Strengthening Your Migraine Brain introduced the concept of executive functioning skills. This is the second installment of a 12-part series. In this series, we’ll explore each of the 11 executive functioning skills as they apply to migraine. The first skill is working memory.

Definition

The book "Smart, But Scattered," by Peg Dawson and Richard Guare, defines working memory as “the ability to hold information in memory while performing complex tasks. It incorporates the ability to draw on past learning or experience to apply to the situation at hand or to project into the future.”

The RAM of our brains

Random access memory (RAM) is the short-term memory of a computer. Our working memory functions in a similar way by allowing us to hold on to a limited amount of temporary information. As more RAM is used, a computer slows down and may even stop working temporarily. This happens to us, too. Our brains will only hold so much information in working memory before they start to arbitrarily remove those bits of information they deem unnecessary. That’s when we start forgetting.

Signs that our working memory is impaired:

• We can’t remember words.
• We can’t understand or follow instructions.
• We have difficulty expressing our thoughts.
• We forget where we left our keys
• We enter a room, only to forget why we’re there.
• We forget to toss the laundry in the dryer.
• We forget that important phone call.

Factors affecting working memory

• The migrainous process itself impairs executive functioning.
• Anxiety and depression are common psychiatric comorbidities. Both impair working memory.
• Fibromyalgia is also a common comorbidity that impairs working memory.
• Normal cognitive functioning is typically restored once a migraine attack has ended.

Because we know that migraine attacks will affect our working memory, we can take steps between attacks to minimize the effects. We can also talk to our loved ones and employers, teaching them about our temporary limits during an attack. Working memory impairment means that we are more prone to errors while doing tasks that require concentration and quick thinking.

Discovering our baseline

We can discover the impact migraine has on our working memory by answering three simple questions. Here's what to keep in mind when answering the questions, and how to get your score:

• Choose an answer that best reflects your typical response between attacks.
• Choose an answer that best fits your typical response during an attack.
• Compare the two scores. High scores indicate strong working memory. The greater the difference between the two scores, the more migraine impacts your working memory.

“I have a good memory for facts, dates, and details.”

1. Strongly disagree (1 point)
2. Disagree (2 points)
3. Tend to disagree (3 points)
4. Neutral (4 points)
5. Tend to agree (5 points)
6. Agree (6 points)
7. Strongly agree (7 points)

“I am very good at remembering the things I have committed to do.”

1. Strongly disagree (1 point)
2. Disagree (2 points)
3. Tend to disagree (3 points)
4. Neutral (4 points)
5. Tend to agree (5 points)
6. Agree (6 points)
7. Strongly agree (7 points)

“I seldom need reminders to complete tasks.”

1. Strongly disagree (1 point)
2. Disagree (2 points)
3. Tend to disagree (3 points)
4. Neutral (4 points)
5. Tend to agree (5 points)
6. Agree (6 points)
7. Strongly agree (7 points)

Strategies to strengthen working memory

• Visualize the task accomplished.
• Verbalize the steps required to complete the task.
• Play card games, crossword puzzles, Sodoku, etc.
• Engage in active reading by taking notes, underlining or highlighting, and writing questions while reading.
• Break tasks down into smaller steps. Create a graphic representation of the steps.
• Engage the senses see it, hear it, associate a song with it, etc.
• Use mnemonics to facilitate memorization.
• Strategies to compensate for working memory impairment
• Keep all notes and reminders in one place. It can be a notebook, planner, software, or electronic device. Avoid using paper scraps or post-it notes that can be easily misplaced.
• Maintain a current calendar with email and/or text reminders. Most cell phones can sync to an electronic calendar (Outlook, Google, etc.), and send reminders.
• Ask a trusted person to send reminders of important tasks, appointments, and events.
• Keep a revolving task list.
• Maintain an up-to-date contact list of phone numbers, addresses, and email addresses.
• Talk to family and friends about this challenge. Ask for their patience, understanding, and help.

If we have concerns about our working memory, it’s important to talk to our doctors about a referral to a behavioral health professional. There are neuropsychological tests that can measure our cognitive abilities and identify areas of needed improvement. The results can then be used to develop a behavioral treatment plan to improve executive functioning.

Sources:

¹ Dawson P, Guare R. Smart But Scattered: The revolutionary “executive skills” approach to helping kids reach their potential. New York: Guilford Press; 2009.

² Gil-Gouveia R, Oliveira A, Pavao Martins, I (2014). Cognitive dysfunction during Migraine attacks: A study on Migraine without aura. Cephalalgia. 2014;35:662-674. Doi: 10.1177/0333102414553823

³ Huang L, juan Dong H, Wang X, et al. (2017). Duration and frequency of Migraines affect cognitive function: evidence from neuropsychological tests and event-related potentials. Journal of Headache and Pain. 2017; 18:54. Doi: 10.1186/s10194-017-0758-6.

⁴ Koppen H, Palm-Meinders I, Kruit M, et al. (2011). The impact of a Migraine attack and its after-effects on perceptual organization, attention, and working memory. Cephalalgia. 2011;31(14):1419-1427. doi:10.1177/0333102411417900.