Maybe you felt the migraine brain fog rolling in when you poured yourself a cup of hot coffee and promptly put it in the refrigerator. Or maybe it was when you walked into a room to get something, but couldn’t remember what. These, and a million other tales of confusion, are reminders that migraine not only creates head pain, but can also affect how the brain works — or doesn’t.
Where Is My Mind?
Cognitive impairment — what we call brain fog — is a real, temporary symptom of migraine. Scientists aren’t sure precisely why it happens, but here’s what we know.
Brain fog looks like: Feeling distracted and forgetful, difficulty concentrating and retrieving words, short term memory loss, decreased alertness, loss of sense of direction, inability to complete simple tasks.
Migraine affects how the brain processes input. Migraine is a neurological condition that affects the way the brain processes information. The impact of migraine is felt not only along the brain’s pain pathways, but on cognitive function, too. It affects information processing speed, attention, executive function (decision making, reasoning, problem solving), memory, and verbal skills. Brain fog can be so difficult that some people with migraine consider it more disabling at work than even head pain.
Brain fog can happen at any phase of a migraine attack. You may feel the fog before, during, or after the headache phase. It more commonly descends post-attack and can last for hours or days. Those with chronic migraine may experience some degree of brain fog all the time.
Some medications contribute to brain fog. Unfortunately, certain meds used for migraine prevention can have cognitive side effects. Topiramate (Topamax) makes many people feel dopey. Tricyclic antidepressants (amitriptyline, nortriptyline) and neuroleptics (promethazine, metoclopramide, prochlorperazine) can be sedating, producing a spaced-out sense of the world.
Should I Worry About My Migraine Brain Fog?
“Do I have the beginning of dementia?” we might ask ourselves, as we stare at our medicine cabinet and wonder whether if we were about to take our medications, or if we just did. You’re not alone in your worry that brain fog could be the sign of something more serious. But long-term studies have not shown that people with migraine experience cognitive decline over time, as you’d see in dementia. Migraine is a far more common condition to have than dementia, particularly in people younger than 60.
Just in case, though, most neurologists will administer some cognitive tests as part of their initial neurologic exam. Let your doctor know if:
- Your diminished ability to concentrate persists outside of an attack
- Your cognitive symptoms are worsening significantly, even though your headaches haven’t changed
Either could be warning signs of other conditions and may warrant follow-up testing.
Aura Symptom Alert: Rarely, migraine aura can present as an extreme condition known as transient global amnesia (TGA), a sudden, temporary memory loss. The person — usually age 50 or older — knows who they are, and can perform tasks, but is unable to form new memories or recall recent events. It usually improves over a few hours. Doctors theorize this phenomenon is caused when changes in the pre-headache brain touch upon the hippocampus, which is critical for memory creation.
How To Manage Brain Fog
One way to manage the brain fog of a migraine attack is to effectively manage the attack itself. Remember that the best way to treat a migraine attack is with the right medication for you, at the right dosage, taken as quickly as possible.
Post-attack, your brain fog should gradually improve along with your other migraine symptoms. So if your fog doesn’t lift between attacks, it’s time to consider increasing or altering your preventive strategies. Talk to your doctor about the medications or lifestyle strategies that might work best for you.
Until your head clears, here are some useful strategies for lingering brain fog:
- Take notes. Writing things down is a good technique to aid memory and keep you on task. If you’re on an important call or in a meeting, take notes you can refer to later. Make lists of reminders — emails to send, projects to do, appointments to make — then cross things off.
- Invite help. It may feel awkward to tell someone you have brain fog from migraine, but it’s better than acting loopy with no explanation. People will be more compassionate if they know you blanked on their name because of migraine.
- Plan ahead. It takes those of us with brain fog longer to do the same work as those without. Don’t wait until the last minute to complete projects.
Brain fog can have a significant effect on your day-to-day life when you have migraine. Improved migraine control helps, so doublecheck that your current strategies are working for you. In the meantime, take a step forward by putting in place smart, adaptive strategies, so you can get the most out of every day.