Migraine is a genetic neurological disease that affects brain function. Migraine affects brain function, not its structure, which is why migraine cannot be seen on brain imaging. Migraine is so much more than head pain. Migraine attacks can cause many symptoms such as thinking difficulties, nausea, vomiting, and dizziness.

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Cognitive dysfunction (inability to think as well as usual) is the second leading cause of migraine attack disability after head pain.  

Phases of a migraine attack

The difficulty thinking due to a migraine attack can start as early as two days before head pain and last up to two days after the resolution of the head pain. There are three to four phases of a migraine attack:

1. early symptoms (prodrome)

2. sometimes an aura(gradually progressing symptoms such as vision changes, tingling, weakness, speaking difficulty before the head pain)

3. headache

4. symptoms that occur after the head pain (postdrome)

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About one in three people with migraine have a prodrome phase before the headache and about two in three have a postdrome phase. The postdrome phase starts from two days to a few hours before the headache and consists in different symptoms such as fatigue, repetitive yawning, sensitivity to lights and sounds, and includes cognitive dysfunction such as difficulty concentrating, speaking, or reading for 30% of people.

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During the head pain part of the migraine attack, about 90% of people experience cognitive dysfunction such as difficulty in concentrating, planning, reasoning, thinking, paying attention, problem-solving. Difficulty concentrating is also part of the postdrome phase, which starts after the resolution of the headache and cast last up to 48 hours.

The thinking difficulties during migraine attacks are common, disabling, and can be frightening. A lot of people with migraine worry that the ability of their brain to think is affected outside of migraine attacks. One thing to consider and discuss with your headache doctor is whether any of your medications can affect your ability to think. Some medications that can help with headaches can also have side effects on your ability to think. If you develop those side effects, it will be better to try another medication instead.

Migraine can affect the ability to think early in life

Regardless of medications, potential mood disorders, and cognitive changes during migraine attacks, the current scientific data to date suggests that migraine can be associated with difficulties with our ability to think even outside of migraine attacks during the first half of our lives. A study that followed children over time showed that the children who later develop migraine performed worse in school and on tests of attention and language comprehension than children who did not develop migraine later in life. This study suggests that having a genetic predisposition to migraine may affect our ability to think and perform at school even before we develop symptoms that can be identified as migraine attacks.

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More than 15 studies support the idea that having migraine is associated with poorer performance in terms of attention, calculation, orientation, problem-solving, planning, language, thinking speed, spatial skills, and memory in the first 50 years of life compared to people who do not have migraine. We do not know why having migraine seems to be associated with some difficulty in our ability to think early in life. There are different hypotheses such as different levels in brain chemicals that help communication between neurons (neurotransmitters), functional disconnection between different brain regions, overload of the brain areas that are responsible for both thinking and processing pain.

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Migraine is not associated with dementia later in life

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The good news is that there is no strong scientific evidence to date that would suggest an association between migraine and dementia. Seven large studies that followed people over time and looked at migraine and cognitive function later in life did not show an association between migraine and dementia. We do not know why the difference in ability to think between people who have migraine and those who don’t have migraine early in life disappears later in life. Hypotheses include that the ability to think improves as people tend to be less affected by migraine in life or that other risk factors for dementia take over later in life and annul the difference observed earlier in life.

Migraine attacks commonly impair our ability to think. Having migraine may predispose to not performing as well in some thinking tasks earlier in life such as attention, planning, problem-solving. However, to date, it seems unlikely that migraine would predispose to dementia. If your everyday life is affected by migraine attacks, you should consider tracking your migraine attacks and speaking with a board-certified neurologist by joining Neura Health.

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