Abstract
Background: The King-Devick test (KDT) is a timed rapid number naming task that involves complex cerebral functions. The objective of this study was to determine whether there is a difference in the KDT during the interictal phase compared to the prodrome phase, migraine headache attack, postdrome phase or non-migraine headache attack.
Methods: This prospective observational study evaluated 30 adult subjects with migraine with aura (n=15) or migraine without aura (n=15), per International Classification of Headache Disorders 3rd edition criteria. The participants completed a minimum of three symptom diary entries and KDT entries each day for up to 4 months. Diary entries included a self-report of what migraine phase or headache type they felt they were in and what symptoms they were experiencing at that moment. Primary KDT outcome was time in seconds to complete the test with zero errors.
Results: Mean age of participants was 44 years old (range 23 – 65) with the majority being female (29/30, 96.7%) and identifying as White race (27/30,90.0%). The KDT time with zero errors was significantly slower during prodrome, migraine headache, and postdrome phases of migraine attacks and non-migraine headache attacks compared to the interictal baseline (Table 1); with the slowest changes observed during the migraine headache phase (median 3.8 seconds slower, p<0.001) compared to interictal baseline. The slowing of the KDT time with zero errors during the different phases of migraine and non-migraine headache was more prominent in those with migraine with aura compared to subjects with migraine without aura (Table 2). Additionally, the slowing noted during a migraine headache was more prominent than during a non-migraine headache.
Conclusions: This observational study shows significant changes in the KDT time with zero errors during different phases of migraine and non-migraine headache attacks compared to the interictal phase; with changes being more prominent among subjects with migraine with aura. This study highlights that cerebral function changes could be detected starting during the prodrome phase and continue throughout the migraine headache and postdrome phases. It also provides initial data to suggest a potential role for the KDT to act as an objective tool to assess patient state during different phases of migraine and possibly distinguish migraine from non-migraine headache.
Summary Points:
- Significant changes in the King-Devick test were observed in the prodrome phase and continued throughout the different phases of migraine and non-migraine headache attacks compared to the interictal phase; with changes being more prominent among subjects with migraine with aura.