Definition of Balance and Cognition Related to Disability Levels in Vestibular Migraine Patients

Abstract

Objective: To compare the balance and cognition of vestibular migraine (VM) patients with migraineurs without vertigo history and healthy subjects, and to examine the effects of disability level on these functions. Material-method:The study consisted of 32 VM patients, 32 migraineurs and 31 healthy subjects with similar sex and age. Balance functions were assessed with Balance Evaluation Systems Test (BEST), dizziness and headache severity with Visual Analogue Scale (VAS), disability related to dizziness with Dizziness Handicap Inventory (DHI), cognition with Stroop test.Results: There was no statistical significant difference among the three groups in terms of age, gender, height, weight, marital status and education levels (p>0.05). Headache severity was higher in migraineurs than vestibular migraineurs and healthy subjects, also dizziness severity was higher in vestibular migraineurs than migraineurs and healthy subjects (p<0.0167). The outcomes of BEST 4, 5, 6 and BESTtotal were significantly impaired in VM patients than migraineurs and healthy subjects, and worse in migraineurs rather than healthy subjects (p<0.0167). Stroop effect of cognitive examination was worse in VM and migraine patients rather than healthy subjects (p<0.0167). There was no significantly difference between VM and migraineurs (p>0.0167). There was a negative correlation between Stroop effect and BEST-total in VM patients significantly (r=-0.509, p=0.003), and no significant correlation in migraineurs (p>0.05). Disability levels of VM patients were low in 38.7%, mild in 51.6% and severe in 9.7% related to DHI. There was no significant difference between balance and cognition function in terms of disability levels (p>0.05). Conclusion:The balance and cognition in VM patients and migraineurs were impaired rather than healthy subjects. The patient groups differed from each other in terms of vertiginous complaints rather than cognition. Solving the functional limitations with further longitudinal examinations can facilitate the treatment. The appropriate physiotherapy programs and patient education methods can be planned for these various issues.

Altered structure of the vestibular cortex in patients with vestibular migraine

“…Demographic data were collected from the patients in a face‐to‐face interview with a standardized questionnaire and questions. Patients rated the pain intensity of migraine attacks using the VAS (0 = no pain; 10 = worst possible pain) and additionally completed the MIDAS, HIT‐6 and DHI (Balci, Senyuva, & Akdal, ; Sauro et al, ). Four patients with VM were on migraine‐preventive medications (e.g., beta‐blockers).…”

Vestibular Rehabilitation and Factors That Can Affect Outcome

“…20,26 Postural control, as measured with the Balance Evaluation Systems Test, and cognition (Stroop test) were compared in patients with VM and those with migraine alone. 27 The patients with migraine or VM had worse balance and cognition compared with age-matched control patients. 27 People who present with mixed central and peripheral vestibular disorders do not improve as much as patients with peripheral vestibular dysfunction do.…”

“…27 The patients with migraine or VM had worse balance and cognition compared with age-matched control patients. 27 People who present with mixed central and peripheral vestibular disorders do not improve as much as patients with peripheral vestibular dysfunction do. 28 There are, however, improvements noted in function and self-rated dizziness handicap scores, especially when they were poor at the outset of physical therapy.…”

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

“…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]. On the contrary, it is also evidenced no balance neither otoneurologic differences between patients with and without vestibular symptoms [6,[21][22][23][24][25].…”

“…Taking all together, it is not clear if the statements of worse balance in patients with vestibular migraine or migraine-associated dizziness are influenced by the migraine subdiagnosis, since patients with aura and chronic migraine present a high prevalence of structural brain alterations [26][27][28], balance impairments [5][6][7], vestibular symptoms [1][2][3][4][5] and dysfunctions [20]. To improve our understanding regarding the migraine spectrum and to ensure adequate classification and subsequent treatment, it is important to determine whether the balance instability of these patients is determined by the presence of vestibular symptoms or by the migraine features itself [15,20]. Therefore, our aim was to investigate the factors that could explain the balance alterations in migraine patients, including dizziness or vertigo, presence of aura and chronicity of the migraine.…”