TOPLINE:

Patients with episodic or chronic migraine who responded to preventive treatment with anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) or botulinum toxin (BoNT) showed a significantly greater improvement in interictal executive cognitive performance than those who did not respond, regardless of the treatment type.

METHODOLOGY:

• Researchers conducted an observational two-centre cohort study to evaluate whether preventive treatment with anti-CGRP mAbs or BoNT improves interictal cognitive performance in patients with migraine and whether changes in performance differ between treatment responders and non-responders.
• They included 90 patients with migraine (mean age, 42 years; 96.7% women), comprising 58 with chronic migraine and 32 with episodic migraine; 64 patients were treated with anti-CGRP mAbs, and 26 were treated with BoNT. The mean follow-up duration was 4.5 months.
• Participants underwent two comprehensive cognitive evaluations at baseline and after 3-6 months of treatment, covering four domains: episodic memory, language, attention and processing speed, and executive functions.
• Patients were classified as responders on the basis of the predefined criteria, with treatment response defined as a reduction in monthly moderate-to-severe headache days of at least 30% in those with chronic migraine and at least 50% in those with episodic migraine between baseline and the second visit.
• The primary outcome was the effect of treatment response on cognitive performance over time.

TAKEAWAY:

• After a mean follow-up of 4.5 months, 52.2% of patients were classified as responders, with a higher proportion of responders in the mAbs group than in the BoNT group (59.4% vs 34.6%).
• Across both evaluation periods, a significant within-patient improvement was observed in all cognitive domains: executive function (mean difference, -0.29), attention and processing speed (mean difference, -0.23), language (mean difference, -0.21), and episodic memory (mean difference, -0.43; P < .05 for all).
• Responders showed a greater improvement in executive function scores than non-responders (average change, 0.41 vs 0.17).
• Other cognitive measures such as episodic memory, language, and attention and processing speed did not differ significantly between responders and non-responders.

IN PRACTICE:

"[The study] data support the view that migraine-related cognitive dysfunction is not necessarily permanent, but rather a dynamic and potentially reversible component of disease burden that parallels clinical response to preventive therapy," the authors wrote.

SOURCE:

The study was led by Isabel Pavão Martins, Faculty of Medicine, Centro de Estudos Egas Moniz, University of Lisbon, Lisbon, Portugal. It was published online on June 15, 2026, in Cephalalgia.

LIMITATIONS:

The short follow-up period may have prevented patients from achieving full therapeutic benefits. The treatment groups were relatively small in size, especially the BoNT group. Only the episodic memory test included an alternative version to minimise learning effects, whereas the other tests lacked validated alternative versions.

DISCLOSURES:

This study did not receive any specific funding from any sources. Several authors declared receiving honoraria for lecturing, consultancy, or participation in clinical trials; educational support; or travel grants from various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.