Migraine and IQ: Are People With Migraines More Intelligent?

People with migraine are not more intelligent than people without it. Population studies that test whole communities find that people with migraine score about the same as everyone else on intelligence tests, with at most a small disadvantage on some verbal measures.

Migraine is common. A review of 357 population-based publications put its global prevalence at about 14%, so any link with intelligence would matter to a lot of people. This page explains where the "migraine high IQ" idea came from, what large population studies actually find, how an attack affects thinking in the moment, whether years of migraine harm cognition, and what is known about children with migraine.

An old clinical belief held that migraine was more common among intelligent people and the higher social classes. That impression came from the patients doctors saw, and patients who reach a doctor are a selected group.

The first careful test of the idea came from Waters, who identified people with migraine, people with other headaches and people with no recent headache from a random general-population sample, then measured intelligence and social class in about 400 of them. He found no evidence that people with migraine were more intelligent or of higher social class. He did find a hint that more intelligent people with migraine, and people in the higher social classes, were more likely to consult a doctor about their headaches. That pattern would make clinic waiting rooms look clever without migraine itself having anything to do with intelligence.

Later population data point the same way. In the American Migraine Prevalence and Prevention Study, which surveyed more than 250,000 people aged 12 and older, migraine prevalence rose as household income fell, for both women and men. Stewart and colleagues found that the difference came mainly from a higher rate of new cases in lower-income groups. A condition that is more common at lower incomes is a poor candidate for a marker of high ability.

The best evidence comes from cohorts that measured ability before or regardless of headache status. Waldie and colleagues used the Dunedin study in New Zealand, a birth cohort followed from age 3, and classified headache at age 26 using International Headache Society criteria. People with migraine were "subtly but significantly" lower than both headache-free peers and people with tension-type headache on tests of verbal ability, especially language comprehension, from ages 3 to 13. Their reading, arithmetic and spatial ability were normal. Because the verbal difference appeared in early childhood and held regardless of headache history, the authors concluded that it was unlikely to be caused by repeated attacks.

In middle age the picture looks even more ordinary. Gaist and colleagues studied 1,393 Danish twins, 536 of whom had migraine diagnosed by neurologists. Average scores on verbal fluency, digit span, delayed word recall and a symbol substitution task did not differ between twins with and without migraine. Comparing twins within the same pair, where one had migraine and the other did not, gave the same answer.

A 2022 meta-analysis by Gu and colleagues reported lower "general cognitive function" in people with migraine (a standardized mean difference of -0.40) and slightly lower language scores (-0.14), with no reliable differences in attention, memory, executive function or visuospatial ability. The general measure in that analysis came from brief screening tools, the Mini-Mental State Examination and the Montreal Cognitive Assessment, which are built to detect impairment and are not IQ tests. Taken together, these studies describe a group that sits in the ordinary range, with a possible small verbal shortfall in some samples. If you want to know what the verbal side of a test measures, our guide to the Verbal Comprehension Index explains it.

Between attacks, most people with migraine think normally. During an attack, many do not. A systematic review by Gil-Gouveia and Martins pooled 24 clinical studies with 7,007 patients and found that cognitive complaints were the most frequent symptom of the prodrome (reported in about 30% of patients) and of the headache phase (about 38%), while fatigue dominated the recovery phase (about 70%).

This matters for anyone taking an intelligence test. A score obtained in the hours before, during or after an attack will tend to underestimate a person's usual ability, in the same way that illness, poor sleep or pain can. Our article on factors that affect your IQ test results covers these temporary influences. Anyone whose thinking does not clear between attacks, or whose aura brings new weakness or speech problems, should see a doctor promptly, because those features need a medical explanation.

Brain imaging raised a reasonable worry. In the Dutch CAMERA-2 study, Palm-Meinders and colleagues rescanned people with migraine and controls after 9 years. Women with migraine had a higher rate of new deep white matter hyperintensities, small bright spots on MRI (77% versus 60%), yet the lesions were not significantly linked to change in cognitive scores, and the number or frequency of migraine attacks did not predict their progression.

Long-term cognitive studies are reassuring. In the Women's Health Study, Rist and colleagues followed 6,349 women aged 65 and older with up to three rounds of cognitive testing. Women with migraine, with or without aura, did not decline faster than women without it, and they were not more likely to be among the 10% with the steepest decline. In the French EVA study of 1,170 adults followed for 4 to 5 years, migraine was not linked to faster decline in any cognitive domain, and people with migraine declined slightly less on the Wechsler Adult Intelligence Scale.

Two caveats deserve mention. Migraine with aura is associated with roughly twice the risk of ischaemic stroke (a pooled relative risk of 2.16 in a meta-analysis by Schürks and colleagues), and stroke can affect cognition, as our page on IQ and stroke explains. The increase was seen mainly in people with aura, and it was larger in women, in people under 45, in smokers and in women using oral contraceptives. The same 2022 meta-analysis also reported a modest association between migraine and later dementia (an odds or risk ratio of 1.30), based on observational studies that cannot rule out shared risk factors.

