Abstract
Background:
Headache presents as a common symptom turned disorder ranging from harmless to life threatening. The inconsistent conclusions across various studies or methodological lacunae have resulted in absence of a unified neuropsychological profile. Thus, the efficacy of establishing a holistic picture of deficits and their rehabilitation in Indian context creates a need for comprehensive investigative tools.
Aim:
To explore the impact of headache, on the neuropsychological functioning of individuals using AIIMS Comprehensive Neuropsychological Battery.
Materials and Methods:
This was a cross-sectional and comparative hospital-based study. The sample compared 20 patients with diagnosis of any kind of headache, according to International Classification of Headache Disorders-3 (ICHD-3) criteria with 20 matched healthy controls selected via purposive sampling. Both the groups were subjected to AIIMS Comprehensive Neuropsychological Battery and NEO-Five Factor Inventory-3, and a comprehensive neuropsychological profile was obtained. The profile obtained was further subjected to analysis using the independent samples t-test and product moment correlation using Statistical Package for Social Sciences software (Version 27.0).
Results:
The findings indicate no significant impairment in any of the groups for neuropsychological correlates due to all scores being within normal ranges. Higher scores on neuroticism were found in patients with headache, with a higher incidence in females of the clinical group.
Conclusion:
The present study underscores neuropsychological deficits as perceived component among the headache population as conducted using a complete battery standardized in the Indian context. A longitudinal approach with greater sample size and randomized sampling might promise better results and generalizability.
Keywords: Cognitive functions, neuropsychological assessment, perceived deficits, personality, psychological disorders
Headache with high lifetime prevalence among individuals presents an impaired impression worldwide. Several forms of headache resulting from neurophysiological or psychological abnormalities have a lifetime prevalence of around 96% and higher in females. Global prevalence for tension-type headache is approximately 40%, followed by migraine at 10% and chronic daily headaches at 3 to 5%.[1] The cyclical causality might further lead to disturbances in neuropsychological functioning which can be quantified using standard tools. Different cognitive and behavioral responses have been impeded by headache, and the literature presents ambiguous findings. Some present actual cognitive deterioration, while others indicate no significant impairment. Mild transient cognitive impairments might be present during active phase of migraine along with immediate postheadache neurological consequences not specific to any type of headache but occurring with comorbid conditions.[2] Meta-analysis studies found patients with chronic daily headaches to have difficulty and actual impairment in various aspects of memory and concentration along with a negative correlation between pain levels and delayed verbal memory.[3] Acute tension-type headache associated with a negative affect might result in poor performance in working and semantic memory tasks, slower psychomotor performances, and increased distraction from irrelevant stimuli.[4]
The personality profiles have indicated higher scores on neuroticism[5] among individuals suffering from headache with significantly higher scores among women, with being more prone to anger, rigidity, depression, and anxiety states. On exploring the relation between chronic tension-type headache and various personality traits, the findings indicated higher scores on neuroticism domain with a significantly raised level of psychological distress and anxiety than general sample.[6]
Inconsistent conclusions across studies might be attributed to lack of key concepts while speculating sensitivity, but not the specificity of the impairment in individuals diagnosed with headache. The literature seems to be limited on identifying and attributing the neuropsychological findings to the cognitive deficits in individuals with tension-type headache. It has been of great importance to know that despite the remission from the physiological component of pain, the neurocognitive deficits persist and seem to hamper the general task performance rather than just specific attentional processes, irrespective of their task complexities in patients with headache.[7] The current study attempts to conceptualize these neuropsychological deficits to form a better idea. In addition, researches have been done on the headache population before using separate tools; however, no study has been conducted using a standardized battery on Indian population. The findings from this study can help develop a holistic multifaceted idea regarding the different neuropsychological functioning and personality styles of the individuals experiencing headache.
