Memory and Concentration Problems With Migraine: Do They Improve When Prevention Works?
In 96 adults starting a CGRP antibody or Botox, people whose migraine responded reported a bigger improvement in memory and concentration complaints than people whose migraine did not.
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Why This Study Was Done
Many people with migraine describe trouble remembering things, finding words, or staying focused, both during attacks and on days in between. These complaints are often called brain fog, and they are now recognized as part of migraine for many patients rather than a separate problem.
A practical question follows: if preventive treatment brings migraine under better control, do these memory and concentration problems ease too? A study published on October 28, 2026 in the journal Headache looked at exactly that in 96 adults starting preventive treatment in Portugal.
How the Study Was Done
This was a prospective cohort study at two headache centers, one in Lisbon and one in Porto, running from October 2023 to August 2025. Each person was compared with themselves before and after starting treatment.
All participants began one of two preventive treatments:
- A CGRP monoclonal antibody, such as erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality), or eptinezumab (Vyepti), in 65 people.
- OnabotulinumtoxinA (Botox) injections in 31 people.
CGRP antibodies and Botox act mainly outside the brain, on nerves and blood vessels around the head. Some older preventive drugs, such as topiramate (Topamax), can cause word-finding and concentration problems of their own, which would make it hard to tell whether any change in thinking came from the drug or from better migraine control. Choosing treatments that mostly work outside the central nervous system makes the comparison cleaner.
Memory and concentration complaints were measured with the Subjective Memory Complaints scale, a questionnaire about everyday difficulties with memory. Anxiety and depression symptoms were measured with the Hospital Anxiety and Depression Scale. Both were filled in before treatment and again 3 to 6 months later.
Episodic migraine: at least a 50% drop in monthly moderate to severe headache days.
Chronic migraine: at least a 30% drop in monthly moderate to severe headache days.
These are the usual cutoffs for a responder. Our preventive response calculator uses the same idea if you want to check your own numbers.
Who Took Part
Most participants had chronic migraine, meaning 15 or more headache days a month. If you are unsure which group you fall into, the chronic migraine calculator walks through the criteria.
What the Study Found
People whose migraine responded to treatment reported a larger improvement in memory and concentration complaints than people whose migraine did not respond. On the questionnaire, responders' scores improved by about 2.2 points more than nonresponders' scores, with a 95% confidence interval of 0.8 to 3.6 points.
The researchers used a regression model so they could check whether the type of treatment or mood symptoms explained the result. They did not. The improvement tracked with whether migraine got better, regardless of which of the two treatments a person received.
The Role of Depression
Depression can affect memory and concentration on its own, so the researchers looked at people with and without depression symptoms at the start of the study.
| Group | What improvement in memory complaints was linked to |
|---|---|
| Borderline or clinically significant depression symptoms at baseline | Mainly improvement in depression symptoms |
| No depression symptoms at baseline | Only migraine treatment response |
For people without depression, better migraine control on its own was linked to clearer thinking. For people with depression symptoms, mood seemed to play a larger part, and memory complaints improved more when depression improved. In practice, this supports treating both migraine and mood when someone describes brain fog.
Common Questions This Study Helps Answer
Is migraine brain fog real?
Yes. Memory and concentration complaints are increasingly recognized as part of migraine, and this study shows they can change when migraine changes. Our post on opioids, disability, and cognition in migraine looks at another side of the same problem.
Will my memory get better if my preventive works?
In this study, people whose migraine responded reported more improvement than people whose migraine did not. That is encouraging, but it is an average across a small group, and it is based on how people rated their own memory rather than on memory tests.
Does it matter which preventive I use?
Between CGRP antibodies and Botox, the type of treatment made no difference. What mattered was whether the treatment worked. The study did not include oral preventives such as topiramate (Topamax), propranolol (Inderal), or amitriptyline (Elavil), so it cannot say how they compare. For a broader view of the options, see our summary of the AAN and AHS prevention guideline.
What if my treatment is not working?
About half of the people in this study did not reach the responder cutoff within 3 to 6 months. Switching or adding treatment is common, and our post on Botox for chronic migraine in real-world patients looks at results in patients treated outside clinical trials.
Should I mention memory problems to my clinician?
Yes. Brain fog is easy to leave out of a short appointment, but it affects work and daily life and can help guide treatment choices. The migraine appointment summary sheet is a simple way to make sure it gets mentioned.
Limitations to Keep in Mind
- Self-rated memory. The study measured how people felt about their memory and concentration, a self-reported outcome, not performance on formal cognitive tests.
- Small sample. With 96 people, smaller differences, such as between the two treatments, could be missed.
- No control group. Everyone received treatment, so the study compares responders with nonresponders rather than with untreated people.
- Specialist clinics. Nearly all participants were women, and most had chronic migraine, so the results may not apply to everyone with migraine.
- Short follow-up. Changes were measured 3 to 6 months after starting treatment.
Key Takeaways
- In 96 adults starting a CGRP antibody or Botox (onabotulinumtoxinA), people whose migraine responded reported a greater improvement in memory and concentration complaints than those whose migraine did not.
- The type of treatment did not matter. Improvement tracked with how well migraine was controlled.
- In people without depression symptoms, improvement was linked only to migraine response. In people with depression symptoms, it was mainly linked to improving mood.
- The study relied on self-rated memory, had no untreated comparison group, and followed people for 3 to 6 months.
This article is for educational purposes only and does not replace professional medical advice, diagnosis, or treatment. New or worsening memory problems, confusion, or changes in thinking should be evaluated by a healthcare provider, since they can have causes other than migraine.
References
- Taveira MC, Dourado Sotero F, Nobre J, et al. Subjective cognitive symptoms improve following effective migraine treatment: A patient-reported outcome study. Headache. Published online October 28, 2026. doi:10.1111/head.70250.
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