Can head pain cause memory or concentration problems?
Often it does. In our center we use a questionnaire to assess memory or neurocognitive functioning.
We have found that many headache patients report cognitive inefficiency, confusion, and problems with thinking clearly. At work patients may compromise by doing easier tasks, while at home they may leave out ingredients in recipes they have made hundreds of times. These tasks involve the brain's ability to perform various intellectual functions, from the elementary to the more complex. Even a simple task, such as picking up a paper clip, involves some foresight and planning, some physical ability or "motor" skills, the integration of visual and motor skills, and memory.
What specific symptoms do MHNI patients report?
Problems with speech production, stuttering, word-finding problems, decreased vocabulary, completion of sentences, and mathematical computation are reported. Organization of any sort, from leading the budget committee to planning a picnic, may be difficult for someone suffering a headache. External distraction—people talking, phones ringing, voices in the hallway—or internal distraction—pain, worries about money—interrupt the thinking sequence, making the headache sufferer more prone to error.
What becomes more frightening and frustrating to the patient is that their ability to retrieve information from memory appears to decline over time, which appears to be a function of both chronic headache disorders and medication side effects.
What are the first steps to address pain-related changes in thinking and judgment?
An evaluation of cognitive functioning is essential with respect to a patient's ability to perform their job, drive, handle machinery and equipment, manage medications safely, and/or interact socially. It is important to let your pain professional know if you have observed difficulties with thinking or if you have observed changes in your abilities over time.
At MHNI a neuropsychologist explores all aspects of cognitive functioning or thinking with the patient. Objective evaluation is warranted if you or a family member are observing errors or changes that interfere with your functioning at home or on the job. As part of your multidisciplinary team, a neuropsychologist will perform a series of tests to understand your cognitive strengths and changes. Your physician will further help to determine if your memory function is impacted by pain, changes in your brain, or your medications.
A treatment plan would then focus on strategies that emphasize your strengths and bolster any weaknesses, work around your pain attacks, and increase your functioning.
Are there any studies that look at the impact of pain on thinking?
Yes. A study to measure cognitive efficiency during migraine compared headache patients at baseline (when they did not have a headache) and then during a migraine. The results showed a significant drop in a patient's ability to perform on neurocognitive tests when they had a migraine. Other studies indicated similar results.
A study underway at MHNI indicates that headache sufferers have problems with thinking when they have a headache, and concentration and problem-solving can actually lead to an increase in headache pain.
Cognitive functioning, including memory and vocabulary, has also been found to be impaired in fibromyalgia patients. Consistent with headache patients, this impairment does not appear to be specifically age-related; both younger and older patients may experience impaired memory functioning.
