Assessing Cognitive Decline in Migraine Associated With Medication Overuse

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A recent study examined cognitive changes in a type of migraine termed chronic migraine with medication overuse headache (CM-MOH).

A recent study examined cognitive changes in a type of migraine termed chronic migraine with medication overuse headache (CM-MOH), a common type of headache that is associated with a greater risk of stroke and white matter lesions.

Chronic migraine (CM) is marked by headaches occurring for more than 15 days per month, with no less than 8 days of episodes and symptoms lasting for at least 3 months.

The cross-sectional study was conducted between December 2015 and January 2017. Patients were divided into 3 groups: CM-MOH, chronic migraine without medication overuse (CMwoMOH), and migraine without aura.


Of the 116 patients in the study, there were 21 with CM-MOH, 20 with CMwoMOH, 35 with migraine without aura, and 40 controls. Age and education were the independent risk factors of cognitive decline. All of the patients took nonsteroidal anti-inflammatory drugs (NSAIDs), such as aminopyrine, phenacetin, aspirin, ibuprofen, and acetaminophen, to relieve headache.

In all cases, cognitive function was assessed during times in between headache using Addenbrooke’s Cognitive Examination Test (ACE-R), Trail Making Test A/B (TMT A/B), and Digit Symbol Test (DST). Researchers collected detailed headache characteristics and evaluation of anxiety, depression, and living and sleep quality.

After adjusting, the risk of cognitive decline was higher in CM compared with control groups in ACE-R score and language fluency (P <.05). In addition, CM-MOH sufferers had a higher risk of memory and executive dysfunction (P <.05).

There was no difference in cognitive function between CM-MOH, those who overused NSAIDs, and CMwoMOH (P >.05). CM-MOH got significantly higher scores than migraine without aura in anxiety and depression, with poorer performances in sleep and life quality (P <.05).

Migraine sufferers with cognitive function decline during acute attacks may have had decreased regional blood flow during episodes. However, these deficits, along with the loss of executive function skills, language skills, visuospatial ability, and ability to perform complex tasks rebounded.

It still is not known if cognitive decline in CM-MOH patients could become irreversible and should be a topic for future study, the researchers said.


Xiaoying C, Xiaotian X, Aiwu Z, et al. Cognitive decline in chronic migraine with nonsteroid anti-inflammation drug overuse: a cross-sectional study [published online May 6, 2019]. Pain Res Manag. doi: 10.1155/2019/7307198.