Veteran Analysis Reveals Significant Cognitive Symptoms Stemming From Migraine and Traumatic Brain Injury

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Findings from a recently published large-scale analysis highlighted the high burden of cognitive impairment among veterans with both migraine and TBI.

Matthew Herbert, PhD

(Credit: MIRECC)

A recent observational study of more than 338,000 veterans showed that those with migraine, traumatic brain injury (TBI), or both experienced significantly higher levels of cognitive symptoms compared with those without these conditions. Published in Headache, results also revealed that the presence of both migraine and TBI led to the highest levels of cognitive impairment, suggesting the need for targeted assessment and treatment strategies for affected veterans.¹

Using self-reported data, researchers assessed cognitive function in veterans using the Medical Outcomes Study Cognitive Functioning Scale Revised (MOS-Cog-R). Among the 338,217 veterans analyzed, 8.9% reported having migraine (n = 30,080), 9.4% reported TBI (n = 31,906), and 2.3% reported experiencing both conditions (n = 7828). Veterans who had either migraine or TBI reported similar levels of cognitive symptoms, with mean scores of 74.19 and 73.87, respectively. These levels were substantially higher than those seen in veterans without these conditions, who had an average cognitive function score of 62.52.

However, the study, led by Matthew Herbert, PhD, assistant adjunct professor of psychiatry at University of California, San Diego, reported that veterans with both migraine and TBI experienced the most severe cognitive symptoms, demonstrated by a mean MOS-Cog-R score of 83.01. This group also had the highest prevalence of psychiatric conditions, including depression (64.4%), anxiety (47.7%), and post-traumatic stress disorder (54.2%).

The study, conducted as part of the Million Veteran Program, aimed to evaluate the spectrum and severity of cognitive symptoms in veterans with migraine and TBI and to determine the extent to which psychiatric conditions contribute to these symptoms. Given the high prevalence of TBI and psychiatric disorders among veterans, understanding their impact on cognitive function could be critical for improving long-term health outcomes.

Although psychiatric conditions such as depression and anxiety are known to contribute to cognitive impairment, the study reported that the relationship between migraine, TBI, and cognitive symptoms persisted even after accounting for these factors. Statistical analysis revealed a significant association between migraine, TBI, and cognitive symptoms (B = −2.20; standard error = −0.36; P <.001), indicating that cognitive difficulties in these veterans were not solely driven by mental health conditions.

These findings highlighted the importance of considering cognitive impairment in veterans with migraine, even in the absence of TBI. Traditionally, cognitive symptoms in veterans have been closely linked to TBI,²but this study underscored that migraine alone can result in cognitive difficulties comparable to those seen in TBI cases. The study’s results emphasized the need for further research to better understand the underlying mechanisms contributing to cognitive symptoms in veterans with migraine and TBI. Researchers even suggested investigating potential environmental and genetic factors that may exacerbate cognitive impairment in this population for future studies.

Clinically, these findings reinforced the importance of screening for cognitive symptoms in veterans with migraine, even when TBI is not present. Given the substantial burden of cognitive impairment,³ targeted interventions such as cognitive rehabilitation programs and individualized treatment strategies may be necessary to improve quality of life for affected veterans. By recognizing the significant cognitive challenges faced by veterans with migraine and TBI, this research potentially paves the way for improved assessment and treatment approaches, ultimately aiming to enhance the long-term health and well-being of those who have served.

REFERENCES
1. Herbert MS, Merritt VC, Afari N; Million Veteran Program, Gasperi M. Cognitive symptoms in veterans with migraine or traumatic brain injury: A Million Veteran Program study. Headache. 2025;65(3):430-438. doi:10.1111/head.14815
2. Barnes DE, Kaup A, Kirby KA, Byers AL, Diaz-Arrastia R, Yaffe K. Traumatic brain injury and risk of dementia in older veterans. Neurology. 2014;83(4):312-319. doi:10.1212/WNL.0000000000000616
3. Chu NM, Chen X, Gross AL, et al. Cognitive impairment burden in older and younger adults across the kidney transplant care continuum. Clin Transplant. 2021;35(10):e14425. doi:10.1111/ctr.14425