Balance Impairments in Different Subgroups of Patients With Migraine

Carvalho, Gabriela Ferreira; Bonato, Paolo; Florêncio, Lidiane Lima; Pinheiro, Carina Ferreira; Dach, Fabíola; Bigal, Marcelo E.; Bevilaqua-Grossi, Débora

doi:10.1111/head.13009

Cited by 25 publications

(67 citation statements)

References 43 publications

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“…Migraineurs present a high prevalence of vestibular symptoms, such as dizziness and vertigo [1][2][3][4][5][6][7][8][9][10]. The cooccurrence of these symptoms with migraine is more frequent than expected by chance [10,11] during both the ictal and interictal period [6,9], and it can augment the impact on migraineurs' quality of life [1,4]. In that way, these symptoms can be considered as either part of the migraine presentation [11] or a different classificationas described in the Appendix of the International Classification of Headache Disorders (ICHD-III) as vestibular migraine [12], which was jointly formulated with the Committee for Classification of Vestibular Disorders of the Bárány Society [13].…”

Section: Introductionmentioning

confidence: 99%

“…In that way, these symptoms can be considered as either part of the migraine presentation [11] or a different classificationas described in the Appendix of the International Classification of Headache Disorders (ICHD-III) as vestibular migraine [12], which was jointly formulated with the Committee for Classification of Vestibular Disorders of the Bárány Society [13]. Patients with chronic migraine and migraine with aura present more prevalence of vestibular symptoms compared to migraineurs without aura [1][2][3][4][5][6]9]. Furthermore, it has been suggested that the presence of aura and headache frequency can predict dizziness handicap [4].…”

Section: Introductionmentioning

confidence: 99%

“…In addition to vestibular symptoms, migraineurs often present balance disorders [5,7,9,[14][15][16][17][18], which is also augmented by the presence of aura and chronicity in the interictal [5][6][7] and ictal period [19]. Without considering the migraine subdiagnosis, some studies suggest that migraineurs with vestibular symptoms present more balance instability [15,20] in association with [20] or without otoneurologic alterations [15].…”

Section: Introductionmentioning

confidence: 99%

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Subdiagnosis, but not presence of vestibular symptoms, predicts balance impairment in migraine patients – a cross sectional study

et al. 2020

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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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Subdiagnosis, but not presence of vestibular symptoms, predicts balance impairment in migraine patients – a cross sectional study

et al. 2020

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“…Moreover, over 1.5-fold increase was detected for vestibular function, visual disturbances and dizziness (H81, H53, R42). It is possible that these changes may reflect migraine comorbidity related to balance and postural impairment as previously shown [14,[32][33][34]. Moreover, these may be linked to challenges in bodyboard control as detected in clinical practice for migraine patients.…”

Section: Increased Comorbidity Based On Phenotypic Disease Networkmentioning

confidence: 81%

Burden of migraine in Finland: multimorbidity and phenotypic disease networks in occupational healthcare

Korolainen¹,

Tuominen²,

Kurki

et al. 2020

J Headache Pain

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Background: Migraine is a complex neurological disorder with high co-existing morbidity burden. The aim of our study was to examine the overall morbidity and phenotypic diseasome for migraine among people of working age using real world data collected as a part of routine clinical practice. Methods: Electronic medical records (EMR) of patients with migraine (n = 17,623) and age-and gender matched controls (n = 17,623) were included in this retrospective analysis. EMRs were assessed for the prevalence of ICD-10 codes, those with at least two significant phi correlations, and a prevalence >2.5% in migraine patients were included to phenotypic disease networks (PDN) for further analysis. An automatic subnetwork detection algorithm was applied in order to cluster the diagnoses within the PDNs. The diagnosis-wise connectivity based on the PDNs was compared between migraine patients and controls to assess differences in morbidity patterns. Results: The mean number of diagnoses per patient was increased 1.7-fold in migraine compared to controls. Altogether 1337 different ICD-10 codes were detected in EMRs of migraine patients. Monodiagnosis was present in 1% and 13%, and the median number of diagnoses was 12 and 6 in migraine patients and controls. The number of significant phi-correlations was 2.3-fold increased, and cluster analysis showed more clusters in those with migraine vs. controls (9 vs. 6). For migraine, the PDN was larger and denser and exhibited one large cluster containing fatigue, respiratory, sympathetic nervous system, gastrointestinal, infection, mental and mood disorder diagnoses. Migraine patients were more likely affected by multiple conditions compared to controls, even if no notable differences in morbidity patterns were identified through connectivity measures. Frequencies of ICD-10 codes on a three character and block level were increased across the whole diagnostic spectrum in migraine. Conclusions: Migraine was associated with an increased multimorbidity, evidenced by multiple different approaches in the study. A systematic increase in the morbidity across the whole spectrum of ICD-10 coded diagnoses, and when interpreting PDNs, were detected in migraine patients. However, no specific diagnoses explained the morbidity. The results reflect clinical praxis, but also undoubtedly, the pathophysiological phenotypes related to migraine, and emphasize the importance of better understanding migraine-related morbidity.

