Cognitive Reserve and Its Associations with Pain, Anxiety, and Depression in Patients with Chronic Migraine: A Retrospective Study

Abstract

Background/Objectives: Cognitive dysfunction is frequently observed in chronic migraine (CM) patients, but the contributing medical and psychological factors remain unclear. This study investigated associations between the cognitive reserve and medical, psychological, and lifestyle factors in individuals with CM. Methods: A retrospective review was conducted at a tertiary referral center in Taiwan. Cognitive function was evaluated via the mini-mental state examination (MMSE), while anxiety and depression were evaluated via the Beck Anxiety and Depression Inventories. Clinical variables included monthly headache days, headache intensity (numerical rating scale), migraine-related disability, and use of preventive medications. Multivariable linear regression analyses were performed to identify independent predictors of the cognitive reserve after adjusting for relevant covariates. Results: Among 50 participants (86.0% women; mean age 42.48 ± 13.47 years), six (12.0%) exhibited objective cognitive impairment (MMSE < cutoff). After a covariate adjustment, higher headache intensity was significantly associated with a lower cognitive reserve in anxiety and depression models. Patients with objective cognitive impairment reported significantly higher levels of pain, anxiety, and depression. Conclusions: The headache intensity, anxiety, and depression were significantly linked to a lower cognitive reserve in CM patients. These findings highlight the importance of incorporating routine psychological and cognitive assessments in CM care and suggest potential targets for integrative treatment strategies.

Keywords: cognitive impairment; headache intensity; mental health; neurocognitive assessment; psychiatric comorbidity; psychological distress; quality of life.

Figure 1

Group differences in headache intensity and psychological symptom severity between patients with chronic migraine with and without objective cognitive impairment. Box plots present (A) headache intensity (measured by the NRS), (B) the BAI scores, and (C) the BDI scores according to cognitive status (yes vs. no). The central line within each box indicates the median value; box boundaries represent the IQR, and whiskers extend to the furthest data points within 1.5 × IQR. Data points exceeding this range are plotted individually as open circles to denote outliers. Outliers are depicted using unfilled circles. Abbreviations: NRS, numerical rating scale; BAI, Beck Anxiety Inventory; BDI, Beck Depression Inventory; IQR, interquartile range.

Figure 2

Scatter plots illustrating the associations between cognitive reserve and (A) headache intensity (measured by the NRS), (B) anxiety severity (the BAI scores), and (C) depressive symptoms (the BDI scores) in patients with chronic migraine. Linear regression lines are included to indicate the direction and strength of each relationship. Cognitive reserve was defined as residual scores derived from MMSE values adjusted for years of education. Abbreviations: NRS, numerical rating scale; BAI, Beck Anxiety Inventory; BDI, Beck Depression Inventory; MMSE, mini-mental status examination.