Cognition during ictal and interictal migraine phases: A pilot study using ecological momentary assessment
Laura Sebrow1, Richard B Lipton2, Christopher L Metts3
1Department of Neurology, Northwell Health, Manhasset, New York, USA.
Objective:
The present study aimed to evaluate cognitive functioning during ictal and interictal phases of the migraine attack using smart-phone based ambulatory cognitive tests.
Background:
Cognitive problems have been increasingly recognized as an important part of the burden of migraine. People with migraine report subjective cognitive problems more often during the ictal phase than during the interictal phase of the migraine attack. However, objective evidence of cognitive impairment during attacks is limited. To address this gap, we used smart-phones and an ecological momentary assessment (EMA) design to repeatedly assess migraine symptoms and cognitive performance as people went about their daily lives.
Methods:
In this longitudinal study, 19 adults with migraine completed an EMA protocol. Using a downloadable iPhone app, participants were asked five times daily to complete a headache questionnaire and to take an ultra-brief cognitive battery over 2-4 weeks. The cognitive battery (i.e., Trail Making Test [TMT], Stroop Test, Spatial Memory Test) assessed the domains of working memory, processing speed, and aspects of executive functioning (set-shifting, cognitive inhibition). The ictal phases were defined by the presence of current head pain. The interictal phases were defined by the absence of head pain. Separate mixed-effects models were run for each cognitive outcome to examine cognitive performance during the ictal phase relative to the interictal phase.
Results:
Participants were 68% female and 84% White; the median (interquartile range) age was 34.0 (27.0-39.0) years. The majority had a tertiary education with 47% holding an undergraduate degree and 47% a graduate degree. The Stroop Test and the Spatial Memory test revealed cognitive decrements in performance in the ictal phase relative to the interictal phase. Specifically, during the ictal phases, there were fewer Spatial Memory successes/sequences (B = -0.20, 95% confidence interval [CI] -0.38 to -0.01; p = 0.038) and Spatial Memory largest successes/sequences (B = -0.22, 95% CI -0.43 to -0.01; p = 0.038). Additionally, there were fewer Stroop non-congruent items correct (B = -0.37, 95% CI -0.70 to -0.03, p = 0.006; odds ratio 3.03, 95% CI 1.26-7.26, p = 0.013), and greater Stroop non-congruent item errors (B = 0.23, 95% CI 0.02-0.44; p = 0.031). The TMT parts A and B did not significantly differ based on migraine phase.
Conclusion:
We found decrements in objective cognitive performance in the domains of working memory and cognitive inhibition in the ictal vs. the interictal phases of migraine using EMA, replicating and extending prior work on cognitive performance. These methods further characterize the cognitive burden of migraine and could be extended to assess cognition in the prodrome and postdrome, as well as assess the cognitive benefits of acute and preventive treatment in randomized trials.
