Characterizing inter- and intra-individual differences in migraine-related cognitive symptoms and impairment across the migraine cycle: An analysis of the MiCOAS qualitative project
James McGinley1, Rikki Mangrum1, Dawn Buse2, Calvin Hall1, Carrie Houts1, Tracy Nishida1, R.J. Wirth1, Richard Lipton3
1Vector Psychometric Group, 2Vector Psychometric Group & Albert Einstein College of Medicine, 3Albert Einstein College of Medicine
Objective:

To investigate individual differences in two cognitive features across phases of the migraine cycle.

Background:

Previous qualitative work from the Migraine Clinical Outcome Assessment System (MiCOAS) project showed that persons with migraine experience a broad array of cognitive-related features. Little is known about how specific cognitive features differ within-person across the phases of the migraine cycle. The current work evaluates individual differences in two specific cognitive areas.

Design/Methods:

Forty individuals with migraine participated in semi-structured interviews that probed typical symptoms by migraine phases (pre-headache, headache, post-headache and interictal). Responses were transcribed and coded using content and thematic analysis methods, and 12 cognition-related concepts emerged. The current work focuses on two cognitive areas not attributed to pain interference (fogginess and memory issues). Descriptive statistics (n, %) and conditional branching pattern analyses with tree diagrams illustrated how the selected cognitive symptoms manifested across migraine phases. 

Results:

The sample was 77.5% female, 67.5% white, average age 44 (50% episodic migraine, 50% chronic migraine) with about two-thirds reporting the symptoms (fogginess: n=25, 62.5%; memory issues: n=27, 67.5%). Participants’ symptom patterns varied across phases, but important trends occurred. Of those reporting fogginess, only one participant reported the symptom solely in the headache phase (4.0%) compared to 16 participants (64%) uniquely in phases outside the headache phase. Of those reporting memory issues, the majority (88.9%) had memory issues for >1 phase outside of the headache phase and few were impacted only within the headache phase (11.1%;).

Conclusions:

Most participants reported memory issues or fogginess during ≥1 migraine phase. Intraindividual patterns of symptoms provided unique insights into symptom timing and may provide insights into possible phenotypes. Results highlight possible drawbacks of concentrating only on the headache phase. Future research should consider other cognition areas and how heterogeneity should be handled in clinical practice and trials. 

10.1212/WNL.0000000000203191