Subdiagnosis, but Not Presence of Vestibular Symptoms, Predicts Balance Impairment in Migraine Patients - a Cross Sectional Study

Overview

Journal J Headache Pain

Publisher Biomed Central

Date 2020 May 26

PMID 32448118

Citations 6

Authors

Leticia Zorzin

Gabriela F Carvalho

Jens Kreitewolf

Roberto Teggi

Carina F Pinheiro

Jessica R Moreira

Fabiola Dach

Debora Bevilaqua-Grossi

Affiliations

Soon will be listed here.

Abstract

Background: Vestibular symptoms and balance changes are common in patients with migraine, especially in the ones with aura and chronic migraine. However, it is not known if the balance changes are determined by the presence of vestibular symptoms or migraine subdiagnosis. Therefore, the aim of this study was to verify if the migraine subdiagnosis and/or the presence of vestibular symptoms can predict balance dysfunction in migraineurs.

Methods: The study included 49 women diagnosed with migraine with aura, 53 without aura, 51 with chronic migraine, and 54 headache-free women. All participants answered a structured questionnaire regarding migraine features and presence of vestibular symptoms, such as dizziness/vertigo. The participants performed the Modified Sensory Organization Test on an AMTI© force plate. The data were analysed using a linear mixed-effect regression model.

Results: The presence of vestibular symptoms did not predict postural sway, but the subdiagnosis was a significant predictor of postural sway. Migraine with aura patients exhibited more sway than migraine patients without aura when the surface was unstable. Additionally, we found high effect sizes (ES > 0.79) for postural sway differences between patients with chronic migraine or with aura compared to controls or migraine without aura, suggesting that these results are clinically relevant.

Conclusions: The subdiagnosis of migraine, instead of the presence of vestibular symptoms, can predict postural control impairments observed in migraineurs. This lends support to the notion that balance instability is related to the presence of aura and migraine chronicity, and that it should be considered even in patients without vestibular symptoms.

Citing Articles

Local Dynamic Stability of Trunk During Gait Can Detect Dynamic Imbalance in Subjects with Episodic Migraine.

Castiglia S, Sebastianelli G, Abagnale C, Casillo F, Trabassi D, Di Lorenzo C Sensors (Basel). 2024; 24(23).

PMID: 39686163 PMC: 11644986. DOI: 10.3390/s24237627.

Interictal widespread pressure hyperalgesia and aura: associations with vestibular migraine in a cross-sectional study.

Toriyama T, Hanaoka Y, Horiuchi T Front Neurol. 2024; 15:1405590.

PMID: 39022731 PMC: 11253371. DOI: 10.3389/fneur.2024.1405590.

Impairments to the multisensory integration brain regions during migraine chronification: correlation with the vestibular dysfunction.

Dong L, Fan X, Fan Y, Li X, Li H, Zhou J Front Mol Neurosci. 2023; 16:1153641.

PMID: 37465368 PMC: 10350528. DOI: 10.3389/fnmol.2023.1153641.

Central sensorimotor integration assessment reveals deficits in standing balance control in people with chronic mild traumatic brain injury.

Campbell K, King L, Parrington L, Fino P, Antonellis P, Peterka R Front Neurol. 2022; 13:897454.

PMID: 36341095 PMC: 9634071. DOI: 10.3389/fneur.2022.897454.

The effects of visual context on visual-vestibular mismatch revealed by electrodermal and postural response measures.

Al-Sharif D, Tucker C, Coffman D, Keshner E J Neuroeng Rehabil. 2022; 19(1):113.

PMID: 36266687 PMC: 9584264. DOI: 10.1186/s12984-022-01093-5.

References

de Vries R, Hartogs B, Morey R . A Tutorial on Computing Bayes Factors for Single-Subject Designs. Behav Ther. 2015; 46(6):809-23. DOI: 10.1016/j.beth.2014.09.013. View

Obermann M, Wurthmann S, Steinberg B, Theysohn N, Diener H, Naegel S . Central vestibular system modulation in vestibular migraine. Cephalalgia. 2014; 34(13):1053-61. DOI: 10.1177/0333102414527650. View

Luke S . Evaluating significance in linear mixed-effects models in R. Behav Res Methods. 2016; 49(4):1494-1502. DOI: 10.3758/s13428-016-0809-y. View

Schmitz N, Admiraal-Behloul F, Arkink E, Kruit M, Schoonman G, Ferrari M . Attack frequency and disease duration as indicators for brain damage in migraine. Headache. 2008; 48(7):1044-55. DOI: 10.1111/j.1526-4610.2008.01133.x. View

