• unlimited access with print and download
    $ 37 00
  • read full document, no print or download, expires after 72 hours
    $ 4 99
More info
Unlimited access including download and printing, plus availability for reading and annotating in your in your Udini library.
  • Access to this article in your Udini library for 72 hours from purchase.
  • The article will not be available for download or print.
  • Upgrade to the full version of this document at a reduced price.
  • Your trial access payment is credited when purchasing the full version.
Buy
Continue searching

The effects of migraine headache and physical activity on cognitive function

ProQuest Dissertations and Theses, 2009
Dissertation
Author: Marguerite Theresa Moore
Abstract:
Migraine headaches are a common and often debilitating neurological disorder affecting between 18-25% of the female population and 6-13% of the male population. There has been no universal agreement on the long or short-term effects of chronic migraine headaches on neurocognitive function or on the cognitive recovery patterns following a migraine. Research has also been inconclusive on the effects physical activity may have on the intensity and frequency of migraine attacks. The purpose of this study was to investigate the effects of physical activity on neurocognitive function and recovery patterns in collegiate students who incur a migraine headache compared to collegiate students who do not incur a migraine. One hundred twenty-two (122) individuals completed baseline testing with 44 migraineurs incurring a migraine and completing all testing. They were matched to 44 non-migraine controls for sex, education level and age. A pre-test/post-test design was used with the following independent variables: migraine status, physical activity, testing occasion sex, exercise, sleep, and diagnosis status. The dependent variables were the four composite scores of ImPACT (verbal memory composite score, visual memory composite score, reaction time composite score, and motor processing speed), level of pain, and impact of headache scores. Descriptive statistics and several analyses using MANOVAs, ANOVAs and t-tests which were performed with the alpha level set a priori at .05. Repeated measures one-way ANOVA revealed declines in neurocognitive function of migraineurs in verbal memory (ρ=.045), visual memory (ρ=.041), and reaction time (ρ< .001) at 24 hours. When compared to non-migraine controls MANOVA tests revealed a main effect for group x time for visual memory (ρ=.036), motor processing speed (ρ=.044) and reaction time (ρ=.002) composite scores. Post hoc Univariate ANOVAs revealed that migraineurs experienced the largest declines between baseline and 24 hours with verbal memory (ρ=.005), visual memory (ρ=.001) motor processing speed (ρ=.003) and reaction time (ρ=.002) worse than controls. Reaction time (ρ=.028) and motor processing speed (ρ=.022) remained impaired at 48 hours, and motor processing speed (ρ=.009) was significantly impaired at 7 days. Physical activity levels did not significantly affect neurocognitive function in migraine or non-migraine groups (ρ-values range 0.232-0.933). Females reported higher pain levels than males (ρ=.028). Sleep, exercise, and type of medication did not significantly affect neurocognitive function scores in migraineurs. Physical activity levels significantly decreased the HIT (Headache Impact Test) overall scores (ρ=.020) with results approaching significance in both migraineurs (ρ=.080) and non-migraineurs (ρ=.094). Conclusively, migraineurs neurocognitive function is affected in the postdromal phase of migraine, with cognitive decline reversible within a few days of onset. Physical activity had no impact on neurocognitive function scores; however, collegiate students who performed physical activity rated their HIT scores lower than those not physically active. Further research is warranted to determine the degree of cognitive deficits the general population may incur after a migraine, and ways to minimize postdromal effects.

TABLE OF CONTENTS LIST OF TABLES xi LIST OF FIGURES xiii CHAPTER 1 1 Introduction 1 Overview of the Problem 1 Significance of the Problem 7 Statement of the Problem 9 Need for Study 9 Hypotheses and Research Questions 10 Primary Hypotheses 10 Effects of Testing Occasion on Neurocognitive Function 10 Effects of Migraine Status on Neurocognitive Function 11 Effects of Physical Activity by Testing Occasion on Neurocognitive Function 11 Exploratory Hypotheses 12 Exploratory Research Questions 13 Assumptions, Limitations and Delimitations 13 Assumptions of the Study 13 Limitations of the Study 14 Delimitations of the Study 14 Operational Definitions 15 Definitions 17 CHAPTER 2 21 Literature Review 21 Migraine Symptoms and Management 21 Migraine without Aura 22 Migraine with Aura 23 Associated Syndromes for Migraine Headache 25 Migraine Prodromal Phase 27 Migraine Postdromal Phase 28 Migraine Treatment 29 Vl l