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“…Posture control alterations have been demonstrated in migraineurs through increased sway area 12,13 and sway velocity, 14 as well as decreased stability limits, expressed by longer reaction time, lower velocity, and smaller excursion limits compared to controls 15 . These individuals also exhibit a longer time to perform functional activities, including gait tasks, sit‐to‐stand transitions, and stepping up/down, 16 and greater self‐reported falls than controls 17 …”

Section: Introductionmentioning

confidence: 99%

The Influence of Photophobia on Postural Control in Patients With Migraine

et al. 2020

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Background People with migraine exhibit postural control impairments. These patients also have an increased light sensitivity due to the disease, and it remains during the headache‐free period. It is currently unknown if increased lighting levels can alter the balance control, especially in individuals with visual hypersensitivity, such as migraineurs. This study aimed to assess the balance and photophobia of women with migraine and non‐headache controls under different light conditions. Methods This cross‐sectional study consisted of 14 women with migraine (mean ± SD 30.6 ± 8.1 years old) and 14 women without any kind of headache (mean ± SD 27.2 ± 2.8 years old) screened from a tertiary headache clinical hospital and the local community. Quiet standing balance was evaluated during bipodal and unipodal support, under 3 light conditions: ambient (AMB) – 270 lx, visual discomfort threshold (VDT) – 400 lx, and intense visual discomfort (IVD) – 2000 lx. Sway area of the center of pressure was processed and compared between groups. The association of migraine with the risk of presenting a greater imbalance in the discomfort lighting conditions was verified. Results Compared to the non‐headache controls, the migraine group presented greater sway area in bipodal stance under the 3 light conditions (mean difference (95% CI)): AMB 0.81 cm2 (0.19 to 1.43), P = .011; VDT 3.17 cm2 (0.74 to 5.60), P = .001; IVD 5.56 cm2 (2.75 to 8.37), P < .0001. Within‐subject analysis showed increased sway area in bipodal stance among all lighting conditions for the migraine group only (mean difference (95% CI)): VDT‐AMB 2.20 cm2 (0.23 to 4.18), P = .024; IVD‐AMB 4.50 cm2 (2.38 to 6.62), P < .0001, IVD‐VDT 2.29 cm2 (0.57 to 4.01), P = .005. The Prevalence Ratio (PR) analysis showed that migraine was associated with the risk of presenting greater imbalance in both bipodal and unipodal standing conditions for both VDT (PR value (95% CI) – bipodal: PR = 4.00 (1.02 to 15.59), P = .045; unipodal: PR = 4.00 (1.43 to 11.15), P = .008), and the IVD (bipodal: PR = 3.33 (1.13 to 9.58), P = .025; unipodal: PR = 5.50 (1.48 to 20.42), P = .010) lighting conditions. Conclusion Photophobia might be a disturbing factor that worsens the balance of patients with migraine during the quiet standing posture.

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Balance Impairments in Different Subgroups of Patients With Migraine

Cited by 25 publications

References 43 publications

Subdiagnosis, but not presence of vestibular symptoms, predicts balance impairment in migraine patients – a cross sectional study

Subdiagnosis, but not presence of vestibular symptoms, predicts balance impairment in migraine patients – a cross sectional study

Burden of migraine in Finland: multimorbidity and phenotypic disease networks in occupational healthcare

The Influence of Photophobia on Postural Control in Patients With Migraine

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