Herbert Matthew S, Merritt Victoria C, Afari Niloofar, Gasperi Marianna
VA San Diego Healthcare System, San Diego, California, USA.
VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.
Headache. 2025 Mar;65(3):430-438. doi: 10.1111/head.14815. Epub 2024 Aug 28.
To examine the spectrum and severity of cognitive symptoms in veterans with migraine, traumatic brain injury (TBI), or both; and to evaluate the extent to which psychiatric conditions contribute to the relationship of migraine and TBI with cognitive symptoms.
Migraine contributes significantly to global disability, with veterans facing additional burdens due to high comorbidity of TBI and psychiatric conditions. Understanding the intersection of these conditions is crucial for improving veterans' health-care outcomes.
This observational study used self-reported data from 338,217 veterans enrolled in the Million Veteran Program (MVP) to assess cognitive symptoms using the Medical Outcomes Study Cognitive Functioning Scale Revised (MOS-Cog-R) and psychiatric conditions in veterans with migraine only, TBI only, both, or neither.
Of the participants, 30,080/338,217 (8.9%) veterans reported migraine, 31,906/338,217 (9.4%) reported TBI, and 7828/338,217 (2.3%) reported both migraine and TBI. Veterans with only migraine or only TBI reported similar levels of cognitive symptoms (M = 74.19, standard deviation [SD] = 25.18; M = 73.87, SD = 24.98, respectively), which were substantially higher than veterans without these conditions (M = 62.52, SD = 27.90). Veterans with both conditions reported the most cognitive symptoms (M = 83.01, SD = 22.13) and psychiatric conditions (depression = 5041/7828 [64.4%], anxiety = 3735/7828 [47.7%], post-traumatic stress disorder = 4243/7828 [54.2%]). The association of migraine and TBI with cognitive symptoms persisted beyond the influence of psychiatric conditions (B = -2.20, standard error = -0.36, p < 0.001).
Veterans with migraine reported cognitive challenges analogous to veterans with TBI, indicating a need for careful attention to cognitive symptoms in veterans with migraine. Further, the associations of migraine and TBI with cognitive symptoms in veterans were not explained by psychiatric conditions. These findings encourage future research to elucidate the association between self-reported and objective cognitive symptoms and to identify factors, including environmental exposure and genetic influences, contributing to cognitive impairment to optimize the assessment and treatment of veterans with migraine.
研究患有偏头痛、创伤性脑损伤（TBI）或两者皆有的退伍军人认知症状的范围和严重程度；并评估精神疾病在偏头痛和TBI与认知症状关系中所起作用的程度。
偏头痛对全球残疾问题有重大影响，由于TBI和精神疾病的高共病率，退伍军人面临额外负担。了解这些疾病之间的交叉关系对于改善退伍军人的医疗保健结果至关重要。
这项观察性研究使用了参加百万退伍军人计划（MVP）的338,217名退伍军人的自我报告数据，通过修订的医学结果研究认知功能量表（MOS-Cog-R）评估认知症状，并评估仅患有偏头痛、仅患有TBI、两者皆有或两者皆无的退伍军人的精神疾病情况。
在参与者中，30,080/338,217（8.9%）的退伍军人报告患有偏头痛，31,906/338,217（9.4%）报告患有TBI，7828/338,217（2.3%）报告同时患有偏头痛和TBI。仅患有偏头痛或仅患有TBI的退伍军人报告的认知症状水平相似（分别为M = 74.19，标准差[SD] = 25.18；M = 73.87，SD = 24.98），这显著高于没有这些疾病的退伍军人（M = 62.52，SD = 27.90）。同时患有这两种疾病的退伍军人报告的认知症状最多（M = 83.01，SD = 22.13），精神疾病情况也最多（抑郁症 = 5041/7828 [64.4%]，焦虑症 = 3735/7828 [47.7%]，创伤后应激障碍 = 4243/7828 [54.2%]）。偏头痛和TBI与认知症状之间的关联在精神疾病的影响之外仍然存在（B = -2.20，标准误 = -0.36，p < 0.001）。
患有偏头痛的退伍军人报告的认知挑战与患有TBI的退伍军人类似，这表明需要密切关注患有偏头痛的退伍军人的认知症状。此外，偏头痛和TBI与退伍军人认知症状之间的关联不能用精神疾病来解释。这些发现鼓励未来的研究阐明自我报告的认知症状与客观认知症状之间的关联，并确定包括环境暴露和基因影响在内的导致认知障碍的因素，以优化对患有偏头痛的退伍军人的评估和治疗。