Pathology of Migraine 31 Differential Diagnosis for Migraine Headache 34 Headache Attributed to Rhinosinusitis 34 Cluster Headache 35 Tension-Type Headache 36 Headaches Associated with Substances or their Withdrawal 37 Medication-Overuse Headache 37 Epidemiology of Migraine 40 Prevalence and Demographics of Migraine Headaches 41 Prevalence and Incidence of the Diagnosis of Migraine 42 Burden of Migraine 44 Neurocognitive Function of Migraine Patients 46 Migraine is not Associated with Long- Term Cognitive Decline 47 Reversible Cognitive Decline 49 Migraine is Associated with Long-Term Cognitive Decline 50 Physical Activity and Migraine 52 Migraine and Exercise Physiology 53 Physical Activity Defined 54 Physical Activity and Neurocognitive Function 55 Instrument Validity 57 Headache Impact Test (HIT) 57 Behavior Risk Factor Surveillance System 58 Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) 58 Summary of the Literature 63 CHAPTER 3 65 Methods 65 Experimental Design 65 Research Participants 66 Sample Size Estimate 68 Instrumentation 69 Headache Impact Test (HIT) 69 Migraine History Questionnaire 69 Physical Activity Questionnaire 70 24 Hours Questionnaire 70 viii

Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) 71 Reliability and Validity of ImPACT 74 Procedures 75 Baseline Evaluation 75 Post-tests Evaluation 76 Data Analysis 77 Hypotheses 1, 2, and 3 77 Exploratory Hypotheses 77 Research Questions 78 Threats to Validity and Study Limitations 79 Threats to Internal Validity 79 Threats to External Validity 82 Limitations of the Study 83 CHAPTER 4 84 Results 84 Demographic Data 84 Hypothesis Data 89 Results: Effects of Testing Occasion on Neurocognitive Function among the Migraine Group 89 Results: Effects of Testing Occasion on Neurocognitive Function among the Non- Migraine Group 93 Results: Effects of Migraine Status on Neurocognitive Function 95 Results: Effects of Physical Activity by Testing Occasion on Neurocognitive Function 104 Exploratory Hypotheses 106 Results: Exploratory Research Questions 108 CHAPTER 5 I l l Discussion I l l Discussion of Results I l l Effect of Time on Neurocognitive Function Scores I l l Effect of Migraine Status on Neurocognitive Function Scores 117 Effect of Physical Activity Status on Neurocognitive Function Scores 118 Additional Hypotheses and Research Questions 120 Limitations 124 ix

Conclusions 124 Recommendations for Future Research 126 APPENDIXES A-E 128 HEADACHE IMPACT TEST 130 INFORMED CONSENT 133 MIGRAINE HISTORY QUESTIONAIRRE 136 PHYSICAL ACTIVITY QUESTIONAIRRE 140 24 HOUR QUESTIONAIRRE 143 WORKS CITED 146 x

LIST OF TABLES Table 1: Aura Symptoms 17 Table 2: Primary Headache Classification Criteria 38 Table 3: Secondary Headache Classification Criteria 40 Table 4: Approximate Classification Ranges for Index Scores-University Women 62 Table 5: Approximate Classification Ranges for Index Scores- University Men 63 Table 6: Sample Size Estimates 68 Table 7: Demographic Data of Migraine and Physical Activity Groups 86 Table 8: Hours of Sleep, Total Symptoms, and ImPACT Neurocognitive Composite Scores for Migraine and Physical Activity Groups 87 Table 9: Means and Standard Deviations for ImPACT Composite Scores for Migraine Group 90 Table 10: One-way ANOVAs for Migraine Group x Time for Neurocognitive Composite Scores 91 Table 11: Pairwise Comparisons for Migraine Group Verbal Memory Composite Scores 91 Table 12: Pairwise Comparisons for Migraine Group for Visual Memory Composite Scores 92 Table 13: Pairwise Comparisons for Migraine Group for Reaction Time Composite Scores 92 Table 14: Means and Standard Deviations for ImPACT Composite Scores for the Non- migraine Group 94 Table 15: One-way ANOVAs for Non-migraine Group x Time for Neurocognitive Composite Scores 94 Table 16: Pairwise Comparisons for Non-migraine Group for Motor Processing Speed Composite Scores 95 Table 17: Repeated Measures MANOVAs for Group x Time for Neurocognitive Composite Scores 97 XI

