Cognitive impairment in tension-type headache is associated with altered hippocampal functional connectivity

Tension-type headache (TTH) is a widespread primary headache disorder that causes mild to moderate pain, which may be seen together with cognitive deficits. It is unclear if TTH-linked cognitive impairment is associated with functional alterations. Seventy-five participants were enrolled in the study. Mini Mental State Evaluation (MMSE) and Montreal Cognition Assessment (MoCA) tests were applied to evaluate cognitive impairment. A neuroimaging analysis was applied to determine whether the hippocampus responsible for pain and cognition was affected in TTH patients. Our functional data revealed significant alterations in the connectivity of the subiculum, hippocampal fissure, and left whole hippocampus. Among the significant functional brain alterations observed, the right subiculum consistently interacted with MoCA scores and increased pain intensity. Our findings suggest that TTH patients with cognitive impairment may exhibit unique functional alterations in the hippocampus. This suggests a potential negative association between pain modulation and cognitive processes in the hippocampus that may be responsible for the increased risk of dementia in these patients.