attack had reduced cognitive function compared with HA-free migraine patients, and this dysfunction was independent of HA severity. These findings suggest that the presence of a headache attack itself – regardless of its severity – may impair cognitive function and have potential implications for work efficiency and presenteeism.