Table 18: Univariate ANOVA for Group Differences at Baseline for Neurocognitive Composite Scores 97 Table 19: Univariate ANOVA for Group Differences at 24 hours for Neurocognitive Composite Scores 98 Table 20: Univariate ANOVA for Group Differences at 48 hours for Neurocognitive Composite Scores 98 Table 21: Univariate ANOVA for Group Differences at 7 days for Neurocognitive Composite Scores 99 Table 22: Repeated Measures ANOVA for Neurocognitive Function Composite Scores for Migraine x PA Status x Time 105 Table 23: Repeated Measures ANOVA for Non-Migraine x PA Status x Time for Neurocognitive Function Scores 105 Table 24: T-test for Pain level at 24 hours x Sex or Diagnosis Status 107 Table 25: Means and Standard Deviations for Migraine Group and PA Status for HIT Scores 108 Table 26: Two-way ANOVA for Migraine Group x PA Status 108 Table 27: Means and Standard Deviations for Migraine Group x Type of Medication. 109 Table 28: Means and Standard Deviations for Neurocognitive Function and Hours of Sleep since Migraine 110 Table 29: ANOVA for Hours of Sleep since Migraine for Neurocognitive Function.... 110 Xl l

LIST OF FIGURES Figure 1. Means for Group x Time for Verbal Memory Composite Scores 100 Figure 2. Means for Group x Time for Visual Memory Composite Scores 101 Figure 3. Means for Group x Time for Motor Processing Speed Scores 102 Figure 4. Means for Group xTime for Reaction Time Composite Scores 103 Xlll

CHAPTER 1 Introduction Overview of the Problem Migraine headaches are a common and often debilitating neurological disorder affecting between 18-25% of the female population and 6-13% of the male population (Lipton, Scher, Kolodner, Liberman, Steiner, & Stewart, 2002; Lipton, Diamond, Reed, Diamond, & Stewart, 2001; Launer, Terwindt, & Ferrari, 1999; Lipton, Stewart, Celentano, & Reed, 1992). There has been no universal agreement on the long or short- term effects of chronic migraine headaches on neurocognitive function or on the cognitive recovery patterns following a migraine. Individuals suffering from migraine headaches report lower visual processing speed (Wray, Mijovic-Prele, & Kosslyn, 1995), verbal ability (Waldie, Hausmann, Milne, & Poulton, 2002), and decreased reaction time (Zeitlin & Oddy, 1984). Researchers suggest migraine headaches may produce structural and functional brain dysfunctions (Elkind & Scher, 2005; Swartz & Kern, 2004; Kruit, et al., 2004). Specifically, MRI studies on migraine subjects suggest asymptomatic subcortical (Swartz & Kern, 2004) and deep white matter changes (Swartz & Kern, 2004; Kruit, et al., 2004), and abnormalities in the cerebellar region of the posterior circulation (Swartz & Kern, 2004). Research has also been inconclusive on the effects physical activity may have on the intensity and frequency of migraine attacks. Physical activity either exacerbates or diminishes a migraine headache (Folkins & Sime, 1981; Rooke, 1968; Lambert & Burnet, 1985). To date, no research (to my knowledge) has examined the effect(s) physical activity and migraines have on neurocognitive function. 1

Migraine headaches affect individuals differently and are associated with a variety of symptoms. Classifications have been developed to differentiate "migraine without aura," often called the common migraine, and, "migraine with aura," often called classic or classical migraine. Aura commonly manifests as visual disturbance, verbal difficulties, and sensory disturbances. Migraine headaches may occur only on one side of the head, with pulsating or throbbing pain. The quantity/quality of pain either stops or limits the individual performance of daily activities (Society I. H., 2005). In addition, patients suffer from nausea or vomiting, photophobia or phonophobia. Aura classically manifests as visual disturbances, sensory disturbances, or as difficulty with speech (Society I. H., 2005). College students are subject to many of the common triggers for migraine headaches in their daily lives. Students studying for tests often skip meals, study through the night, under sleep or oversleep, or suffer from post-crisis letdown when they cram prior to exams. Many female college students use oral contraceptives. Oral contraceptives worsen migraine headaches in some patients, but are also used to moderate migraines in others (Granella, Sances, Pucci, Nappi, Ghiotto, & Nappi, 2000). The general onset age for migraines is during and following the pubertal years, often putting college students early in the disorders course. Migraineurs with a shorter onset history are often unaware of what triggers their migraines and consequently suffer needlessly. Most triggers are inconsistent and are associated with migraine on one occasion but not on another (Robbins, 1993). This makes it more difficult for many patients to begin a preventative program because they cannot determine their personal migraine triggers. 2

