Migraine Hangover: Cognitive Symptoms Explained

Written by Olivia Orr, RN, BSN

How would you like to feel hungover without the fun? Many people with migraine experience this phenomenon, termed brain fog or cog fog. Brain fog is a combination of symptoms that cause difficulty making decisions, holding attention, understanding language, speaking, remembering, and completing familiar, everyday tasks.

Migraine Brain Fog

The difficulty you have during a migraine is real but often misunderstood by people who are unaffected by migraine. Brain fog begins during the prodrome phase (before the headache) and lasts throughout the postdrome phase (after the headache). Both phases of migraine can last for hours to days, often varying with each migraine attack. Beginning symptoms may be so subtle that they are difficult to recognize. It may seem like increased forgetfulness, saying the wrong words, or feeling extra tired. Cognitive changes during a migraine attack have been researched and proven to be a neurological process.

What's Happening in My Brain?

Neuroimaging studies, such as MRI and PET scans, show that the same brain areas activated with migraine pain are involved during the prodrome, or premonitory, phase of migraine. People in the beginning stage of migraine often report fatigue, cognitive difficulty, and light sensitivity. These areas are activated even in patients who are not experiencing aura symptoms, suggesting that this is part of the migraine process. Another study using computerized cognitive tests reported slower response times, reduced attention span, and poorer memory during migraine days than non-migraine days.

During a migraine episode, the brain experiences cortical spreading depression, a slow wave of electrical activity that affects how the brain functions. The brain becomes hypersensitive to external stimuli, such as light and sound, and depleted of energy for other cognitive processes that regulate memory and critical thinking. Inflammation, neurotransmitter imbalances, and changes in blood flow to the brain reduce attention, thinking, and memory capabilities during a migraine attack.

Why it's Worse for Some People

Subtypes of migraine have differing symptoms; migraine varies person to person and sometimes episode to episode. Factors that increase cognitive symptoms are aura, migraine type, dehydration, skipped meals, stress, sleep disruption, and hormonal changes. The extent of the brain areas affected also differs among individuals.

How to Cope When You Can't Think

Prepare ahead of time so you know how to handle cognitive challenges during a migraine episode. Make a list of helpful ideas and keep it in a visible place so it's easily accessible if you become confused or forgetful. This list could include:

• Make fewer decisions

• Tell a trusted person what you're experiencing

• Dim the lights/ use earplugs to reduce sensory input

• Drink water and use electrolytes

• Supplement with magnesium

• Rest with a cool compress in a dark room

• Cancel plans

• Gentle pacing

When the migraine episode is over, record the length of the episode from prodrome to postdrome, any symptoms that occurred, possible triggers, treatments administered, and activities engaged (such as rest). Review your journal periodically, notice patterns, and adjust your list accordingly so you know what helps you. Long-term lifestyle adjustments, such as stress management techniques, cognitive behavioral therapy, physical exercise, adequate sleep, and a balanced diet, can reduce migraine frequency and improve cognitive function.

When to Talk to a Doctor

Contact your doctor if you experience new or worsening cognitive decline, sudden speech or balance problems, unilateral weakness/vision loss, or symptoms that last longer than several days. Other medical conditions, such as a stroke, can resemble migraine and need to be ruled out. If you're concerned about anything in particular, trust your instincts and contact your physician.

Conclusion

Brain fog can be debilitating at worst and frustrating at best. If you experience cognition problems during a migraine episode, let someone know what's happening, especially if you're not at home. Safety is your priority. And remember, migraine brain fog isn't you being scatterbrained or disorganized; it's a neurological process that will pass.

References

1. SciELO Brazil - Cognitive impairment in chronic migraine: a cross-sectional study in a clinic-based sample Cognitive impairment in chronic migraine: a cross-sectional study in a clinic-based sample

2. Cognitive impairment in a classical rat model of chronic migraine may be due to alterations in hippocampal synaptic plasticity and N-methyl-D-aspartate receptor subunits - PMC

3. Preventive treatment can reverse cognitive impairment in chronic migraine - PMC

4. Cognitive assessment during the phases of a spontaneous migraine: a prospective cohort study - PMC

5. Full article: Migraine and cognitive impairment: the interconnected processes

6. Imaging the Premonitory Phase of Migraine - PMC

Assessed and Endorsed by the MedReport Medical Review Board