Frontal lobe dysfunction in patients with chronic migraine: a clinical–neuropsychological study

Abstract

Neuropsychological tests have demonstrated a frontal lobe dysfunction in several psychiatric and neurological disorders. Our purpose was to examine whether similar functional differences would be found in patients with chronic migraine. The Gambling Task (GT), the Tower of Hanoi-3 (TOH-3) and the Object Alternation Test (OAT) were administered to 23 female patients previously treated for chronic migraine and to 23 healthy women who were similar to the patients in age and educational level, and the mean test scores of the two groups were compared (Student's t and Pearson correlation coefficient). The patient group scored significantly higher than the controls on the TOH-3 and, especially, the OAT. In the patients, no significant relationship was found between the neuropsychological test scores and those for the Minnesota Multiple Personality Inventory (MMPI), the Spielberg State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). In conclusion, the data suggest a relation between chronic headache and dorsolateral function (as tested by the TOH-3) and orbitofrontal function (as tested by the OAT). The decision-making function related to ventromedial prefrontal cortex (tested by the GT) did not show a statistically significant difference between patients and controls. These neuropsychological findings seem to be partly independent of the patient's psychological traits and psychiatric disorders.

Introduction

Several studies have been performed to explore the associations among migraine, personality traits and psychiatric disorders (Merikangas et al., 1988, Merikangas et al., 1990, Merikangas et al., 1993, Stewart et al., 1989, Marchesi et al., 1989, Brandt et al., 1990, Breslau et al., 1991, Breslau et al., 1994, Breslau and Davis, 1993, Rasmussen, 1992, Merikangas, 1994, Breslau and Andreski, 1995, Silberstein et al., 1995). In epidemiological studies, a relationship has been observed between migraine and depression (Merikangas et al., 1988, Merikangas et al., 1993, Brandt et al., 1990, Breslau et al., 1991, Breslau and Andreski, 1995, Rasmussen, 1992, Merikangas, 1994). This relationship was confirmed by prospective studies (Merikangas et al., 1990, Breslau et al., 1994). Breslau et al. (1994) performed a longitudinal study on a random sample of 1007 young adults to estimate the relative risk for major depression associated with prior migraine and the relative risk for migraine associated with prior major depression. They concluded that the previously observed cross-sectional association between migraine and major depression might be the result of bi-directional influences, with each disorder increasing the risk for first onset of the other. More recently, Mongini et al. (2003) examined the association between personality traits, depression and migraine in the long term in 56 women with migraine, and concluded that the co-occurrence of personality changes and depression in women with migraine is accompanied by a more negative long-term headache prognosis.

A number of neuropsychological tests have been used to assess frontal lobe function in different patient categories. Frontal lobe dysfunction has been identified in psychiatric and neurological conditions such as schizophrenia (Bustini et al., 1999, Goldberg et al., 1990), obsessive-compulsive disorder (OCD) (Abbruzzese et al., 1995, Veale and Sahakian, 1996, Cavedini et al., 1998), pathological gambling (Cavedini et al., 2002), Alzheimer's disease and Parkinson's disease (Freedman, 1990), and depression (Austin et al., 1992, Dolan et al., 1994, Merriam et al., 1999).

Our purpose was to apply a test battery to patients who suffered from chronic migraine to examine if prefrontal neuropsychological functioning would be affected in this condition.