Migraine headaches have a prodromal phase and a postdromal phase. The phase of the migraine occurring prior to the main migraine attack is referred to as the prodromal phase. This warning phase can be operative eight to 48 hours prior to an attack. It often manifests as common signs of discomfort, such as dizziness or cervical neck pain, and can go unnoticed by the migraineurs (Waelkens, 1985). Triggers associated with migraine headache include stress, anxiety, fatigue, post-crisis letdown (the stress relief following a crisis), depression, irregular sleep patterns (under or oversleeping), menstruation, ovulation, physical and intellectual effort, environmental factors (exposure to heat or cold), weather changes, missing meals and oral contraceptives (Turner, Molgaard, Gardner, Rothrock, & Stang, 1995). Edibles such as cheese, chocolate, and alcohol are also known triggers for migraines (Robbins, 1993; Wacogne, Lacoste, Guillibert, Hugues, & Le Jeunne, 2003; Puri, et al., 2006). A large percentage of migraineurs are unable to identify their triggers, making it idiopathic in nature. Postdrome phase refers to the phase of the migraine after the main migraine attack. The average postdrome phase lasts 25.2 hours. The quality and breadth of postdromal symptoms suggest involvement of the whole brain, specifically the frontal lobe and hypothalamus areas (Blau, 1991). Postdrome symptoms may be used to diagnose migraine in the absence of aura. Blau (1991) reported on the most common symptoms in a group of 40 migraineurs who completed a questionnaire on the day following their most recent attack. These symptoms were physical and mental tiredness, impaired concentration, subdued or depressed mood, and reduced physical activities. Many migraineurs experience low-grade headaches or a feeling of "hangover" during this phase (Kelman, 2005b). The postdrome phase has a significant effect on a college student 3

with migraines. While the severe headache may be gone, lesser, but still debilitating, symptoms continue and are not commonly recognized by teachers, parents and even the student. Anecdotal evidence suggests students feel they do not perform to their potential and report lower grades on tests, quizzes and other modes of testing following a migraine attack. Difficulties arise in determining duration of time from completion of the attack due to the postdromal phase. Therefore, most studies determine time from initiation or start of the migraine. Overall, the postdromal phase has a significant impact on the individual's level of daily activities the day following a migraine headache. Scientific evidence confirms health benefits are seen with moderate-intensity physical activity (U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition and Physical Activity, 1999). The U.S. Department of Health and Human Services defines how physical activity recommendations are met as moderate-intensity for at least 150 min per week, or vigorous-intensity for at least 75 min per week, together with muscle strengthening activities on two or more days of the week. Moderate physical activity is defined as some increase in breathing or heart rate, while vigorous physical activity is defined as a large increase in breathing or heart rate where conversation is difficult or broken (U.S. Department of Health and Human Services, 2008). Previous research has examined physical activity relating to cardiovascular fitness. There is contemporaneous but conflicting research on the relationship between physical activity and migraine. Stress, or post-crisis letdown, is a known trigger for migraine, while mild to moderate physical activity is known to diminish stress (Turner, 4