The significance of the present study underscores an intriguing paradox, whereby despite the lack of measurable neuropsychological impairments, patients with headache have often reported perceived cognitive deficits, even during periods when they were not experiencing headaches. This suggests that the experience of cognitive impairment might be more psychological or emotional in orientation than purely neurocognitive. The subjective feelings of cognitive deficit stemming from consistent emotional and psychological toll building up while living with chronic pain, accompanied with the emotional burden of anticipating future headaches and their constant management can contribute to a heightened awareness of minor cognitive lapses. This heightened awareness might result into cognitive biases where patients attribute normal forgetfulness or occasional difficulties in concentration to their exacerbating condition reinforcing the belief that their cognitive function is deteriorating due to headaches, thereby creating a feedback loop even in the absence of objective evidence for such deterioration.
The aim of the current study was to explore the impact of headache, on the neuropsychological functioning of individuals using AIIMS Comprehensive Neuropsychological Battery.
MATERIAL AND METHODS
This was conducted as a cross-sectional hospital-based study comparing two groups of participants: a clinical group with diagnosis of any kind of headache according to International Classification of Headache Disorders (ICHD-3)[8] criteria (n = 20) and a control group of matched healthy controls (n = 20). The study was conducted at the Headache Clinic, Out Patient Department and Psychosocial Unit over a period of 2 years, where patients presented with complaints of cognitive dysfunction occurring frequently in their daily activities. Most commonly stated were problems with attention, memory, intellectual processing, and speed. The recruitment was based on availability of patients for over a period of 1 year along with the healthy controls. Based on age, sex, educational qualification, and handedness; using Sociodemographic Datasheet and Sidedness Bias Schedule,[9] the sample was selected via purposive sampling and matched for both groups to avoid any confounding factors. The participants of both the groups were selected within the age range of 18–50 years inclusive of males and females with a minimum educational qualification of 6th pass and an understanding of both English and Hindi. All the participants of the clinical group were receiving standard pharmacological treatment only. Permission from the Institute Ethics Committee (Ref. No. IEC/CIP/2018-19/420), Date of Approval - 9th June 2020) was sought along with written informed consent from the participants was obtained and the procedures were followed in accordance to ethical standards of the Committee and Helsinki Declaration of 1975, revised in 2000. The participants were subjected to tools of Raven’s Standard Progressive Matrices,[10] Headache Impact Test-6,[11] Migraine Disability Assessment Scale,[12] Hamilton Depression Rating Scale,[13] and Hamilton Anxiety Rating Scale.[14] General Health Questionnaire-12 as an addition to all the others was administered to the control group only, and a cutoff score of 15 was used for the present study.[15] The participants who were right handed without any comorbid illness had an average and above level of intellectual functioning, mild levels of depression and anxiety, with mild and above level of severity of headache, and high disability due to headache were selected as the clinical group. The control group included individuals who scored average and above in intellectual functioning, and low in the screening tools for headache, along with absence or low levels of any anxiety and depression symptoms or other comorbid illness. Both the groups were subjected to AIIMS Comprehensive Neuropsychological Battery[16] and NEO-Five Factor Inventory-3[17] (NEOFFI-3), and a comprehensive neuropsychological profile was obtained.
The profiles were used for statistical analysis after verifying the normality criterion (significance level 0.05) using Statistical Package for Social Sciences (SPSS), version 27. The categorical demographic variables were analyzed using descriptive statistics of chi square test and Fisher’s exact test. The continuous variables were analyzed using the independent samples t-test. Pearson product moment coefficient of correlation was used to measure the relation between the neuropsychological correlates, with significance level kept at 0.05.
RESULTS
The normality analysis of the demographic variables was conducted initially. The Shapiro–Wilk scores indicated that both age and educational level satisfy the normality criterion for both the clinical and control groups. According to the normality analysis, the variables were put to analysis again using parametric statistical measures.
