Gerstein Maya T, Wirth R J, Uzumcu Alyssa A, Houts Carrie R, McGinley James S, Buse Dawn C, McCarrier Kelly P, Cooke Alexis, Touba Nancy M, Nishida Tracy K, Goadsby Peter J, Dodick David W, Lipton Richard B
Patient Centered Outcomes, OPEN Health Group, Bethesda, Maryland, USA.
Vector Psychometric Group, LLC, Chapel Hill, North Carolina, USA.
Headache. 2023 Mar;63(3):441-454. doi: 10.1111/head.14484. Epub 2023 Mar 10.
To capture patients' perspectives on migraine-related cognitive symptoms during pre-headache, headache, post-headache, and interictal periods.
Migraine-related cognitive symptoms are reported by people with migraine both during and between attacks. Associated with disability, they are increasingly viewed as a priority target for treatment. The Migraine Clinical Outcome Assessment System (MiCOAS) project is focused on developing a patient-centered core set of outcome measures for the evaluation of migraine treatments. The project focuses on incorporating the experience of people living with migraine and the outcomes most meaningful to them. This includes an examination of the presence and functional impact of migraine-related cognitive symptoms and their perceived impact on quality of life and disability.
Forty individuals with self-reported medically diagnosed migraine were recruited via iterative purposeful sampling for semi-structured qualitative interviews conducted using audio-only web conferencing. Thematic content analysis was performed to identify key concepts around migraine-related cognitive symptoms. Recruitment continued until concept saturation was achieved.
Participants described symptoms consistent with migraine-related deficits in language/speech, sustained attention, executive function, and memory that manifest during pre-headache (36/40 [90%] reported ≥1 cognitive feature), headache (35/40 [88%] reported ≥1 cognitive feature), post-headache (27/40 [68%] reported ≥1 cognitive feature), and interictal periods (13/40 [33%] reported ≥1 cognitive feature). Among participants reporting cognitive symptoms during pre-headache, 32/40 (81%) endorsed 2-5 cognitive symptoms. Findings were similar during the headache phase. Participants reported language/speech problems consistent with, for example, impairments in receptive language, expressive language, and articulation. Issues with sustained attention included fogginess, confusion/disorientation, and trouble with concentration/focus. Deficits in executive function included difficulty processing information and reduced capacity for planning and decision-making. Memory issues were reported across all phases of the migraine attack.
This patient-level qualitative study suggests that cognitive symptoms are common for persons with migraine, particularly in the pre-headache and headache phases. These findings highlight the importance of assessing and ameliorating these cognitive problems.
了解偏头痛患者在头痛前、头痛期、头痛后及发作间期对偏头痛相关认知症状的看法。
偏头痛患者在发作期间及发作间期均报告有偏头痛相关认知症状。这些症状与残疾相关，越来越被视为治疗的优先目标。偏头痛临床结局评估系统（MiCOAS）项目专注于开发一套以患者为中心的核心结局指标，用于评估偏头痛治疗。该项目致力于纳入偏头痛患者的体验以及对他们最有意义的结局。这包括检查偏头痛相关认知症状的存在及其功能影响，以及它们对生活质量和残疾的感知影响。
通过迭代目的抽样法招募了40名自我报告经医学诊断为偏头痛的个体，采用仅音频的网络会议进行半结构化定性访谈。进行主题内容分析以确定围绕偏头痛相关认知症状的关键概念。招募工作持续进行，直至达到概念饱和。
参与者描述了与偏头痛相关的语言/言语、持续注意力、执行功能和记忆方面的缺陷症状，这些症状在头痛前（36/40 [90%]报告有≥1种认知特征）、头痛期（35/40 [88%]报告有≥1种认知特征）、头痛后（27/40 [68%]报告有≥1种认知特征）和发作间期（13/40 [33%]报告有≥1种认知特征）均有出现。在头痛前报告有认知症状的参与者中，32/40（81%）认可2 - 5种认知症状。头痛期的结果类似。参与者报告了与例如接受性语言、表达性语言和发音障碍一致（相符）的语言/言语问题。持续注意力方面的问题包括头脑不清、困惑/迷失方向以及注意力集中困难。执行功能缺陷包括信息处理困难以及计划和决策能力下降。在偏头痛发作的各个阶段均报告有记忆问题。
这项患者层面的定性研究表明，认知症状在偏头痛患者中很常见，尤其是在头痛前和头痛期。这些发现凸显了评估和改善这些认知问题的重要性。
