Cognitive reserve and well-being in migraine patients: a multidimensional approach to migraine assessment in an Italian tertiary headache center

Background: Migraine is a painful neurological condition affecting emotional, cognitive, and daily life functioning. Cognitive reserve (CR) is a protective factor against neurological damage and deterioration, but its proxies have been under-investigated in migraine. The present cross-sectional study aims to investigate the relationship between CR and several self-reported health measures in migraine; and how these health measures differ between CR grades. Methods: Data were collected from an Italian tertiary center between 2022 and 2023. One hundred and eighty eligible outpatients aged from 18 to 75 years were administered a protocol consisting of: the Migraine Disability Assessment; Brief Pain Inventory (BPI); Numeric Rating Scale; Short Form-36; Self-Rating Anxiety Scale; Self-rating Depression Scale (SDS). In addition, years of illness, frequency and intensity of migraine attacks, and Cognitive Reserve Index as a gradable measure of CR, were also collected. Spearman correlation and ANOVAs were performed, setting p significance at <0.05. Results: A negative correlation between perceived pain intensity, attacks, and socio-behavioral proxies of CR emerged. Higher CR was also associated with fewer headache attacks (rs=-0.176; p=0.019). Lower intensity was found to be specifically related to leisure time (rs=-0.084; p=0.049). ANOVAs highlighted differences across graded CR levels in headache-related indices, including psychological and functional status (BPI-interference: F=4.302; p=0.026; SDS: F=3.887; p=0.033; enjoyment of life: F=3.672; p=0.043), also post-hoc confirmed. Conclusions: Overall, our results suggest a link between CR levels and headache-related measures, emphasizing the importance of life-long coping strategies and healthy habits to decrease pain perception. In particular, individuals with low CR reporting higher levels of pain may benefit from integrated assessment and tailored treatment options to experience. Further studies may delve into the CR threshold hypothesis in the context of headache to identify high-risk categories of patients and foster their symptom management.