Molgaard, Gardner, Rothrock, & Stang, 1995). Logically, exercise is frequently promoted as a method of migraine management (Folkins & Sime, 1981). Some individuals use vigorous exercise successfully to abort a migraine headache at the first signs of onset (Darling, 1991). Conversely, exertional exercise without proper warm-up can be a trigger for migraine headaches (Lambert & Burnet, 1985; Rooke, 1968). The relationship between migraine and exercise has been explored by researchers. Data indicate pain intensity and frequency of migraines decrease after a regular exercise program was initiated (Lockett & Campbell, 1991; Koseoglu, Akboyraz, Soyuer, & Ersoy, 2003). The results of these studies strongly suggest an ongoing exercise program is essential for decreased migraine frequency. However, previous researchers stopped short of examining neurocognitive function of migraineurs meeting physical activity recommendations and those not meeting physical activity recommendations in a collegiate population. Several studies examined cognitive function and migraine headaches; however, research is inconclusive whether migraine headaches lead to cognitive dysfunction over time (Jelicic, van Boxtel, Houx, & Jolles, 2000; Magnusson & Becker, 2003; Gaist, et al., 2005; Launer, Terwindt, & Ferrari, 1999; Waldie, Hausmann, Milne, & Poulton, 2002). Direct comparison can be difficult due to the methodological problems of selection bias (convenience sample or hospital sample) and small sample size (Hooker & Raskin, 1986; Leijdekkers, Goudswaard, Menges, & Oriebeke, 1990; Le Pira, Zappala, Giuffrida, Lo Bartola, Morana, & Lanaia, 2000; Le Pira, et al., 2004; Haverkamp, Honscheid, & Miiller-Sinik, 2002; Zeitlin & Oddy, 1984). Consequently, it is difficult to determine the long-term effects of migraine headache on cognitive function. 5

A number of studies found migraine is not associated with cognitive decline (Lipton et al, 2002; Hu, Markson, Lipton, Stewart, & Berger, 1999; Schreiber, Hutchinson, Webster, Ames, Richardson, & Powers, 2004; Bell, Primeau, Sweet, & Loftland, 1999). A Danish twin study concluded that lifetime diagnosis of migraine health was not associated with cognitive deficits, which is an epidemiological gold standard (Gaist, et al., 2005). Similarly, Haverkamp and colleagues found children with migraines and their unaffected sibling also reported no cognitive dysfunctions differences (Haverkamp, Honscheid, & Muller-Sinik, 2002). However, subjects are often recruited from a local migraine group, which may contribute to reporting bias. Prior research has focused on long-term cognitive function following a migraine; however, very few studies have examined short-term cognitive function and the recovery pattern following a migraine headache in a collegiate population. Research has found a reversible cognitive decline in the recovery pattern following migraine headache (Meyer, Thornby, Crawford, & Rauch, 2000). A reversible cognitive decline is defined as a cognitive decline during the headache interval which completely subsides during a measured period after the individual is headache free. Meyer and colleagues (2000) found a reversible cognitive decline 30 hours after recovery from headache and nocturnal sleep. This is after the postdrome phase is complete in most individuals. Cognitive decline can also be reversed by migraine medication. Specifically, two prescription drug studies utilizing sumatriptan (injection and nasal spray) determined cognitive dysfunction was reversible 15 minutes after medication administration (Farmer, Cady, Bleiberg, & Reeves, 2000; Farmer, et al., 2001). A limitation to these studies was not monitoring the subjects beyond 45 minutes. In both studies, cognitive function 6

(simple reaction time, sustained attention/ concentration, working memory, visual-spatial processing) and alertness/fatigue were adversely affected during a migraine headache. However, results of these studies may be skewed by the lack of a comparison to a control group as well as small sample size. Migraine studies have reported long-term or permanent cognitive decline in information processing, reaction time, verbal ability and visual processing (Hooker & Raskin, 1986; Zeitlin & Oddy, 1984; Waldie, Hausmann, Milne, & Poulton, 2002; Wray, Mijovic-Prele, & Kosslyn, 1995). Hooker and Raskin tested 29 migraineurs who exhibited poorer free recall of semantic material and diminished ability to discriminate forms and analyze spatial relationships in the tactile modality. Five subjects reported not feeling as "bright" since migraines started. Zeitlin and Oddy's 19 migraineurs, recruited through a migraine clinic, showed consistently poorer performance on a series of memory and information-processing tests. While many studies found long-term neurocognitive deficits in migraineurs, the two primary limitations of these studies are the lack of a control group and the use of diagnosed migraine patients only. Furthermore, no previous research specified college-aged patients or examined short-term recovery patterns from migraine headaches compared to a control group. Conclusively, it is relevant and significant to determine whether neurocognitive effects of a migraine resolve in a short period of time in a college population. Significance of the Problem Migraine headaches are an episodic and progressive disorder affecting a significant portion of the population, more than asthma and diabetes combined (Lipton et al, 2002; Lipton et al, 2001; Launer, Terwindt, & Ferrari, 1999; Lipton, Stewart, 7