The sample was presented in a distribution where 5% of patients were diagnosed with migraine with aura, 15% were diagnosed with migraine without aura, 12.5% were diagnosed with episodic tension type headache, and 17.5% were presented with a diagnosis of chronic tension-type headache. The mean duration of headache was 5 months, with a mean age of 30 years for the clinical group. The mean educational qualification was 11–13 years. On analyzing the demographic variables, Table 1 presented the categorical variables and indicated that significant difference was only found between the two groups with respect to religion and residence.
Table 1:
Group comparison between patients with Headache and Healthy Control Group in terms of discrete sociodemographic variables
| Variables | Sub- categories |
Headache (n=20) |
Healthy Control (n=20) |
χ2/Fisher’s Exact | df | P | ||
|---|---|---|---|---|---|---|---|---|
| Frequency (f) | Percentages (%) | Frequency (f) | Percentages (%) | |||||
| Marital Status | Single | 7 | 35 | 8 | 40 | 0.11 | 1 | 1.000 |
| Married | 13 | 65 | 12 | 60 | ||||
| Occupation | Home Maker | 7 | 35 | 8 | 40 | |||
| Private Job | 4 | 20 | 4 | 20 | 0.01f | - | 0.920 | |
| Govt. Job | 2 | 10 | 2 | 10 | ||||
| Business | 4 | 20 | 1 | 5 | ||||
| Student | 3 | 15 | 5 | 25 | ||||
| Religion | Hindu | 10 | 50 | 19 | 95 | |||
| Muslim | 6 | 20 | 1 | 5 | 9.48f | - | 0.002* | |
| Christian | 4 | 30 | 0 | 0 | ||||
| Socio-economic Status | Low | 9 | 45 | 4 | 20 | |||
| Middle | 8 | 40 | 13 | 65 | 1.37f | 2 | 0.242 | |
| High | 3 | 15 | 3 | 15 | ||||
| Residence | Rural | 6 | 30 | 1 | 5 | 4.22f | - | 0.040* |
| Urban | 14 | 70 | 19 | 95 | ||||
*Significant at 0.05 level (2 tailed); df - degrees of freedom
When testing the first hypothesis, Table 2 indicated differences between the two groups where the domains had higher mean values in the clinical group as compared to the control group. However, the mean scores of all the functions were within normal range, as tested by the battery. The personality subscales in Table 3 indicated the presence of significant differences between clinical and control groups and Table 4 indicated differences between the study groups with respect to gender.
Table 2:
t-test comparison of different function scales of AIIMS Comprehensive Neuropsychological Battery in group of individuals with Headache and Healthy Control Group
| Function Scales | Mean±SD |
t (df=38) | P | |
|---|---|---|---|---|
| Headache (n=20) | Healthy Control (n=20) | |||
| Motor Scale | 40.900±3.059 | 38.000±1.338 | 3.88 | 0.001* |
| Tactile Scale | 50.250±6.248 | 46.550±3.220 | 2.35 | 0.024* |
| Visual Scale | 48.450±7.037 | 45.150±5.008 | 1.71 | 0.096 |
| Expressive Speech Scale | 45.150±2.739 | 44.100±0.447 | 1.69 | 0.099 |
