NEUROVASCULAR MECHANISMS AND COGNITIVE OUTCOMES IN CHRONIC MIGRAINE

Abstract

Chronic migraine is a debilitating neurological disorder marked by frequent headache episodes and persistent neurobiological alterations that extend beyond pain perception. Beyond recurrent cephalalgia, chronic migraine is increasingly recognized as a condition associated with changes in cerebral hemodynamics and cognitive function, which substantially impact patients’ quality of life, occupational performance, and social interactions. Investigating these alterations is crucial for elucidating the underlying pathophysiology and optimizing therapeutic approaches. Cerebral hemodynamic disturbances in chronic migraine include impaired regulation of cerebral blood flow, endothelial dysfunction, altered cerebrovascular reactivity, and regional perfusion asymmetry. These changes may result from repeated migraine attacks, cortical spreading depression, and dysregulation of autonomic and vascular control mechanisms. Notably, hemodynamic abnormalities may persist during interictal periods, indicating long-term adaptive or maladaptive vascular changes in the brain. Cognitive deficits in chronic migraine patients typically involve impairments in attention, memory, executive functioning, and processing speed. These deficits are frequently accompanied by emotional disturbances, including anxiety, depressive symptoms, and heightened stress sensitivity, which can further aggravate cognitive decline. The severity of cognitive impairment has been correlated with migraine duration, attack frequency, and medication overuse.