Migraines can cause altered speech

Almost 50% of patients with migraines experienced changes in speech during attacks, most commonly comprised of slowed speaking and decreases in the precision of articulation, according to results from a study in Cephalalgia.

“Difficulties with speech and language have been documented during the aura phase of migraine. Although changes in speech during other phases of the migraine attack are reported by patients, objectively measured changes in speech associated with migraine have been inadequately investigated during the non-aura phases of the migraine attack,” noted researchers led by Todd J. Schwedt, MD, neurologist, Department of Neurology, Mayo Clinic, Phoenix, AZ.

In this prospective, longitudinal, observational study, Dr. Schwedt and colleagues compared the effects of migraine on speech before, during, and after migraine attacks. Patients used a mobile app comprised of a speech elicitation tool to provide speech samples three times per day. Using the same app, patients maintained a daily headache diary as well, and were asked to continue until they had experienced 20 migraine attacks (for up to 6 months after study initiation).

“We hypothesized that subtle changes in speech, changes that an individual may or may not notice but that can be detected objectively, are present during the pre-attack phase (defined as 0–12 hours prior to an individual recognizing the start of a migraine attack) and headache phases of the migraine attack,” they explained.

Speech pattern testing was comprised of having patients read and recite five sentences, enunciate four vowel sounds for as long as possible, and repeat the word “buttercup” as many times as possible in one breath.

Dr. Schwedt and fellow researchers classified these samples according to pre-attack (0-12 hours before migraine onset) and interictal (48 hours before the start of an attack and 48 hours after the end of an attack). They measured the following:

• Articulatory precision;
• Rate features, including speaking, pause, and articulation rates;
• Vowel space area, related to the kinematics of speech production by the tongue and mouth;
• Energy decay slope, or the rate at which volume decreases over time;
• Phonatory duration, or the length of time a speaker can produce a vowel sound before taking a breath; and
• Average pitch.

Enrolled were 15 patients with migraine (average age: 44.5 years) and 15 age- and sex-matched healthy controls (average age: 43.1 years). In all, researchers collected 56,767 speech samples, for an average of 11 samples per session. A full 72.1% of migraine attacks were preceded by premonitory symptoms, according to the headache diaries, with the most common symptoms including light sensitivity and neck stiffness. In addition, 20% of patients with migraines reported problems speaking.

In migraineurs, they observed consistent speech changes in speaking rate, articulation rate and precision, and phonatory duration during migraines and during the pre-attack phase, compared with those without migraine. In 7 of the 15 patients with migraine, researchers also observed significant changes in at least one speech characteristic when comparing migraine attack with the interictal phase. Four had similar changes in comparisons of the pre-attack and interictal phases.

In patients without migraine, Dr. Schwedt and colleague observed significantly higher speaking and articulation rates, and lower average pitch compared with patients with migraine during the interictal phase.

Changes in speech did not statistically significantly differ in migraineurs between their pre-attack and migraine phases. But compared with the inter-ictal phase, average pitch was decreased during migraine, and speaking and articulation rates, and articulation entropy all differed significantly during the pre-attack and migraine phases.

Researchers suggested that speech changes may be a feature of migraine attacks, but their results need to be confirmed.

“Changes in speech patterns during migraine attacks might be expected given the relatively widespread alterations in brain function and functional connectivity that occur during migraine attacks. The ability to share our thoughts and ideas through spoken communication is a complex and fragile process,” wrote Dr. Schwedt and colleagues.

Surprisingly, some patients were aware of having problems with their speech, with 20% retrospectively recalling this during the premonitory phase, and 27% prospectively reporting problems.

These researchers found, however, a weak relationship between self-reported changes and objectively measured ones.

“In fact, none of the four individuals who had significant objectively measured changes in speech when comparing the migraine pre-attack to interictal phases self-recognized such speech changes. These results suggest a poor relationship between actual changes in speech and one’s self-perception of speech changes associated with migraine attacks. Patient self-report of speech changes might be inadequate for detecting subtle changes in speech that occur in some patients with migraine attacks,” they wrote.

Dr. Schwedt and colleagues are hopeful, however, that further study into the association between speech alterations and migraines will continue.

“The relative ease with which speech samples can be collected using mobile technology makes it appealing as an objective marker for oncoming or existing migraine attacks,” they concluded.

This research was supported by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.