| Reading Scale | 48.500±1.539 | 48.000±0.000 | 1.45 | 0.154 |
| Writing Scale | 42.250±2.221 | 41.150±0.671 | 2.12 | 0.041* |
| Arithmetic Scale | 43.700±2.716 | 45.000±2.991 | -1.44 | 0.158 |
| Memory Scale | 43.800±4.697 | 37.200±2.949 | 5.32 | 0.001* |
| Intellectual Processes Scale | 36.350±1.387 | 35.400±0.503 | 2.88 | 0.007* |
| Left Hemisphere Scale | 39.400±3.050 | 36.150±1.040 | 4.51 | 0.001* |
| Right Hemisphere Scale | 50.350±4.626 | 42.800±3.189 | 6.01 | 0.001* |
| Pathognomic Scale | 43.000±1.777 | 42.450±1.234 | 1.14 | 0.263 |
| Total Scale | 41.600±2.722 | 38.350±1.663 | 4.56 | 0.001* |
*Significant at 0.05 level (2 tailed); SD=Standard Deviation; df=degrees of freedom
Table 3:
t-test comparison of different sub-scales of NEOFFI-3 Scale in group of individuals with Headache and Healthy Controls
| Sub-Scales | Mean±SD |
t (df=38) | P | |
|---|---|---|---|---|
| Headache (n=20) | Healthy Control (n=20) | |||
| Neuroticism | 60.450±1.157 | 39.800±1.162 | 12.591 | <0.001* |
| Extraversion | 46.950±1.668 | 50.000±3.182 | -0.849 | 0.401 |
| Openness | 44.400±1.309 | 42.400±1.864 | 0.899 | 0.374 |
| Agreeableness | 41.000±1.809 | 43.500±1.862 | -0.963 | 0.342 |
| Conscientiousness | 46.450±1.362 | 55.300±1.573 | -4.253 | <0.001* |
*Significant at 0.05 level (2 tailed); SD=Standard Deviation; df=degrees of freedom; NEOFFI-3=NEO Five Factor Inventory-3
Table 4:
t-test comparison of different sub-scales of NEOFFI-3 Scale with respect to gender in group of individuals with Headache and Healthy Controls
| Sub-Scales | Headache (n=20) (Mean±SD) |
t (df=18) | P | |
|---|---|---|---|---|
| Male | Female | |||
| Neuroticism | 58.710±3.592 | 61.380±5.767 | -1.107 | 0.283 |
| Extraversion | 48.430±4.353 | 46.150±8.754 | 0.640 | 0.530 |
| Openness | 44.710±6.969 | 44.230±5.464 | 0.172 | 0.866 |
| Agreeableness | 42.710±4.309 | 40.080±9.578 | 0.685 | 0.502 |
| Conscientiousness | 46.860±7.559 | 46.230±5.480 | 0.214 | 0.833 |
|
| ||||
| Sub-Scales |
Healthy Controls (n=20) (Mean±SD)
|
t (df=18) | P | |
| Male | Female | |||
|
| ||||
| Neuroticism | 44.000 ± 4.000 | 37.540 ± 4.352 | 3.253 | 0.004* |
| Extraversion | 52.860±11.711 | 48.460±15.645 | 0.649 | 0.525 |
| Openness | 43.570±11.385 | 41.770±6.044 | 0.468 | 0.646 |
| Agreeableness | 48.570±7.976 | 40.770±7.407 | 2.189 | 0.042* |
| Conscientiousness | 56.570±5.593 | 54.620±7.827 | 0.583 | 0.567 |
*Significant at 0.05 level (2 tailed); SD=Standard Deviation; df=degrees of freedom; NEOFFI-3=NEO Five Factor Inventory-3
Although testing the second and third hypotheses, the findings from Tables 5 and 6 indicated that some level of significant correlations existed among all scales except arithmetic scale for the clinical and control groups, respectively.
