Background Chronic migraine is a disabling condition, often associated with comorbidities including cognitive dysfunction, anxiety and depression. It is unclear whether cognitive complaints are associated with the underlying migraine pathophysiological process or related to drugs or comorbidities of depression and anxiety. Objective To evaluate cognitive changes in chronic migraine and assess reversibility of cognitive dysfunction following effective migraine treatment using onabotulinumtoxinA. Methods This was a prospective real-world study of 60 patients with chronic migraine treated with onabotulinumtoxinA. Headache diaries recorded total headache days at baseline and duration of 12 weeks post-treatment. Computerised cognitive tests of reaction time and working memory (WM) speed and accuracy using a purpose-specific website was implemented at baseline, 6 weeks and 12 weeks. The Patient Health Questionnaire (PHQ-9) and Penn State Worry Questionnaire-Past Week (PSWQ-PW) were administered for depression and anxiety levels. Associations between clinical response, cognitive parameters, PHQ-9 and PSWQ-PW were analysed. Results At 6 weeks post-treatment, 88% patients achieved good response ( ≥ 50% reduction in headache frequency) with improvement of PHQ-9, PSWQ-PW, cognitive speed tests and WM accuracy compared with baseline (all p<0.05). There was no overall correlation between good headache response and improved cognitive measures and no association between good headache response and improved PHQ-9 and PSWQ-PW scores. Improved WM accuracy correlated with reduced PSWQ-PW (p=0.047). There was no correlation between improved WM accuracy and reduced PHQ-9. Conclusions OnabotulinumtoxinA treatment for chronic migraine improved anxiety, depression and cognitive performances but these improvements did not correlate with reduction in headache and migraine frequency. Improved WM accuracy was significantly associated with reduced anxiety level.

中文翻译：

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肉毒杆菌毒素A对慢性偏头痛的认知作用

背景慢性偏头痛是一种致残性疾病，通常与认知功能障碍、焦虑和抑郁等合并症有关。目前尚不清楚认知主诉是否与潜在的偏头痛病理生理过程有关，或者与药物或抑郁和焦虑的合并症有关。目的评估慢性偏头痛的认知变化，并评估使用肉毒杆菌毒素A有效治疗偏头痛后认知功能障碍的可逆性。方法 这是一项针对 60 名接受肉毒杆菌毒素 A 治疗的慢性偏头痛患者的前瞻性真实世界研究。头痛日记记录了基线时的总头痛天数和治疗后 12 周的持续时间。在基线、6 周和 12 周时，使用特定目的网站对反应时间和工作记忆 (WM) 速度和准确性进行计算机化认知测试。患者健康问卷 (PHQ-9) 和宾夕法尼亚州立大学忧虑问卷 - 过去一周 (PSWQ-PW) 用于抑郁和焦虑水平。分析了临床反应、认知参数、PHQ-9 和 PSWQ-PW 之间的关联。结果在治疗后 6 周，88% 的患者获得了良好的反应（头痛频率降低 ≥ 50%），与基线相比，PHQ-9、PSWQ-PW、认知速度测试和 WM 准确性有所改善（所有 p<0.05）。良好的头痛反应与改善的认知测量之间没有总体相关性，良好的头痛反应与改善的 PHQ-9 和 PSWQ-PW 评分之间没有关联。提高的 WM 准确度与降低的 PSWQ-PW 相关 (p=0.047)。提高的 WM 准确性和降低的 PHQ-9 之间没有相关性。结论 OnabotulinumtoxinA 治疗慢性偏头痛改善了焦虑、抑郁和认知表现，但这些改善与头痛和偏头痛频率的减少无关。提高 WM 准确性与降低焦虑水平显着相关。