Celentano, & Reed, 1992). During a migraine attack, progression is seen in aura development (if present) and intensity of pain, with prodromal and postdromal symptoms typically leaving migraineurs performing at a decreased capacity for up to one week surrounding a migraine attack. With frequent attacks, migraine is a direct cost to the individual and the economy as a whole. From a collective perspective, direct and indirect costs relating to migraine headaches are estimated at 13 billion dollars, impacting society in many venues, including work productivity, absenteeism and social functioning (Lipton et al, 2001). Ninety one percent (91%) of individuals who suffered from migraine headaches reported functional impairment, with 53% of respondents indicating their headaches cause severe impairment or require bed rest. Another 51% reported a reduction in their school or work productivity of at least 50% during a migraine episode (Lipton et al, 2001). With the average migraineur experiencing one migraine per month, and 25% debilitated by at least two episodes per month, how does this affect college students with migraine headaches (Launer, Terwindt, & Ferrari, 1999)? It is widely held that lost time due to migraine headaches is the result of short-term effects. However, few studies have examined the relationship between migraine headache and short-term cognitive function. College students are expected to be ready on a daily basis for pop quizzes, tests or practical skills tests. Students may study for months for a licensure, board or certification test where the outcome determines their future standing and status in their profession or job. From ages 18-28 the prevalence of migraine increases yearly, and the life of the college student is full of migraine triggers, making it important to determine if migraines affect cognitive function following an attack. 8

Researchers have produced inconsistent results on long-term cognitive function following a migraine headache and the effect(s) of physical activity on migraines. From individuals who suffer exertional migraines to those that ward off migraines through physical activity, no research study has captured the effects of physical activity under an observational approach. Furthermore, no prior research examined the effects of migraine and physical activity on cognitive function within 24-hour, 48-hour, and one-week intervals after a migraine and compared the data to a control group. Finally, prior research did not contrast neurocognitive function following a migraine headache with an individual's baseline neurocognitive test scores. Statement of the Problem The purpose of this study was to investigate the effects of physical activity on neurocognitive function and recovery patterns in collegiate students who incur a migraine headache compared to collegiate students who do not incur migraines. Need for Study The postdromal phase of migraine has yielded inadequate results for the public in general and suffering migraineurs specifically. This phase of the migraine affects migraineurs significantly post migraine and may last for days. Little and limited research has explored the neurocognitive deficits following a migraine, and no prior research determined whether physical activity has any effect on migraine and neurocognitive function. The hypotheses and research questions of this study are listed below. 9

Hypotheses and Research Questions Primary Hypotheses. The primary focus of this study is neurocognitive function as it relates to migraine headaches and individuals who meet or do not meet physical activity recommendations. The independent variables were: A. migraine status migraine (M), non-migraine (NM) B. physical activity met physical activity recommendations PA did not meet physical activity recommendations (NPA) C. testing occasion baseline (B), 24 hours (24h), 48 hours (48h), and one week (7d) The dependent variables were neurological function defined as the four composite scores of ImPACT. The four composite scores of ImPACT are verbal memory composite score, visual memory composite score, reaction time composite score, and processing speed composite score. The ImPACT composite scores were collectively referred to as neurocognitive function. All subjects in this study were college students between the ages of 18 and 28. Specific hypotheses include: Effects of Testing Occasion on Neurocognitive Function HI a. Baseline neurocognitive function scores will be higher than 24 hours post- migraine scores for migrainous college students. Hlb. Neurocognitive function scores at 24 hours will be lower than 48 hours post- migraine scores for migrainous college students. Hlc. Neurocognitive function scores at 48 hours will be lower than 7 days post- migraine scores for migrainous college students. 10

Hid. Neurocognitive function scores at baseline will exhibit no difference than 7 days post-migraine scores for migrainous college students. Hie. Neurocognitive function scores at baseline will exhibit no difference than 24 hours, 48 hours or 7 days post-baseline scores for non-migrainous college students. Effects of Migraine Status on Neurocognitive Function H2a. The migraineurs and non-migraineurs will exhibit no difference in neurocognitive function at baseline. H2b. The migraineurs will exhibit lower neurocognitive function scores than the non- migraineurs at 24 hours post-migraine. H2c. The migraineurs will exhibit lower neurocognitive function scores than non- migraineurs at 48 hours post-migraine. H2d. The migraineurs will exhibit lower neurocognitive function scores than the non- migraineurs at 7 days post-migraine. Effects of Physical Activity by Testing Occasion on Neurocognitive Function H3a. Physically active migraineurs will exhibit no difference in neurocognitive function scores than non-physically active migraineurs at baseline. H3b. Physically active migraineurs will exhibit higher neurocognitive function scores than non-physically active migraineurs at 24 hours. H3c. Physically active migraineurs will exhibit higher neurocognitive function scores than non-physically active migraineurs at 48 hours. H3d. Physically active migraineurs will exhibit no difference on neurocognitive function scores than non-physically active migraineurs at 7 days. 11

