Our objective was to analyze self-reported cognitive dysfunction in migraineurs presenting to a university-based tertiary care headache.

All new patients at a tertiary headache clinic complete a detailed patient intake questionnaire prior to their first visit. This questionnaire contains a section on cognitive symptoms. After seeing the patient, clinicians use IHS beta 3 for specific headache diagnosis, and this is updated in the database as well.

We included questions regarding confusion, decreased ability to concentrate, fatigue, problems with memory, depressed mood, anxious mood, and trouble sleeping.

Of the 2356 patients, 2111 (90.4%) endorsed difficulty with concentration, confusion was present in 861 (36.9%). When asked about their most concerning symptoms associated with headache 1028, (44.3%) had problems with memory. Majority of patients also reported fatigue and low energy 1633 (71%).

A majority of the patients had CM (1603, 71.2%), and MOH (1214, 53.9%).

We found that significant proportion of patients with CM and MOH endorsed subjective cognitive issues that trouble them as much as pain itself. It is not clear what is causing these issues since most patients have normal neurological exams and brain imaging. We speculate that this is likely caused by disruption of normal brain function. Many of the study patients also experience anxiety, depression, problems with sleep, and fatigue. It is likely that the cause of CM contributes to other neuropsychological issues and these are bidirectional and amplify each other.