Abstract
BackgroundThe occurrence of cognitive dysfunctions and psychological symptoms, as well as their mutual relationships, in migraine patients are still debated. The aim of the study was to characterize the cognitive profile and psychological symptoms (i.e. depression, anxiety and apathy) in drug-naïve migraine without aura (MwoA) patients.MethodsSeventy-two consecutive MwoA patients, referred to the Italian University Headache Clinic and 72 healthy subjects (HCs) were enrolled. Patients, during an attack-free period, and HCs completed Montreal Cognitive Assessment (MoCA), Beck Depression Inventory-II (BDI-II), Self-version of Apathy Evaluation Scale (AES-S) and State and Trait Anxiety Inventory (STAI-Y-1 and 2). Clinical parameters of disease severity (i.e. disease duration, migraine attacks per month, mean pain intensity during migraine attacks, migraine disability and impact on daily life) were recorded.ResultsAlthough performance of MwoA patients on MoCA was above Italian cut-off threshold (<15.5) suggesting presence of cognitive impairment, MwoA patients achieved significantly lower scores than HCs on total MoCA scale (22.3 ± 2.7 versus 25.4 ± 2.3) and on its attention (4.9 ± 1.1 versus 5.6 ± 0.7), memory (1.8 ± 1.4 versus 3.1 ± 1.3), visuospatial (3.2 ± 0.9 versus 3.6 ± 0.6) and executive subscales (2.6 ± 1.1 versus 3.1 ± 0.8). In addition, we observed significant correlations between MoCA executive domain subscore and the attack-related disability score (MIDAS).As for behavioral profile, the percentage of depressive symptoms (4.2 %), high state and trait anxiety (13.9 and 9.7 %, respectively), and apathy (11.1 %) in MwoA patients were similar to that of HCs. No significant associations of behavioural symptoms with cognitive performance and clinical parameters were found.ConclusionsDrug-naïve MwoA patients are characterized by subtle cognitive dysfunctions and low percentage of behavioural symptoms. The results support the importance of searching for subclinical cognitive disturbances in patients with MwoA, who deserve to be followed-up to verify whether they develop clinically relevant disorders over time.
Highlights
The occurrence of cognitive dysfunctions and psychological symptoms, as well as their mutual relationships, in migraine patients are still debated
healthy subjects (HCs) were recruited from among patients’ friends, employees at the clinic or university centres, and were included if they gave their written informed consent to participate on a voluntary basis and met the following selection criteria: lack of history of migraine or any other type of headache and/or current diagnosis of migraine according to clinical criteria; lack of history of or actual psychiatric diseases; no use of psychoactive drugs
migraine without aura (MwoA) patients performed significantly lower than HCs on the total Montreal Cognitive Assessment (MoCA) score, and on attention, memory, visuospatial and executive domains
Summary
The occurrence of cognitive dysfunctions and psychological symptoms, as well as their mutual relationships, in migraine patients are still debated. The aim of the study was to characterize the cognitive profile and psychological symptoms (i.e. depression, anxiety and apathy) in drug-naïve migraine without aura (MwoA) patients. Only a few studies took into account the possible relationships between cognitive performances and associated psychological symptoms or behavioural disturbances, which may often occur in migraine patients [20]. Apathy appears as a symptom of depression but as a specific behavioural disturbance [22], with its neural (i.e. abnormalities of prefrontal cortex) and cognitive correlates (i.e. impaired executive/attention and visuospatial abilities) [23, 24]. Until now no study assessed apathy, i.e. a loss of interest and motivation [22], in MwoA
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