Table 5:
Pearson’s Correlation of different function scales of AIIMS Comprehensive Neuropsychological Battery in clinical group of patients with Headache
| Scale† | MoS | TaS | VS | ES | RS | WS | AS | MeS | IPS | LHS | RHS | PS |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TaS | 0.511* | |||||||||||
| α | 0.021 | |||||||||||
| VS | 0.137 | 0.361 | ||||||||||
| α | 0.566 | 0.118 | ||||||||||
| ES | 0.517* | 0.339 | 0.373 | |||||||||
| α | 0.020 | 0.144 | 0.105 | |||||||||
| RS | 0.458* | 0.424 | 0.318 | 0.918* | ||||||||
| α | 0.042 | 0.062 | 0.171 | 0.001 | ||||||||
| WS | 0.290 | 0.143 | 0.551* | 0.755* | 0.654* | |||||||
| α | 0.214 | 0.547 | 0.012 | 0.001 | 0.002 | |||||||
| AS | -0.238 | -0.191 | 0.142 | 0.183 | 0.101 | 0.327 | ||||||
| α | 0.312 | 0.421 | 0.549 | 0.439 | 0.673 | 0.159 | ||||||
| MeS | 0.226 | 0.387 | 0.539* | 0.518* | 0.561* | 0.555* | -0.112 | |||||
| α | 0.339 | 0.092 | 0.014 | 0.019 | 0.010 | 0.011 | 0.638 | |||||
| IPS | 0.269 | 0.293 | 0.328 | 0.346 | 0.284 | 0.363 | 0.099 | 0.262 | ||||
| α | 0.251 | 0.210 | 0.158 | 0.136 | 0.226 | 0.116 | 0.677 | 0.265 | ||||
| LHS | 0.563* | 0.735* | 0.337 | 0.578* | 0.628* | 0.318 | -0.042 | 0.432 | 0.214 | |||
| α | 0.010 | 0.001 | 0.146 | 0.008 | 0.003 | 0.171 | 0.861 | 0.057 | 0.365 | |||
| RHS | 0.624* | 0.547* | 0.449* | 0.548* | 0.455* | 0.365 | -0.230 | 0.735* | 0.308 | 0.467* | ||
| α | 0.003 | 0.013 | 0.047 | 0.012 | 0.044 | 0.114 | 0.329 | 0.001 | 0.186 | 0.038 | ||
| PS | 0.368 | 0.678* | 0.282 | 0.184 | 0.192 | -0.013 | -0.371 | 0.353 | 0.363 | 0.311 | 0.570* | |
| α | 0.110 | 0.001 | 0.228 | 0.438 | 0.416 | 0.956 | 0.108 | 0.127 | 0.116 | 0.182 | 0.009 | |
| ToS | 0.640* | 0.709* | 0.658* | 0.743* | 0.678* | 0.618* | 0.054 | 0.730* | 0.485* | 0.736* | 0.831* | 0.522* |
| α | 0.002 | 0.001 | 0.002 | 0.001 | 0.001 | 0.004 | 0.821 | 0.001 | 0.030 | 0.001 | 0.001 | 0.018 |
*Significant at 0.05 level (2 tailed). MoS=Motor Scale; TaS=Tactile Scale; VS=Visual Scale;ES=Expressive Speech Scale; RS=Reading Scale; WS=Writing Scale; AS=Arithmetic Scale; MeS=Memory Scale; IPS=Intellectual Processes Scale; LHS=Left Hemisphere Scale; RHS=Right Hemisphere Scale; PS=Pathognomic Scale; ToS=Total Scale
Table 6:
Pearson’s Correlation of different function scales of AIIMS Comprehensive Neuropsychological Battery in Healthy Controls
| Scales† | MoS | TaS | VS | ES | WS | AS | MeS | IPS | LHS | RHS | PS |
|---|---|---|---|---|---|---|---|---|---|---|---|
| TaS | -0.037 | ||||||||||
| α | 0.878 | ||||||||||
| VS | 0.393 | 0.350 | |||||||||
| α | 0.087 | 0.130 | |||||||||
| ES | -0.176 | -0.040 | 0.040 | ||||||||
| α | 0.458 | 0.866 | 0.867 | ||||||||
| WS | 0.176 | -0.040 | 0.040 | -0.053 | |||||||
| α | 0.458 | 0.866 | 0.867 | 0.826 | |||||||
| AS | 0.066 | 0.230 | -0.102 | 0.157 | -0.236 | ||||||
| α | 0.783 | 0.330 | 0.669 | 0.508 | 0.316 | ||||||
| MeS | 0.080 | 0.304 | 0.319 | -0.016 | 0.064 | -0.131 | |||||
| α | 0.737 | 0.193 | 0.171 | 0.947 | 0.789 | 0.581 | |||||
| IPS | 0.078 | -0.078 | 0.163 | -0.187 | -0.187 | 0.035 | 0.227 | ||||
| α | 0.743 | 0.744 | 0.492 | 0.429 | 0.429 | 0.884 | 0.335 | ||||
| LHS | -0.151 | 0.744* | 0.218 | -0.034 | 0.419 | -0.068 | 0.161 | -0.222 | |||
| α | 0.524 | 0.001 | 0.356 | 0.887 | 0.066 | 0.777 | 0.497 | 0.348 | |||
| RHS | 0.234 | 0.550* | 0.361 | -0.059 | -0.059 | -0.044 | 0.878* | 0.151 | 0.295 | ||
| α | 0.320 | 0.012 | 0.118 | 0.805 | 0.805 | 0.853 | 0.001 | 0.525 | 0.206 | ||
| PS | 0.478* | -0.172 | 0.372 | 0.105 | -0.086 | 0.257 | 0.032 | 0.034 | -0.219 | 0.064 | |
| α | 0.033 | 0.470 | 0.107 | 0.660 | 0.719 | 0.275 | 0.894 | 0.887 | 0.353 | 0.788 | |
| ToS | 0.118 | 0.110 | 0.183 | -0.050 | -0.050 | -0.063 | 0.607* | -0.050 | -0.002 | 0.550* | 0.124 |
| α | 0.619 | 0.646 | 0.440 | 0.836 | 0.836 | 0.790 | 0.004 | 0.833 | 0.995 | 0.012 | 0.601 |
*Significant at 0.05 level (2 tailed). MoS=Motor Scale; TaS=Tactile Scale; VS=Visual Scale;ES=Expressive Speech Scale; RS=Reading Scale; WS=Writing Scale; AS=Arithmetic Scale; MeS=Memory Scale; IPS=Intellectual Processes Scale; LHS=Left Hemisphere Scale; RHS=Right Hemisphere Scale; PS=Pathognomic Scale; ToS=Total Scale
DISCUSSION
