Is there a relation between untreated severe migraines and memory loss?

Relationship Between Untreated Severe Migraines and Memory Loss

Yes, there is a relationship between untreated severe migraines and cognitive dysfunction, including memory impairment. Cognitive dysfunction has been reported to be the second largest cause of disability, after pain, in migraine patients 1.

Evidence of Cognitive Impairment in Migraine

Timing of Cognitive Impairment

• Cognitive performance is worse during migraine attacks (ictal phase) compared to controls, and can persist into the postictal period 1, 2
• Whether cognitive impairment continues during headache-free periods (interictal phase) remains controversial, with clinic-based studies showing impairment while population-based studies often do not 2

Specific Cognitive Domains Affected

• Memory impairment is documented in both migraine with aura and migraine without aura 3
• Patients with migraine show deficits in:
  • Information processing speed 2
  • Basic attention 2
  • Executive functions 2
  • Verbal and non-verbal memory 3, 2
  • Verbal skills 2

Neuroimaging Evidence

• Migraine alters activity in memory-related brain structures, including:
  • Hippocampus 4
  • Insula 4
  • Frontal, parietal and temporal cortices 4
• These alterations suggest a mechanism by which migraine influences various types of memory, including pain memory, prospective memory, and short- and long-term verbal and visuospatial memories 4

Differences by Migraine Type

Chronic vs. Episodic Migraine

• Chronic migraine patients show increased risk of cognitive decline compared to controls 5
• Patients with chronic migraine perform worse on tests measuring memory and executive function 5

Migraine With vs. Without Aura

• Both groups show impaired visuo-spatial memory tasks 3
• Only migraineurs without aura showed significantly impaired verbal memory performances in some studies 3
• The memory defects in both types appear related to strategically and organizationally defective aspects of learning 3

Medication Overuse and Cognitive Function

• Studies comparing chronic migraine with medication overuse headache (CM-MOH) to chronic migraine without medication overuse (CMwoMOH) found no significant differences in cognitive function between these groups 5
• However, both chronic migraine groups showed higher risk of cognitive decline compared to controls 5

Long-term Implications

• Longitudinal studies do not suggest progressive cognitive decline over time in migraine patients 2
• However, migraine is associated with increased risk of stroke and white matter lesions, which could potentially contribute to cognitive changes over time 5

Clinical Considerations

• Cognitive impairment may limit social and professional interactions, negatively impacting quality of life 1
• Preventive medications and comorbid disorders such as depression and anxiety can impact cognitive function but cannot fully explain the cognitive impairment in migraine 2
• Unlike migraine, tension-type or cluster headache are not associated with cognitive impairment during headache-free periods 2

Pitfalls and Caveats

• Many studies have small sample sizes and methodological limitations 4
• Medication use can confound cognitive assessment results 4
• Anxiety and depression, which frequently co-occur with migraine, can independently affect cognitive function 5, 2
• There is a need for larger studies with appropriate controls for medication use and comorbid conditions 4