Cognitive Decline Associated With Depression, Sleep Quality in Migraineurs

female brain anatomy
female brain anatomy
Depression, anxiety, and poor sleep quality are associated with subjective cognitive decline in patients with migraine.

Researchers found that in patients with migraine, subjective cognitive decline (SCD) was common, and that patients with SCD were more depressed, anxious, and had worse sleep quality and duration than migraineurs without SCD. This suggests that in migraineurs with SCD, attention to psychological or sleep problems is needed, rather than follow-up of cognitive decline. These findings were published in The Journal of Headache and Pain.

Evidence of the association between migraine and cognitive impairment is inconsistent; however, many patients with migraine complain of cognitive impairment. Because it is known that in chronic pain the perception of cognitive abilities is driven by comorbid symptoms rather than actual cognitive decline, Sun Hwa Lee, MD, of Hallym University Dongtan Sacred Heart Hospital in South Korea, and colleagues, conducted this study to assess subjective cognitive decline in migraineurs and its association with comorbidities such as depression, anxiety, and poor sleep.

The researchers used the Korean-Mini Mental State Examination (K-MMSE) and the Korean-Montreal Cognitive Assessment (K-MoCA) to assess patients, and enrolled 188 participants in the study (age 38.1±9.9 years) who scored within normal range. Several self-report questionnaires were then administered to the participants to assess anxiety, depression, and sleep quality: the Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the Pittsburgh Sleep Quality Index (PSQI). The participants also had to report their average achieved sleep hours during weekdays and weekends.

Of the 188 patients with migraine, 44.7% (n=84) reported SCD. These participants reported higher levels of headache pain, as well as a higher prevalence of anxiety, depression, and sleep quality.  In the 84 participants with SCD, 56 (66.7%) scored higher than the cutoff on the GAD-7, 59 (70.2%) scored higher than the cutoff on the PHQ-9, and 73 (86.9%) scored higher than the cutoff on the PSQI. Significant differences were found in anxiety, depression, sleep quality, and weekly sleep duration, but no important group difference was found in weekend sleep duration.

After adjusting for confounding variables (sex, headache characteristics, and psychological variables), the researchers found that depression was linked to an increased risk for SCD (odds ratio [OR] 1.31; 95% CI, 1.16-1.49), and weekly sleep duration was linked to decreased risk of SCD (OR 0.66; 95% CI, 0.44-0.97).

“Interestingly, migraineurs with SCD complained of more severe difficulties in subjectively reported measures, such as pain intensity and headache impact, compared [with] migraineurs without SCD, but this association was not persistent on logistic analysis,” the researchers wrote. “This implies [that subjective difficulties or sensitivity to perceived pain] may be related to psychological impairments and/or sleep problem[s] among migraineurs with SCD.”

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The researchers added that biased perceptions of cognitive abilities may relate more to a patient’s emotional state rather than their objective abilities; they may overestimate minor cognitive disruptions and misinterpret or exaggerate cognitive problems.

The researchers also found that in this study, the average amount of sleep migraineurs with SCD achieved during weekdays was less than 6 hours per night. Previous research has found that migraineurs who regularly sleep 6 hours per night have more severe headache patterns and sleep complaints compared with migraineurs who got more sleep.2 “Thus, short sleep duration during weekdays may account for the poor perception of cognitive function and sleep quality observed in the current study,” they wrote.

Study Limitations          

  • This study could be biased in its sampling procedure; individuals with SCD may have been more inclined to agree to cognitive testing
  • Brief screening tests were used in the study, whereas more detailed cognitive tests may have helped reveal subtle cognitive characteristics 

Future studies should include a large enough control group to provide better standards for understanding SCD in patients with migraine.

Disclosures: Soo-Jin Cho was involved as a site investigator of a multicenter trial sponsored by Otsuka Korea, Eli Lilly and Company, Korea BMS, and Eisai Korea, and received lecture honoraria from Yuyu Pharmaceutical Company.


  1. Lee SH, Kang Y, Cho SJ. Subjective cognitive decline in patients with migraine and its relationship with depression, anxiety, and sleep quality. J Headache Pain. 2017:18(1):77.
  2. Kelman L, Rains JC. Headache and sleep: examination of sleep patterns and complaints in a large clinical sample of migraineurs. Headache. 2015;45(7):904-910.