Persistent cognitive dysfunction in patients with migraine: a case series

BACKGROUND: Cognitive symptoms, including impaired concentration, slowed thinking, and forgetfulness, are common in patients with migraine. Although these symptoms are most prominent during the headache and postdrome phases, some patients experience persistent cognitive symptoms that extend beyond individual migraine attacks and interictal periods. Cortical spreading depression, a key pathophysiological mechanism of migraine, may contribute to neurological and cognitive manifestations and can be visualized indirectly using arterial spin-labeled magnetic resonance imaging (ASL-MRI). We investigated the clinical characteristics of persistent cognitive symptoms in patients with migraine, evaluated cerebral perfusion using ASL-MRI, and assessed the effects of migraine-preventive therapy. CASE PRESENTATION: We present a cohort of 12 consecutive patients with migraine who exhibited cognitive symptoms for over one month, without identifiable physical, neurological, cognitive, or psychiatric disorders. These patients underwent ASL-MRI while experiencing cognitive symptoms. Their ages ranged from 15 to 37 years, comprising five men and seven women. Eleven patients reported cognitive symptoms as their primary complaint during their initial visit, with only three presenting with concomitant headaches on that day. The cognitive symptoms persisted beyond migraine attacks and/or interictal phases, with durations ranging from two months to eight years. All patients displayed regional hypoperfusion in the right or left cerebral hemisphere on ASL-MRI. Treatment with migraine-preventive medications led to improvements in cognitive symptoms. The consistent presence of regional hypoperfusion and the favorable response to migraine-directed therapy suggest that migraine-related cerebral hypoperfusion may contribute to persistent cognitive dysfunction. CONCLUSIONS: Cognitive symptoms associated with migraine may persist for months to years, even in the absence of ongoing headache attacks. Regional cerebral hypoperfusion may reflect these persistent symptoms, and ASL-MRI may be a useful tool for detecting this abnormality. Migraine should be considered in the differential diagnosis of patients presenting with unexplained, persistent cognitive symptoms, particularly when a history of migraine exists.