Cognitive and sensory profiles in patients with epilepsy, migraine, and their comorbidity: a quantitative study

Epilepsy and migraine are highly comorbid neurological disorders with shared pathophysiological features. However, their combined impact on cognitive, emotional, and sensory processing remains insufficiently characterized. This study aimed to quantitatively compare these domains across patients with epilepsy, migraine, their comorbidity, and healthy controls. The study recruited 27 patients with epilepsy, 27 with migraine, 20 with comorbid epilepsy and migraine, and 25 healthy controls. Cognitive function, anxiety, and depression were assessed using the Montreal Cognitive Assessment (MoCA), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS), respectively. Disease-specific scales were also administered. Sensory function was evaluated by measuring the pain perception threshold (PPT) with von Frey filaments and by quantifying the current perception threshold (CPT) and pain tolerance threshold (PTT) using a Neurometer ® at 2000 Hz (Aβ fibers), 250 Hz (Aδ fibers), and 5 Hz (C fibers). All patient groups exhibited significantly lower MoCA scores and elevated SAS anxiety scores relative to healthy controls (all FDR-adjusted q < 0.05). Only the comorbidity group showed significantly higher SDS depressive scores compared with controls; furthermore, depressive scores in the comorbidity group were significantly higher than those in patients with migraine-only. The comorbidity group presented the most pronounced cognitive deficits, particularly in attention, executive function, and visuospatial memory. While PPT and CPT showed no inter-group differences, PTT was significantly reduced across all patient groups at 250 Hz and 5 Hz (all FDR-adjusted q < 0.05); the comorbidity group additionally demonstrated reduced PTT-2000 Hz relative to healthy controls. Correlation analyses revealed positive associations between VAS score and headache attack duration, as well as between MIDAS, HIT-6 scores and VAS score. LSSS score was positively correlated with seizure duration. MoCA score was positively correlated with headache attack duration and HIT-6 score, although this exploratory association may be confounded by inter-group differences. Patients with epilepsy, migraine, or their comorbidity demonstrate significant cognitive and emotional impairments, with more pronounced deficits in selected cognitive and depressive-symptom domains among patients with comorbidity. Widespread reductions in pain-tolerance capacity suggest overlapping alterations in nociceptive processing across both disorders, which may partly explain their clinical comorbidity. These findings support an integrated clinical approach addressing cognitive, emotional, and pain-related sensory dysfunction. This singlecenter crosssectional observational study was retrospectively registered with the Chinese Clinical Trial Registry (ChiCTR, registration No. ChiCTR2200065174) on 30 October 2022.