Russo A, Tessitore A, Tedeschi G . Vestibular migraine. J Headache Pain. 2017; 16(Suppl 1):A48. PMC: 4759326. DOI: 10.1186/1129-2377-16-S1-A48. View

Kreitewolf J, Wostmann M, Tune S, Plochl M, Obleser J . Working-memory disruption by task-irrelevant talkers depends on degree of talker familiarity. Atten Percept Psychophys. 2019; 81(4):1108-1118. DOI: 10.3758/s13414-019-01727-2. View

Kruit M, van Buchem M, Launer L, Terwindt G, Ferrari M . Migraine is associated with an increased risk of deep white matter lesions, subclinical posterior circulation infarcts and brain iron accumulation: the population-based MRI CAMERA study. Cephalalgia. 2009; 30(2):129-36. PMC: 3241741. DOI: 10.1111/j.1468-2982.2009.01904.x. View

Carvalho G, Vianna-Bell F, Florencio L, Pinheiro C, Dach F, Bigal M . Presence of vestibular symptoms and related disability in migraine with and without aura and chronic migraine. Cephalalgia. 2018; 39(1):29-37. DOI: 10.1177/0333102418769948. View

Kruit M, Launer L, Ferrari M, van Buchem M . Infarcts in the posterior circulation territory in migraine. The population-based MRI CAMERA study. Brain. 2005; 128(Pt 9):2068-77. DOI: 10.1093/brain/awh542. View

10.

Tedeschi G, Russo A, Conte F, Laura M, Tessitore A . Vestibular migraine pathophysiology: insights from structural and functional neuroimaging. Neurol Sci. 2015; 36 Suppl 1:37-40. DOI: 10.1007/s10072-015-2161-x. View

11.

Brandt T, Dieterich M . 'Excess anxiety' and 'less anxiety': both depend on vestibular function. Curr Opin Neurol. 2019; 33(1):136-141. DOI: 10.1097/WCO.0000000000000771. View

12.

Carvalho G, Almeida C, Florencio L, Pinheiro C, Dach F, Bigal M . Do patients with migraine experience an increased prevalence of falls and fear of falling? A cross-sectional study. Physiotherapy. 2018; 104(4):424-429. DOI: 10.1016/j.physio.2018.02.001. View

13.

Wrisley D, Whitney S . The effect of foot position on the modified clinical test of sensory interaction and balance. Arch Phys Med Rehabil. 2004; 85(2):335-8. DOI: 10.1016/j.apmr.2003.03.005. View

14.

Carvalho G, Chaves T, Dach F, Pinheiro C, Goncalves M, Florencio L . Influence of migraine and of migraine aura on balance and mobility--a controlled study. Headache. 2013; 53(7):1116-22. DOI: 10.1111/head.12135. View

15.

Kreitewolf J, Mathias S, von Kriegstein K . Implicit Talker Training Improves Comprehension of Auditory Speech in Noise. Front Psychol. 2017; 8:1584. PMC: 5603660. DOI: 10.3389/fpsyg.2017.01584. View

16.

Harno H, Hirvonen T, Kaunisto M, Aalto H, Levo H, Isotalo E . Subclinical vestibulocerebellar dysfunction in migraine with and without aura. Neurology. 2003; 61(12):1748-52. DOI: 10.1212/01.wnl.0000098882.82690.65. View

17.

Akdal G, Donmez B, Ozturk V, Angin S . Is balance normal in migraineurs without history of vertigo?. Headache. 2009; 49(3):419-25. DOI: 10.1111/j.1526-4610.2008.01256.x. View

18.

Balci B, Senyuva N, Akdal G . Definition of Balance and Cognition Related to Disability Levels in Vestibular Migraine Patients. Noro Psikiyatr Ars. 2018; 55(1):9-14. PMC: 6045802. DOI: 10.29399/npa.12617. View

19.

Ceylan M, Yalcin A . Coexistence of Symptoms Associated with Trigeminal Pathways in Chronic and Episodic Migraine and the Effects on Quality of Life. Pain Med. 2018; 20(1):172-179. DOI: 10.1093/pm/pny118. View

20.

Panichi R, Cipriani L, Sarchielli P, DI Mauro M, Pettorossi V, Ricci G . Balance control impairment induced after OKS in patients with vestibular migraine: an intercritical marker. Eur Arch Otorhinolaryngol. 2014; 272(9):2275-82. DOI: 10.1007/s00405-014-3179-z. View