Cognitive Dysfunction in Migraine: Underlying Mechanisms and Clinical Implications.

PURPOSE OF REVIEW: Cognitive dysfunction (CD) is a common and disabling, yet under-recognized, symptom of migraine. Difficulty with receptive and expressive language, attention, and memory are reported ictally, while memory-related deficits are common interictally. Furthermore, migraine-related comorbidities can contribute independently to CD. RECENT FINDINGS: Both subjective patient-reported and objective neuropsychological testing cognitive changes occur in migraine. The pathophysiology of CD in migraine involves altered subcortical activity affecting the hypothalamus, hippocampus, and thalamus, as well as changes in brain network connectivity and energy imbalances. Though some studies suggest benefit for acute and preventive migraine treatments in migraine-related CD, limited data exists. CD is an important aspect of migraine-related disability. Development of validated assessment tools and biomarkers for CD in migraine remains a priority to optimize patient-centered care. Management of migraine-related CD requires a multi-dimensional approach addressing both migraine and comorbidities that can contribute to cognitive symptoms.