H3e. Physically active non-migraineurs will exhibit no difference in neurocognitive function scores than non-physically active non-migraineurs at any testing interval. Exploratory Hypotheses The purpose of the exploratory hypotheses was to examine the relationships between additional variables collected throughout the study. The independent variables were: A. migraine status migraine (M) and non-migraine (NM]) B. sex female and male C. diagnosis status physician diagnosed (PD) and self-diagnosed (SD) D. testing occasion 24 hours only E. physical activity met physical activity recommendations (PA) did not meet physical activity recommendations (NPA). The dependant variables are level of pain and impact of headache scores. The Headache Impact Test (HIT) score was referred to as impact of headache scores. H4. Female migraineurs will rate their pain higher than male migraineurs at 24 hours post-migraine. H5. Physician diagnosed migraineurs will rate their pain higher than self-diagnosed migraineurs at 24 hours post-migraine. H6a. Physically active individuals will score lower than non-physically active individuals on their impact of headache score. H6b. Physically active migraineurs will score lower than non-physically active migraineurs on their impact of headache scores. 12

Full document contains 169 pages
Abstract: Migraine headaches are a common and often debilitating neurological disorder affecting between 18-25% of the female population and 6-13% of the male population. There has been no universal agreement on the long or short-term effects of chronic migraine headaches on neurocognitive function or on the cognitive recovery patterns following a migraine. Research has also been inconclusive on the effects physical activity may have on the intensity and frequency of migraine attacks. The purpose of this study was to investigate the effects of physical activity on neurocognitive function and recovery patterns in collegiate students who incur a migraine headache compared to collegiate students who do not incur a migraine. One hundred twenty-two (122) individuals completed baseline testing with 44 migraineurs incurring a migraine and completing all testing. They were matched to 44 non-migraine controls for sex, education level and age. A pre-test/post-test design was used with the following independent variables: migraine status, physical activity, testing occasion sex, exercise, sleep, and diagnosis status. The dependent variables were the four composite scores of ImPACT (verbal memory composite score, visual memory composite score, reaction time composite score, and motor processing speed), level of pain, and impact of headache scores. Descriptive statistics and several analyses using MANOVAs, ANOVAs and t-tests which were performed with the alpha level set a priori at .05. Repeated measures one-way ANOVA revealed declines in neurocognitive function of migraineurs in verbal memory (ρ=.045), visual memory (ρ=.041), and reaction time (ρ< .001) at 24 hours. When compared to non-migraine controls MANOVA tests revealed a main effect for group x time for visual memory (ρ=.036), motor processing speed (ρ=.044) and reaction time (ρ=.002) composite scores. Post hoc Univariate ANOVAs revealed that migraineurs experienced the largest declines between baseline and 24 hours with verbal memory (ρ=.005), visual memory (ρ=.001) motor processing speed (ρ=.003) and reaction time (ρ=.002) worse than controls. Reaction time (ρ=.028) and motor processing speed (ρ=.022) remained impaired at 48 hours, and motor processing speed (ρ=.009) was significantly impaired at 7 days. Physical activity levels did not significantly affect neurocognitive function in migraine or non-migraine groups (ρ-values range 0.232-0.933). Females reported higher pain levels than males (ρ=.028). Sleep, exercise, and type of medication did not significantly affect neurocognitive function scores in migraineurs. Physical activity levels significantly decreased the HIT (Headache Impact Test) overall scores (ρ=.020) with results approaching significance in both migraineurs (ρ=.080) and non-migraineurs (ρ=.094). Conclusively, migraineurs neurocognitive function is affected in the postdromal phase of migraine, with cognitive decline reversible within a few days of onset. Physical activity had no impact on neurocognitive function scores; however, collegiate students who performed physical activity rated their HIT scores lower than those not physically active. Further research is warranted to determine the degree of cognitive deficits the general population may incur after a migraine, and ways to minimize postdromal effects.