MIGRAINE AND COGNITIVE FUNCTION: IMPACT ON ATTENTION, MEMORY, EXECUTIVE FUNCTION AND LONG-TERM COGNITIVE OUTCOMES- A STRUCTURED LITERATURE REVIEW
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.6679Keywords:
Migraine, Cognitive Dysfunction, Attention, Memory, Executive Function, Brain FogAbstract
Migraine is a highly prevalent and disabling neurological disorder whose burden extends beyond headache pain and sensory symptoms. Cognitive complaints, frequently described by patients as “brain fog,” difficulties with concentration, slowed thinking, forgetfulness, or impaired decision-making, occur across the migraine cycle and may substantially contribute to disability. This structured literature review synthesizes current evidence on cognitive function in migraine, with particular attention to attention and processing speed, memory, executive function, differences between ictal and interictal states, migraine subtype and chronicity, neurobiological mechanisms, treatment-related effects, and long-term cognitive outcomes. A structured search of PubMed/MEDLINE, Scopus, and Web of Science was designed to identify peer-reviewed studies, systematic reviews, meta-analyses, and relevant clinical guidance published primarily between January 2015 and September 2026, with selected earlier landmark studies included where necessary. The literature consistently supports reversible cognitive impairment during migraine attacks, whereas interictal findings are more heterogeneous. Recent meta-analyses suggest measurable deficits in complex attention, executive function, spatial cognition, and working memory, particularly in clinic-based and higher-burden populations. Chronic migraine, medication overuse, sleep disturbance, mood symptoms, and preventive medications may modify cognitive performance. Emerging neuroimaging and digital-assessment studies further support dynamic network-level changes across the migraine cycle. Long-term dementia risk remains debated despite recent meta-analytic signals. Cognitive symptoms should therefore be recognized as a clinically meaningful dimension of migraine and incorporated into patient-centered assessment and treatment evaluation.
References
Araújo, C. M., Barbosa, I. G., Lemos, S. M. A., Domingues, R. B., & Teixeira, A. L. (2012). Cognitive impairment in migraine: A systematic review. Dementia & Neuropsychologia, 6(2), 74–79. https://doi.org/10.1590/S1980-57642012DN06020002
Ashina, M., Katsarava, Z., Do, T. P., Buse, D. C., Pozo-Rosich, P., Özge, A., Krymchantowski, A. V., Lebedeva, E. R., Ravishankar, K., Yu, S., Sacco, S., Ashina, S., Younis, S., Steiner, T. J., & Lipton, R. B. (2021). Migraine: Epidemiology and systems of care. The Lancet, 397(10283), 1485–1495.
Biagianti, B., Grazzi, L., Gambini, O., Usai, S., Muffatti, R., Scarone, S., & Bussone, G. (2012). Orbitofrontal dysfunction and medication overuse in patients with migraine. Headache, 52(10), 1511–1519. https://doi.org/10.1111/j.1526-4610.2012.02277.x
Braganza, D. L., Fitzpatrick, L. E., Nguyen, M. L., & Crowe, S. F. (2022). Interictal cognitive deficits in migraine sufferers: A meta-analysis. Neuropsychology Review, 32(4), 736–757. https://doi.org/10.1007/s11065-021-09516-1
Buse, D. C., Fanning, K. M., Reed, M. L., Murray, S., Dumas, P. K., Adams, A. M., & Lipton, R. B. (2021). Learning the full impact of migraine through patient voices: A qualitative study. Headache, 61(7), 1004–1020.
Cai, X., Xu, X., Zhang, A., Lin, J., Wang, X., He, W., & Fang, Y. (2019). Cognitive decline in chronic migraine with nonsteroid anti-inflammation drug overuse: A cross-sectional study. Pain Research and Management, 2019, 7307198. https://doi.org/10.1155/2019/7307198
Cankaya, S., Ayyildiz, B., Sayman, D., Duran, U., Ucak, D., Karaca, R., Ayyildiz, S., Ozdemir Oktem, E., Lakadamyalı, H., Sayman, C., Ozsimsek, A., Yalçınkaya, A., Hanoglu, L., Velioglu, H. A., & Yulug, B. (2025). Hippocampal connectivity dynamics and volumetric alterations predict cognitive status in migraine: A resting-state fMRI study. NeuroImage, 305, 120961. https://doi.org/10.1016/j.neuroimage.2024.120961
Chowdhury, D., Datta, D., & Mundra, A. (2024). Interictal dysfunctions of attention, vigilance, and executive functions in migraine and their reversal by preventive treatment: A longitudinal controlled study. Annals of Indian Academy of Neurology, 27(3), 254–263. https://doi.org/10.4103/aian.aian_40_24
Christensen, R. H., Eigenbrodt, A. K., Ashina, H., Steiner, T. J., & Ashina, M. (2023). What proportion of people with migraine report postdromal symptoms? A systematic review and meta-analysis of observational studies. Cephalalgia, 43(10), 3331024231206376. https://doi.org/10.1177/03331024231206376
Eigenbrodt, A. K., Ashina, H., Khan, S., Diener, H.-C., Mitsikostas, D. D., Sinclair, A. J., Pozo-Rosich, P., Martelletti, P., Ducros, A., Lantéri-Minet, M., Braschinsky, M., Sanchez Del Rio, M., Daniel, O., Özge, A., Mammadbayli, A., Arons, M., Skorobogatykh, K., Romanenko, V., Terwindt, G. M., ... Ashina, M. (2021). Diagnosis and management of migraine in ten steps. Nature Reviews Neurology, 17(8), 501–514. https://doi.org/10.1038/s41582-021-00509-5
Fernandes, C., Dapkute, A., Watson, E., Kazaishvili, I., Chądzyński, P., Varanda, S., Di Antonio, S., Munday, V., MaassenVanDenBrink, A., & Lampl, C. (2024). Migraine and cognitive dysfunction: A narrative review. The Journal of Headache and Pain, 25(1), 221. https://doi.org/10.1186/s10194-024-01923-y
GBD 2021 Headache Collaborators. (2025). Global, regional, and national burden of headache disorders, 1990–2021, with forecasts to 2050: A global burden of disease study 2021. Cell Reports Medicine, 6(10), 102348. https://doi.org/10.1016/j.xcrm.2025.102348
Gerstein, M. T., Wirth, R. J., Uzumcu, A. A., Houts, C. R., McGinley, J. S., Buse, D. C., McCarrier, K. P., Cooke, A., Touba, N. M., Nishida, T. K., Goadsby, P. J., Dodick, D. W., & Lipton, R. B. (2023). Patient-reported experiences with migraine-related cognitive symptoms: Results of the micoas qualitative study. Headache, 63(3), 441–454. https://doi.org/10.1111/head.14484
Gil-Gouveia, R., & Martins, I. P. (2018). Clinical description of attack-related cognitive symptoms in migraine: A systematic review. Cephalalgia, 38(7), 1335–1350. https://doi.org/10.1177/0333102417728250
Gil-Gouveia, R., & Martins, I. P. (2019). Cognition and cognitive impairment in migraine. Current Pain and Headache Reports, 23, 84.
Gil-Gouveia, R., Oliveira, A. G., & Martins, I. P. (2015). Cognitive dysfunction during migraine attacks: A study on migraine without aura. Cephalalgia, 35(8), 662–674. https://doi.org/10.1177/0333102414553823
Gil-Gouveia, R., Oliveira, A. G., & Martins, I. P. (2015). Assessment of cognitive dysfunction during migraine attacks: A systematic review. Journal of Neurology, 262, 654–665. https://doi.org/10.1007/s00415-014-7603-5
Gil-Gouveia, R., Oliveira, A. G., & Martins, I. P. (2016). The impact of cognitive symptoms on migraine attack-related disability. Cephalalgia, 36(5), 422–430. https://doi.org/10.1177/0333102415604471
Ho, S., Darby, D., & Bear, N. (2020). Cognitive effects of onabotulinumtoxinA in chronic migraine. BMJ Neurology Open, 2(1), e000014. https://doi.org/10.1136/bmjno-2019-000014
Ishii, R., Sakai, F., Sano, H., Nakai, M., Koga, N., & Matsukawa, M. (2024). Quality of life and work productivity and activity impairment among online survey respondents with migraine across a range of headache frequency. Frontiers in Neurology, 15, 1440733. https://doi.org/10.3389/fneur.2024.1440733
Jiang, W., Liang, G.-H., Li, J.-A., Yu, P., & Dong, M. (2022). Migraine and the risk of dementia: A meta-analysis and systematic review. Aging Clinical and Experimental Research, 34(6), 1237–1246. https://doi.org/10.1007/s40520-021-02065-w
Khorsand, B., Teichrow, D., Jicha, C. J., Minen, M. T., Seng, E., Lipton, R. B., & Ezzati, A. (2026). Digital assessment of objective and patient-reported cognition across migraine phases: Results from the MIND cohort [Preprint]. medRxiv. https://doi.org/10.64898/2026.04.14.26350892
Kizilkilic, E. K., Kılboz, B. B., & Üçler Yaman, S. (2026). Interictal and ictal cognitive performance in episodic and chronic migraine. European Journal of Neurology, 33(4), e70584. https://doi.org/10.1111/ene.70584
Lau, C. I., Chen, W.-H., Wang, H.-C., & Walsh, V. (2023). Decision-making impairment under ambiguity but not under risk may underlie medication overuse in patients with chronic migraine. Headache, 63(6), 822–833. https://doi.org/10.1111/head.14513
Lo Buono, V., Bonanno, L., Corallo, F., Pisani, L. R., Lo Presti, R., Grugno, R., Di Lorenzo, G., & Bramanti, P. (2017). Neuropsychological assessment in migraine patients: A descriptive review on cognitive implications. Neurological Sciences, 38(4), 553–562. https://doi.org/10.1007/s10072-017-2814-z
Martins, I. P., Taveira, M. C., Couto, M., Velasco, S., Rato, R., Costa, A., Martins, B., & Sotero, F. D. (2026). Beyond headache: Cognitive improvement in patients with migraine responding to anti-CGRP monoclonal antibodies or botulinum toxin. Cephalalgia, 46(6), 3331024261458424. https://doi.org/10.1177/03331024261458424
McKay, K., & Kelly, K. (2026). Investigating the impact of migraine on short-term and working memory: A systematic review and meta-analysis. Journal of Neurology, 273(4), 214. https://doi.org/10.1007/s00415-026-13672-w
Migliore, S., D'Aurizio, G., Altamura, C., Brunelli, N., Costa, C., Curcio, G., & Vernieri, F. (2022). Task-switching abilities in episodic and chronic migraine. Neurological Sciences, 43(6), 3803–3810. https://doi.org/10.1007/s10072-021-05837-4
Mula, M. (2014). Topiramate and cognitive impairment: Evidence and clinical implications. Therapeutic Advances in Drug Safety, 5(1), 31–40. https://doi.org/10.1177/2042098613507437
Öztürk, B., Özön, A. Ö., & Karadaş, Ö. (2019). Evaluation of cognitive functions in migraineurs treated with topiramate. Journal of Clinical Neuroscience, 59, 89–92. https://doi.org/10.1016/j.jocn.2018.10.134
Pizer, J. H., Aita, S. L., Myers, M. A., Hawley, N. A., Ikonomou, V. C., Brasil, K. M., Hernandez, K. A., Pettway, E. C., Owen, T., Borgogna, N. C., Smitherman, T. A., & Hill, B. D. (2024). Neuropsychological function in migraine headaches: An expanded comprehensive multidomain meta-analysis. Neurology, 102(4), e208109. https://doi.org/10.1212/WNL.0000000000208109
Puledda, F., Sacco, S., Diener, H.-C., Ashina, M., Al-Khazali, H. M., Ashina, S., Burstein, R., Liebler, E., Cipriani, A., Chu, M. K., Cocores, A., Dodd-Glover, F., Ekizoğlu, E., Garcia-Azorin, D., Göbel, C. H., Goicochea, M. T., Hassan, A., Hirata, K., Hoffmann, J., ... Tassorelli, C. (2024). International headache society global practice recommendations for preventive pharmacological treatment of migraine. Cephalalgia, 44(9), 3331024241269735. https://doi.org/10.1177/03331024241269735
Santangelo, G., Russo, A., Trojano, L., Falco, F., Marcuccio, L., Siciliano, M., Conte, F., Garramone, F., Tedeschi, G., & Tessitore, A. (2019). Cognitive functions and psychological symptoms in migraine: A study on patients with and without aura. International Journal of Neuroscience, 129(6), 588–596. https://doi.org/10.1080/00207454.2018.1554658
Vuralli, D., Ayata, C., & Bolay, H. (2018). Cognitive dysfunction and migraine. The Journal of Headache and Pain, 19(1), 109. https://doi.org/10.1186/s10194-018-0933-4
Zhu, W., Zhan, Y., Pei, J., Fu, Q., Wang, R., Yang, Q., Guan, Q., & Zhu, L. (2025). Migraine is a risk factor for dementia: A systematic review and meta-analysis of cohort studies. The Journal of Headache and Pain, 26(1), 136. https://doi.org/10.1186/s10194-025-02078-0
Zucca, M., Rubino, E., Vacca, A., De Martino, P., Roveta, F., Govone, F., Gai, A., Caglio, M., Gentile, S., Giordana, M. T., & Rainero, I. (2020). Metacognitive impairment in patients with episodic and chronic migraine. Journal of Clinical Neuroscience, 72, 119–123. https://doi.org/10.1016/j.jocn.2019.12.048
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