Objective:

Background:

Patients with migraine often experience episodic cognitive difficulties, particularly in attention, processing speed, and working memory, that vary in severity across the course of an attack. Conventional in-clinic assessments cannot capture these day-to-day changes. To address this limitation, we implemented a smartphone-based ecological momentary assessment (EMA) design to measure cognition repeatedly across headache and non-headache days in the real-world setting.

Design/Methods:

We enrolled 129 adults with migraine via social media into the MIND (Migraine Impact on Neurocognitive Dynamics) cohort. For 30 consecutive days, participants recorded daily headache status and completed three brief smartphone tasks: Symbol Search (attention, processing speed), Color Dots (item–location binding in visual working memory), and Color Shapes (feature-binding change detection in visual working memory). We compared each participant’s performance on headache versus non-headache days, adjusting for age, sex, and test-occasion (to account for practice effects).

Results:

Participants had an average age of 38.1 ± 11.5 years, and 84.5% were female. On headache days, response times were slower by 6.2% on Symbol Search (β = 100.7, p < .001) and 4.0% on Color Dots (β = 67.1, p < .001), whereas the 0.8% slowing on Color Shapes was not significant (β = 12.8, p = 0.37). Accuracy rates were comparable between headache and non-headache days across all tasks.

Conclusions: