{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T04:06:21Z","timestamp":1792209981237,"version":"4.4.0"},"posted":{"date-parts":[[2026,4,16]]},"group-title":"Neurology","reference-count":33,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,4,16]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Migraine attacks are frequently accompanied by patient-reported \u201csubjective\u201d cognitive symptoms, but objective findings have been inconsistent. We used high-frequency, smartphone-based cognitive testing to assess within-person changes in subjective and objective cognition across migraine phases using daily diaries.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Adults with migraine were recruited through social media. Eligible participants met ICHD-3 migraine criteria and had 3 to 22 monthly headache days. For 30 days, they completed daily smartphone-based reports on headache features, cognitive symptoms, and three smartphone-based objective cognitive tasks. Objective tests included Symbol Search (processing speed\/visual search), Color Dots (visual working memory\/attention), and Grid Memory (visuospatial working memory). Primary analyses contrasted assessments on current headache days (ictal) versus days with no headache (nonictal). When possible, non-ictal days were subclassified using information from adjacent days as pre-ictal, post-ictal, and interictal days. Outcomes included subjective cognition, reaction time (mean across correctly scored trials), accuracy, and a speed-accuracy composite (Reaction Time\/Accuracy). Mixed-effects models adjusted for age, sex, and practice effects.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The 139 eligible participants (84.9% female; mean age 38.2 years) contributed 3,014 person-days for ictal versus nonictal comparisons (2,097 nonictal; 917 ictal); for 1,828 person-days precise phase classification was possible. Subjective cognitive symptoms were worse on ictal days, with higher odds of more severe brain fog (OR=3.39, 95% CI 2.70-4.27) and task forgetting (OR=2.82, 95% CI 2.29-3.49). In adjusted models, reaction times were slower on ictal days for Symbol Search (reaction time ratio =1.043, 95% CI 1.028-1.059) and Color Dots (ratio=1.015, 95% CI 1.003-1.026) but not Grid Memory (reaction time ratio =1.006, 95% CI 0.985-1.028). Grid Memory accuracy was lower on ictal days (OR=0.867, 95% CI 0.823-0.914). In analyses based on phase, most nonictal phases showed faster reaction time and lower subjective symptom burden relative to ictal days, with limited differentiation among preictal, postictal, and interictal periods.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In persons with migraine, daily smartphone assessments revealed subjective cognitive impairment on ictal vs nonictal days in brain fog and forgetfulness. Objective testing revealed slowing in processing speed and attention and modest differences in the accuracy of working-memory. High-frequency digital cognition appears feasible and may provide scalable functional endpoints for real-world monitoring and treatment evaluation.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.04.14.26350892","type":"posted-content","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T23:00:23Z","timestamp":1776380423000},"source":"Crossref","is-referenced-by-count":4,"title":["Digital Assessment of Objective and Patient-Reported Cognition Across Migraine Phases: Results from the MIND Cohort"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1585-3909","authenticated-orcid":false,"given":"Babak","family":"Khorsand","sequence":"first","affiliation":[{"name":"Department of Neurology, University of California, Irvine; Irvine, USA"},{"name":"Center for Design, Discovery, and Data Analytics in Neurological Disorders (3D-Center), University of California, Irvine; Irvine, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devin","family":"Teichrow","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of California, Irvine; Irvine, USA"},{"name":"Center for Design, Discovery, and Data Analytics in Neurological Disorders (3D-Center), University of California, Irvine; Irvine, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Crystal J.","family":"Jicha","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of California, Irvine; Irvine, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mia T.","family":"Minen","sequence":"additional","affiliation":[{"name":"Department of Neurology, NYU Langone Health, New York, New York, USA"},{"name":"Department of Population Health, NYU Langone Health, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Seng","sequence":"additional","affiliation":[{"name":"VA Headache Centers of Excellence (HCoE) Research, Evaluation, Education, and Engagement Activities Center for Headache (RE3ACH), Orange, CT, USA"},{"name":"Montefiore Headache Center, Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA"},{"name":"Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA"},{"name":"Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard B.","family":"Lipton","sequence":"additional","affiliation":[{"name":"Montefiore Headache Center, Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA"},{"name":"Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Ezzati","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of California, Irvine; Irvine, USA"},{"name":"Center for Design, Discovery, and Data Analytics in Neurological Disorders (3D-Center), University of California, Irvine; Irvine, USA"},{"name":"Department of Epidemiology and Biostatistics, University of California, Irvine; Irvine, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026041918350531000_2026.04.14.26350892v1.1","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1016\/S1474-4422(18)30322-3","article-title":"Global, regional, and national burden of migraine and tension-type headache, 1990\u20132016: a systematic analysis for the Global Burden of Disease Study 2016","volume":"17","year":"2018","journal-title":"The Lancet Neurology"},{"key":"2026041918350531000_2026.04.14.26350892v1.2","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1111\/head.14484","article-title":"Patient-reported experiences with migraine-related cognitive symptoms: results of the MiCOAS qualitative study","volume":"63","year":"2023","journal-title":"Headache: The Journal of Head and Face Pain"},{"key":"2026041918350531000_2026.04.14.26350892v1.3","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1111\/head.14664","article-title":"The impacts of migraine on functioning: results from two qualitative studies of people living with migraine","volume":"64","year":"2024","journal-title":"Headache: The Journal of Head and Face Pain"},{"key":"2026041918350531000_2026.04.14.26350892v1.4","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/s11916-022-01039-5","article-title":"Cognitive impairment in primary and secondary headache disorders","volume":"26","year":"2022","journal-title":"Current Pain and Headache Reports"},{"key":"2026041918350531000_2026.04.14.26350892v1.5","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1186\/s10194-024-01923-y","article-title":"Migraine and cognitive dysfunction: a narrative review","volume":"25","year":"2024","journal-title":"The Journal of Headache and Pain"},{"key":"2026041918350531000_2026.04.14.26350892v1.6","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1111\/ane.13204","article-title":"Subjective cognitive complaints and migraine characteristics: a cross-sectional study","volume":"141","year":"2020","journal-title":"Acta Neurologica Scandinavica"},{"key":"2026041918350531000_2026.04.14.26350892v1.7","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/s10194-017-0779-1","article-title":"Subjective cognitive decline in patients with migraine and its relationship with depression, anxiety, and sleep quality","volume":"18","year":"2017","journal-title":"The journal of headache and pain"},{"key":"2026041918350531000_2026.04.14.26350892v1.8","doi-asserted-by":"crossref","first-page":"103","DOI":"10.62087\/hpr.2024.0022","article-title":"Subjective Cognitive Decline Patterns in Patients with Migraine, with or without Depression, versus Non-depressed Older Adults","volume":"25","year":"2024","journal-title":"Headache and Pain Research"},{"key":"2026041918350531000_2026.04.14.26350892v1.9","unstructured":"Ikechukwu OJ , Khan MN , Khan SM , et al. Association between sleep quality and cognitive complaints among young adults with migraine. Cureus 2025;17."},{"key":"2026041918350531000_2026.04.14.26350892v1.10","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1111\/head.13688","article-title":"The American registry for migraine research: research methods and baseline data for an initial patient cohort","volume":"60","year":"2020","journal-title":"Headache: The Journal of Head and Face Pain"},{"key":"2026041918350531000_2026.04.14.26350892v1.11","doi-asserted-by":"publisher","DOI":"10.1177\/0333102411430265"},{"key":"2026041918350531000_2026.04.14.26350892v1.12","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1007\/s11065-021-09516-1","article-title":"Interictal cognitive deficits in migraine sufferers: a meta-analysis","volume":"32","year":"2022","journal-title":"Neuropsychology Review"},{"key":"2026041918350531000_2026.04.14.26350892v1.13","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1037\/neu0000808","article-title":"Cogniphobia and neuropsychological functioning in migraine","volume":"36","year":"2022","journal-title":"Neuropsychology"},{"key":"2026041918350531000_2026.04.14.26350892v1.14","doi-asserted-by":"publisher","DOI":"10.1177\/1073191116643164"},{"key":"2026041918350531000_2026.04.14.26350892v1.15","doi-asserted-by":"crossref","first-page":"gbaf030","DOI":"10.1093\/geronb\/gbaf030","article-title":"Computational phenotyping of cognitive decline with retest learning","volume":"80","year":"2025","journal-title":"The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences"},{"key":"2026041918350531000_2026.04.14.26350892v1.16","doi-asserted-by":"crossref","first-page":"1684","DOI":"10.1111\/head.14964","article-title":"Cognition during ictal and interictal migraine phases: A pilot study using ecological momentary assessment","volume":"65","year":"2025","journal-title":"Headache: The Journal of Head and Face Pain"},{"key":"2026041918350531000_2026.04.14.26350892v1.17","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1046\/j.1526-4610.2001.041007646.x","article-title":"Prevalence and burden of migraine in the United States: data from the American Migraine Study II","volume":"41","year":"2001","journal-title":"Headache: The Journal of Head and Face Pain"},{"key":"2026041918350531000_2026.04.14.26350892v1.18","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.56.suppl_1.S20"},{"key":"2026041918350531000_2026.04.14.26350892v1.19","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1046\/j.1526-4610.2001.041007638.x","article-title":"Migraine diagnosis and treatment: results from the American Migraine Study II","volume":"41","year":"2001","journal-title":"Headache: The Journal of Head and Face Pain"},{"key":"2026041918350531000_2026.04.14.26350892v1.20","unstructured":"Buse DC , Bigal M , Rupnow M , Reed M , Serrano D , Lipton R. Development and validation of the Migraine Interictal Burden Scale (MIBS): a self-administered instrument for measuring the burden of migraine between attacks. Neurology; 2007: LIPPINCOTT WILLIAMS & WILKINS 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA: A89\u2013A89."},{"key":"2026041918350531000_2026.04.14.26350892v1.21","doi-asserted-by":"publisher","DOI":"10.1176\/appi.psy.50.6.613"},{"key":"2026041918350531000_2026.04.14.26350892v1.22","doi-asserted-by":"crossref","unstructured":"Cohen S , Kamarck T , Mermelstein R. A global measure of perceived stress. Journal of health and social behavior 1983:385\u2013396.","DOI":"10.2307\/2136404"},{"key":"2026041918350531000_2026.04.14.26350892v1.23","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1017\/S1355617724000328","article-title":"Psychometric and adherence considerations for high-frequency, smartphone-based cognitive screening protocols in older adults","volume":"30","year":"2024","journal-title":"Journal of the International Neuropsychological Society"},{"key":"2026041918350531000_2026.04.14.26350892v1.24","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1186\/s10194-018-0933-4","article-title":"Cognitive dysfunction and migraine","volume":"19","year":"2018","journal-title":"The journal of headache and pain"},{"key":"2026041918350531000_2026.04.14.26350892v1.25","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1186\/s10194-022-01462-4","article-title":"Association between migraine and cognitive impairment","volume":"23","year":"2022","journal-title":"The journal of headache and pain"},{"key":"2026041918350531000_2026.04.14.26350892v1.26","doi-asserted-by":"publisher","DOI":"10.1177\/0333102414553823"},{"key":"2026041918350531000_2026.04.14.26350892v1.27","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1038\/s41582-018-0098-4","article-title":"Biological insights from the premonitory symptoms of migraine","volume":"14","year":"2018","journal-title":"Nature Reviews Neurology"},{"key":"2026041918350531000_2026.04.14.26350892v1.28","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1080\/13803395.2021.2009447","article-title":"Sharper in the morning: Cognitive time of day effects revealed with high-frequency smartphone testing","volume":"43","year":"2021","journal-title":"Journal of Clinical and Experimental Neuropsychology"},{"key":"2026041918350531000_2026.04.14.26350892v1.29","doi-asserted-by":"publisher","DOI":"10.1177\/0333102419828967"},{"key":"2026041918350531000_2026.04.14.26350892v1.30","doi-asserted-by":"publisher","DOI":"10.1177\/0333102420941839"},{"key":"2026041918350531000_2026.04.14.26350892v1.31","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1111\/j.1526-4610.2009.01411.x","article-title":"How well do headache patients remember? A comparison of self-report measures of headache frequency and severity in patients with migraine","volume":"49","year":"2009","journal-title":"Headache: The Journal of Head and Face Pain"},{"key":"2026041918350531000_2026.04.14.26350892v1.32","doi-asserted-by":"crossref","unstructured":"Torelli P , Jensen R. Headache diaries and calendars. Handbook of Clinical Neurology: Elsevier, 2010: 137\u2013146.","DOI":"10.1016\/S0072-9752(10)97010-3"},{"key":"2026041918350531000_2026.04.14.26350892v1.33","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.10-5627"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.04.14.26350892","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T01:35:17Z","timestamp":1776648917000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.04.14.26350892"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,16]]},"references-count":33,"URL":"https:\/\/doi.org\/10.64898\/2026.04.14.26350892","relation":{},"subject":[],"published":{"date-parts":[[2026,4,16]]},"subtype":"preprint"}}