Brain Processing of Visual Self-Motion Stimuli in Patients With Migraine

Abstract

Objective:To investigate the behavioral and neuronal responses of patients with migraine to a visual stimulation of self-motion through a virtual roller coaster ride, in comparison to controls.Methods:Twenty consecutive migraine patients from a university-based hospital headache clinic and 20 controls were included. Participants underwent an experiment where a visually displayed self-motion paradigm was presented based on customized roller coaster videos during fMRI. Within each video, blocks of motion stimulation were interleaved with low speed upward motion in a random order. In the scanning intervals and after the experiment, participants rated their perceived level of vestibular symptoms and motion sickness during the videos. We hypothesized that migraine patients will perceive more motion sickness and that this correlates with a different central processing and brain responses.Results:Compared to controls, migraine patients reported more dizziness (65% versus 30% p= 0.03) and motion sickness [SSQ score 47.3 (95%CI 37.1, 57.5) versus 24.3 (95%CI 18.2, 30.4)] as well as longer symptom duration [01:19 min (95%CI 00:51, 01:48) versus 00:27 min (95%CI 00:03, 00:51)] and intensity [VAS 0-100, 22.0 (95%CI 14.8, 29.2) versus 9.9 (95%CI 4.9, 14.7)] during the virtual roller coaster ride. Neuronal activity in migraine patients were more pronounced in clusters within the superior [Contrast estimate 3.005 (90%CI 1.817, 4.194)] and inferior occipital gyrus [Contrast estimate 1.759 (90%CI 1.062, 2.456)], pontine nuclei [Contrast estimate 0.665 (90%CI 0.383, 0.946)] and within the cerebellar lobules V/VI [Contrast estimate 0.672 (90%CI 0.380, 0.964)], while decreased activity was seen in the cerebellar lobule VIIb [Contrast estimate 0.787 (90%CI 0.444, 1.130)] and in the middle frontal gyrus [Contrast estimate 0.962 (90%CI 0.557, 1.367)]. These activations correlated with migraine disability (r= -0.46, p= 0.04) and motion sickness scores (r= 0.32, p= 0.04). We further found enhanced connectivity between the pontine nuclei, cerebellar areas V/VI, interior and superior occipital gyrus with numerous cortical areas in migraine patients but not in controls.Conclusions:Migraine is related to abnormal modulation of visual motion stimuli within superior and inferior occipital gyrus, middle frontal gyrus, pontine nuclei, cerebellar lobules V, VI and VIIb. These abnormalities relate to migraine disability and motion sickness susceptibility.

Postural control impairment in patients with headaches—A systematic review and meta‐analysis

“…55,56 It is speculated that those symptoms manifest in patients with migraine because of central changes 7,46,52 related to the overlap between trigeminal and vestibular pathways 10,52,[57][58][59] and vasospasm-induced ischemia of the labyrinth and brainstem, 60,61 alongside cerebellar dysfunction. [11][12][13][14][15] In patients with tension-type and cervicogenic headache, balance alterations can be related to peripheral mechanisms, including altered neck proprioceptive afferences due to a great number of mechanoreceptors with central and reflex connections to the visual, vestibular, and central nervous systems. [16][17][18] Indeed, neck pain or muscle fatigue are related to a mismatch between abnormal information from the neck and normal information from the vestibular and visual systems.…”

“…[4][5][6][7][8] Among these comorbidities, balance dysfunction is often verified in patients with migraine, 4 followed by tension-type 9,10 and cervicogenic headache. 5 This clinical observation can be related to certain headache pathophysiological mechanisms, such as cerebellar dysfunction in migraine [11][12][13][14][15] or altered neck afferent inputs in tension-type and cervicogenic headache. [16][17][18][19] Despite the emerging number of publications on the topic, data from studies have never been combined in a systematic review.…”

The not so hidden impact of interictal burden in migraine: A narrative review

“…Patients with migraine also show interictal vestibular symptoms of dizziness and vertigo ( 23 ). Participants with migraine underwent fMRI while watching customized forward self-motion roller coaster videos on a screen, and rating their perceptions of dizziness and motion sickness during the interictal phase ( 23 ).…”

“…Participants with migraine underwent fMRI while watching customized forward self-motion roller coaster videos on a screen, and rating their perceptions of dizziness and motion sickness during the interictal phase ( 23 ). Changes in activity of brain regions (inferior and superior occipital gyrus, middle frontal gyrus, pontine nuclei, and cerebellar lobules V, VI, and VIIb) correlated with motion sickness and disability scores, suggesting an increased susceptibility to dizziness and motion sickness ( 23 ). It has been suggested that there are common mechanisms and neurologic pathways that contribute to symptoms of motion sickness and of migraine ( 24 ).…”

Prevalence and risk factors of migraine headache among university students: A cross-sectional study in Lebanon

“…5 The main reported headache triggers are stress, the beginning of the menstrual cycle in women, hunger, changes in the weather, a lack of sleep, strong scents such as perfumes, neck pain, light, alcohol, smoking, sleeping late, heat, certain foods, heavy exercise and sexual activity. 6,7 Diagnostic criteria have been developed to facilitate migraine diagnosis and management. These have allowed studies to achieve comparable statistics on the prevalence, incidence, and course of diseases.…”