Objective: The present study aimed to evaluate cognitive functioning during ictal and interictal phases of the migraine attack using smart-phone based ambulatory cognitive tests.

Background: Cognitive problems have been increasingly recognized as an important part of the burden of migraine. People with migraine report subjective cognitive problems more often during the ictal phase than during the interictal phase of the migraine attack. However, objective evidence of cognitive impairment during attacks is limited. To address this gap, we used smart-phones and an ecological momentary assessment (EMA) design to repeatedly assess migraine symptoms and cognitive performance as people went about their daily lives.

Methods: In this longitudinal study, 19 adults with migraine completed an EMA protocol. Using a downloadable iPhone app, participants were asked five times daily to complete a headache questionnaire and to take an ultra-brief cognitive battery over 2-4 weeks. The cognitive battery (i.e., Trail Making Test [TMT], Stroop Test, Spatial Memory Test) assessed the domains of working memory, processing speed, and aspects of executive functioning (set-shifting, cognitive inhibition). The ictal phases were defined by the presence of current head pain. The interictal phases were defined by the absence of head pain. Separate mixed-effects models were run for each cognitive outcome to examine cognitive performance during the ictal phase relative to the interictal phase.

Results: Participants were 68% female and 84% White; the median (interquartile range) age was 34.0 (27.0-39.0) years. The majority had a tertiary education with 47% holding an undergraduate degree and 47% a graduate degree. The Stroop Test and the Spatial Memory test revealed cognitive decrements in performance in the ictal phase relative to the interictal phase. Specifically, during the ictal phases, there were fewer Spatial Memory successes/sequences (B = -0.20, 95% confidence interval [CI] -0.38 to -0.01; p = 0.038) and Spatial Memory largest successes/sequences (B = -0.22, 95% CI -0.43 to -0.01; p = 0.038). Additionally, there were fewer Stroop non-congruent items correct (B = -0.37, 95% CI -0.70 to -0.03, p = 0.006; odds ratio 3.03, 95% CI 1.26-7.26, p = 0.013), and greater Stroop non-congruent item errors (B = 0.23, 95% CI 0.02-0.44; p = 0.031). The TMT parts A and B did not significantly differ based on migraine phase.

Conclusion: We found decrements in objective cognitive performance in the domains of working memory and cognitive inhibition in the ictal vs. the interictal phases of migraine using EMA, replicating and extending prior work on cognitive performance. These methods further characterize the cognitive burden of migraine and could be extended to assess cognition in the prodrome and postdrome, as well as assess the cognitive benefits of acute and preventive treatment in randomized trials.

Keywords: cognition; ecological momentary assessment; migraine.

© 2025 American Headache Society.

目标: 本研究旨在利用基于智能手机的门诊认知测试评估偏头痛发作期和间歇期的认知功能。

背景: 认知问题已被越来越多地认为是偏头痛负担的重要组成部分。患有偏头痛的人在偏头痛发作期间报告主观认知问题的频率比间歇期更高。然而，针对发作期间的认知障碍的客观证据有限。为了解决这一不足，我们使用智能手机和生态瞬时评估（EMA）设计，在人们日常生活中反复评估偏头痛症状和认知表现。

方法: 在这项纵向研究中，19名患有偏头痛的成年人完成了EMA协议。参与者每天五次被要求通过下载的应用程序完成头痛问卷并进行超简化的认知测试，持续2-4周。该认知测试包括连线测验（TMT）、斯特鲁普测验、空间记忆测验，评估了工作记忆、处理速度以及执行功能的某些方面（集合转换和认知抑制）。发作期定义为存在当前头痛的情况，间歇期则为无头痛的状态。对于每个认知结果，都分别运行了混合效应模型以研究在发作期的认知表现相对于间歇期的表现。

结果: 参与者中女性占68%，白人占84%；年龄的中位数（四分位距）为34.0（27.0-39.0）岁。多数参与者接受过高等教育，其中47%拥有学士学位，47%拥有研究生学位。斯特鲁普测验和空间记忆测试显示，在发作期相对于间歇期认知表现有所下降。具体而言，在发作期间，空间记忆的成功序列（B = -0.20, 95%置信区间[CI] -0.38至-0.01; p = 0.038）和最大的成功序列（B = -0.22, 95% CI -0.43 至 -0.01; p = 0.038）较少。此外，斯特鲁普不一致项目正确率也较低（B = -0.37, 95% CI -0.70 至 -0.03, p = 0.006；比值比为3.03，95% CI 1.26-7.26, p = 0.013），不一致项目的错误率较高（B = 0.23, 95% CI 0.02 至 0.44; p = 0.031）。TMT的A部分和B部分根据偏头痛阶段没有显著差异。

结论: 我们发现，在基于EMA的偏头痛发作期，相对于间歇期，在工作记忆和认知抑制领域中的客观认知表现有所下降。这些方法进一步表征了偏头痛的认知负担，并可用于评估产前和后期内的认知状态，以及在随机试验中评估急性治疗和预防性治疗的认知益处。

关键词: 认知；生态瞬时评估；偏头痛。

© 2025 American Headache Society.