The Impact of Migraine on Cognitive Performance

Migraine represents a highly prevalent and frequently debilitating neurological disorder, characterised by recurrent episodes of moderate to severe headache, often accompanied by associated symptoms such as nausea, photophobia, phonophobia, and occasionally transient focal neurological phenomena known as aura (Ruschel, 2024; Amiri et al., 2022). The duration of migraine attacks typically ranges from several hours to up to 72 hours, with variability in frequency and pattern whereby attacks may present sporadically or progress to a chronic state, operationally defined as headache occurring on 15 or more days per month (Voelker, 2025). Globally, migraine affects approximately one in seven individuals, constituting a significant public health burden. The disorder is categorised into subtypes—namely migraine with aura, migraine without aura, and chronic migraine—each defined by distinct clinical characteristics and epidemiological profiles. The overall impact of migraine extends beyond the nociceptive dimension, as frequent and disabling attacks interfere substantially with occupational performance, social participation, and daily functioning, thereby contributing to a marked diminution in health-related quality of life and productivity (Ruschel, 2024; Amiri et al., 2022).

Cognitive performance encompasses an individual’s capacity to process, retain, and utilise information, spanning domains such as memory, attention, executive functioning, and reasoning abilities (Silva et al., 2022). These cognitive faculties underpin essential higher-order functions including learning, problem-solving, task organisation, and adaptation to environmental contingencies. Variability in cognitive performance is influenced by a constellation of factors, including genetic predisposition, educational background, age-related changes, physical health status, and lifestyle factors. Deficits in cognitive functioning—whether transient or persistent—can adversely affect academic attainment, occupational efficacy, and interpersonal relationships. Within the context of neurological conditions such as migraine, disruptions to attentional control, memory retrieval, and executive processing may potentiate the functional sequelae of the disorder and contribute to increased psychological morbidity (Silva et al., 2022).

A robust corpus of peer-reviewed literature substantiates that migraine exerts a deleterious effect on cognitive performance, particularly during acute headache phases. Clinical observations of migraineurs frequently report impairments in domains of memory, sustained attention, and cognitive processing speed, with empirical neuropsychological investigations corroborating these subjective complaints through objective demonstration of deficits (Yang et al., 2017; Ribas et al., 2008). Specifically, migraineurs with higher attack frequency and prolonged headache duration often perform significantly worse than matched controls on assessments of episodic memory, visuospatial skills, and executive function. These cognitive impairments are observed to fluctuate temporally, manifesting during the prodromal phase, persisting throughout the headache episode, and occasionally extending into the postdromal period. The pathophysiological substrates implicated include cortical spreading depression, transient cerebral hypoperfusion, neurovascular dysregulation, as well as the influence of pharmacological treatments and comorbid affective disorders such as anxiety and depression, all of which modulate cognitive processing efficacy during interictal and ictal periods (Yang et al., 2017; Ribas et al., 2008).

Notwithstanding measurable cognitive effects, it is imperative to highlight that the extent of cognitive impairment in migraine is variable and does not invariably reach clinical thresholds indicative of dementia or lasting neurocognitive disorder. Many individuals with migraine exhibit restoration of baseline cognitive performance during interictal intervals, underscoring the predominantly episodic nature of these deficits (Ribas et al., 2008). Current evidence suggests that cognitive dysfunction associated with migraine is largely reversible and closely correlated with the temporal dynamics of headache episodes rather than representing a progressive neurodegenerative trajectory. Clinical and demographic modifiers, including migraine subtype, attack frequency, headache duration, presence of psychiatric comorbidities, and medication utilisation patterns, significantly influence the severity and persistence of cognitive impairments. Therapeutic strategies encompassing effective analgesia, migraine prophylaxis, and psychological interventions have demonstrated efficacy in reducing attack frequency and severity, potentially mitigating transient cognitive disturbances and improving overall patient functionality and quality of life.

In conclusion, migraine constitutes a multifaceted neurological disorder with substantive implications for cognitive function extending beyond the primary symptomatology of headache. The disorder’s impact on cognitive domains such as attention, memory, and executive functioning may contribute to the broader functional disability associated with migraine. Recognition and comprehensive assessment of cognitive symptoms in clinical practice are essential components of holistic migraine management, facilitating targeted interventions that address both neurological and cognitive aspects. Ongoing research continues to elucidate the complex biopsychosocial mechanisms underlying migraine-related cognitive dysfunction, thereby informing the development of more precise therapeutic modalities aimed at ameliorating the full spectrum of migraine-associated impairments (Yang et al., 2017; Ribas et al., 2008; Silva et al., 2022).