Migraine often begins in childhood. A 2022 narrative review by Tarantino and colleagues concluded that children and adolescents with migraine generally have normal intelligence, though some show an uneven profile with relative weaknesses in verbal comprehension, attention, processing speed and verbal memory between attacks. The authors stressed that the studies are small, use different methods and are far from conclusive.

For a child whose headaches are disrupting school, the useful steps are practical. A paediatrician or paediatric neurologist can confirm the diagnosis, and if learning problems persist between attacks, a school psychologist or neuropsychologist can test the child on a pain-free day so the results reflect the child's usual ability.

No. Population studies find that people with migraine score about average on intelligence tests, and the old belief that migraine favours the intelligent seems to come from who chooses to see a doctor.

Large studies of middle-aged and older adults find no faster cognitive decline in people with migraine. Some cohorts find a small verbal shortfall that was present in early childhood, before attacks began.

Yes. Cognitive symptoms are common before and during attacks, so a test taken then can underestimate usual ability. Testing on a headache-free day gives a fairer result.

Women with migraine in one Dutch study developed more small white matter spots on MRI over 9 years, but these were not significantly linked to cognitive change. Migraine with aura does carry a higher relative risk of stroke, which a doctor can assess.

Start with a GP or a neurologist. If problems persist between attacks, a neuropsychologist can carry out a full assessment.

Migraine and IQ are largely unrelated. The idea that migraine marks a brilliant mind came from clinic samples, and population studies that test everyone find ordinary scores, with a possible small verbal weakness in some groups and no faster decline over decades. The real cognitive cost of migraine is temporary: thinking can slow during an attack, so any test taken then will undersell a person's ability. If you have migraine and want an accurate benchmark of your reasoning, choose a headache-free day and take a full-length online IQ test.

1. Stovner, L. J., Hagen, K., Linde, M., & Steiner, T. J. (2022). The global prevalence of headache: An update, with analysis of the influences of methodological factors on prevalence estimates. The Journal of Headache and Pain, 23, 34. doi.org

2. Waters, W. E. (1971). Migraine: Intelligence, social class, and familial prevalence. British Medical Journal, 2(5753), 77-81. doi.org

3. Stewart, W. F., Roy, J., & Lipton, R. B. (2013). Migraine prevalence, socioeconomic status, and social causation. Neurology, 81(11), 948-955. doi.org

4. Waldie, K. E., Hausmann, M., Milne, B. J., & Poulton, R. (2002). Migraine and cognitive function: A life-course study. Neurology, 59(6), 904-908. doi.org

5. Gaist, D., Pedersen, L., Madsen, C., Tsiropoulos, I., Bak, S., Sindrup, S., McGue, M., Rasmussen, B. K., & Christensen, K. (2005). Long-term effects of migraine on cognitive function: A population-based study of Danish twins. Neurology, 64(4), 600-607. doi.org

6. Gu, L., Wang, Y., & Shu, H. (2022). Association between migraine and cognitive impairment. The Journal of Headache and Pain, 23, 88. doi.org

7. Gil-Gouveia, R., & Martins, I. P. (2018). Clinical description of attack-related cognitive symptoms in migraine: A systematic review. Cephalalgia, 38(7), 1335-1350. doi.org

8. Palm-Meinders, I. H., Koppen, H., Terwindt, G. M., Launer, L. J., Konishi, J., Moonen, J. M. E., ... Kruit, M. C. (2012). Structural brain changes in migraine. JAMA, 308(18), 1889-1897. doi.org

9. Rist, P. M., Kang, J. H., Buring, J. E., Glymour, M. M., Grodstein, F., & Kurth, T. (2012). Migraine and cognitive decline among women: Prospective cohort study. BMJ, 345, e5027. doi.org

10. Rist, P. M., Dufouil, C., Glymour, M. M., Tzourio, C., & Kurth, T. (2011). Migraine and cognitive decline in the population-based EVA study. Cephalalgia, 31(12), 1291-1300. doi.org

11. Schürks, M., Rist, P. M., Bigal, M. E., Buring, J. E., Lipton, R. B., & Kurth, T. (2009). Migraine and cardiovascular disease: Systematic review and meta-analysis. BMJ, 339, b3914. doi.org

12. Tarantino, S., Proietti Checchi, M., Papetti, L., Ursitti, F., Sforza, G., Ferilli, M. A. N., ... Valeriani, M. (2022). Interictal cognitive performance in children and adolescents with primary headache: A narrative review. Frontiers in Neurology, 13, 898626. doi.org

Hero image: Airy scotoma1, by H. Airy, public domain. Via Wikimedia Commons.