The assessments and the profiles indicating higher frequency of females in the clinical group can be corroborated to the fact that approximately 18% of females and 6% of males over the age of 11 years might develop primary headaches[18] with a lifetime prevalence of 93% in men and 99% in women.[19] The higher incidence of married population in the clinical group can be contrasted with the finding that unmarried individuals had a higher prevalence of headache than married individuals.[20] The possible reason for this finding might be using purposive sampling and lower mean age of marital status in North India, thereby leading to inclusion of more married individuals. The homemakers had the highest frequency in both the groups which is in consonance with the findings of the study conducted in Iran that primary headaches are mostly seen in housewives, workers, and university students with housewives having the highest prevalence followed by occupations involving complicated intellectual and physical needs.[21] For the present study, the homemakers presenting the highest frequency of headache might be due to their involvement in physical and emotional needs of the family, more so, as compared to their spouse. The religion prevalence indicated higher frequency of Hinduism, which is consistent with the findings that there was higher prevalence of severe headache and pain catastrophizing tendencies among individuals with Hindu religion.[22] The low socioeconomic status domain was found to have the highest frequency and can be corroborated with high rate of frequently occurring migraine and chronic headaches in low socio-economic population.[23] The higher incidence of headache among urban population was in agreement with the findings of higher prevalence of headache in urban over rural was found among migraineurs, patients with tension type headache, and other types of headache.[24]
The mean age of the clinical group being 30 years was in consonance with the fact that all headaches have a peak during ages 22–34 years with migraine being more prevalent across ages 35–44 and tension-type headache ranging highest during 15–24 years.[25] The educational level in the current study was found to be at least 11 years. This was corroborated with the findings of a Brazilian Nationwide study that individuals with higher education had a higher prevalence of migraine, more in subjects with >11 years of education than those with <8 years of education.[26]
According to the present study, most of the patients had a diagnosis of chronic tension-type headache and episodic tension-type headache, followed by migraine without aura and with aura, respectively. This is in consonance with the findings of a global-based population study, where the percentage of population with tension-type headache was 42%, migraine was 11%, and 3% for chronic daily headache.[27]
The findings indicate that the mean values of each scale as well as individual scores of the participants were all in the normal range but with significant difference in most of the scales during group comparison. The scores, however, were all higher in the group of patients with headache except arithmetic scale which is in consonance with the findings that patients with headache performed significantly below the level of healthy controls over a variety of functions including sensorimotor functions, attention and information processing, language, and memory.[28]
The findings for the personality profile indicated that among the other domains of the NEOFFI-3 scale, neuroticism was found to be the highest in the patients with headache. The neuroticism domain was found to be significantly different when compared to the control group with respect to the same. The profile analysis also indicates that the level of conscientiousness was higher in the control group as compared to the clinical group with existing significant difference between the groups. The findings are in consonance with the fact that higher neuroticism scores have been found in patients with chronic and episodic headache groups, higher in migraine followed by tension-type headache.[29] They are also in consonance with the findings that subjects with migraine[30] and tension-type headache[31] scored higher on neuroticism scale when compared to healthy controls. The lower scores on conscientiousness for the headache group is in contrast with the finding that the migraine group scored higher in conscientiousness scale when compared to other headache groups.[32] In relation to this, higher conscientiousness has been associated with a lower risk of concurrent headaches and persistent pain.[33]
The subscales as assessed with respect to gender indicate that the patients with headache had the highest mean scores in the neuroticism subscale and that the females had a higher score than males which is in consonance with the findings that migraineurs with or without aura scored high on neuroticism, with a higher incidence marked for women compared to nonheadache control groups.[34] This might be due to the negative gender expectations, self-perception, and body image in females, due to hormonal changes and societal expectations during adolescence.
No neuropsychological deficits were found in either the study group or the control group in the present study. However, on further scrutiny, the headache group had higher mean scores across different domains of the AIIMS Comprehensive Neuropsychological Battery, which nonetheless were within normal range. In addition, the higher scores did not present as objective neuropsychological deficits, rather were identified by the patients as subjective and perceived components as was presented in their chief complaints.
The implications of the present study indicate the importance of patients’ subjective experiences and perceptions in the management of headache, even if these experiences do not align with objective test results or during nonheadache. This not only ensures better treatment adherence but also provides a holistic approach that includes psychological support, patient education, and personalized care plans to improve their overall well-being and quality of life. Furthermore, the findings present a need for a more nuanced approach to explore the underlying mechanisms behind these perceived cognitive deficits using more sensitive cognitive assessments, neuroimaging techniques, or longitudinal approaches to track changes over time.
Strengths and limitations
The possible strengths included matched demographics between the two groups and the use of AIIMS Comprehensive Neuropsychological Battery which was standardized on Indian population as a comprehensive measure against past literature where individual tests were administered on similar population. Significant limitations however included lack of sample size estimation and wide age range. The study indicates a deviation from the abnormal profiles as found in neuropsychological components with different types of headache and may provide a framework for further assessments with larger and random sampling and establishing targets for better generalizability and clinical interventions.
CONCLUSION
The study highlights the intricate nature of cognitive experiences in headache patients, advocating for an assessment strategy that combines both objective neuropsychological evaluations and subjective self-reports. Such an integrated approach holds the potential to enhance our understanding and improve the management of cognitive symptoms associated with headache disorders. To further elucidate the underlying mechanisms of these perceived cognitive deficits, ongoing research is essential, with a focus on refining and optimizing assessment tools to better capture the full spectrum of cognitive challenges faced by this population.
Data availability
Data will be available from the corresponding author on reasonable request.
Author contributions
AG conceptualized, pinpointed resources, and developed the methodology, investigated, curated data, formally analyzed the data along with visualization and writing of original draft and review of the paper. AS and MB supervised and validated the process.
Ethics statement
This study was approved by the Institute Ethics Committee, Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand-834006.
Conflicts of interest
There are no conflicts of interest.
Patients’ consent
Written informed consent was taken from all organisations participants prior to conducting the research.
Funding Statement
Nil.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data will be available from the corresponding author on reasonable request.