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

Abstract

ObjectiveTo summarize the evidence regarding static and dynamic balance alterations among patients with headache.MethodsElectronic databases (PubMed, CINAHL, and Web of Science) were searched by two researchers independently up to September 2021. Two reviewers selected eligible studies, extracted the data, and assessed the quality of evidence using the Downs and Black checklist. Case‐control studies were included if they involved balance assessment of any kind of headache, including objective outcome measures of dynamic and static tests such as body sway displacement, limits of stability (LOS), gait, and tandem walk tests. A meta‐analysis and post hoc sensitivity analyses were performed when possible.ResultsTwenty‐two studies (1202 patients with headache and 597 controls) were included in this review and 16 of them in the meta‐analysis. Risk of bias ranged from low to moderate among all studies. Greater sway area in static posturography was shown by patients with migraine in comparison to controls, with more consistent differences in more challenging test conditions, such as over a foam surface with eyes closed (difference of 4.8 cm2, 95% CI: 3.8–5.9). Lower performance of patients with migraine during the tandem walk test (difference of −7.8 cm/s, 95% CI: −9.0 to −6.5) and slower reaction time in the LOS test (difference of 0.3 s, 95% CI: 0.2–0.4) were also verified. There is no evidence of altered sway velocity and length in static posturography among patients with migraine (p > 0.05). The level of evidence is very low for balance alteration of any kind among patients with tension‐type and cervicogenic headache owing to the limited number of studies and high heterogeneity.ConclusionThis review confirmed the presence of static and dynamic balance alterations among patients with migraine. Future studies with low risk of bias are needed to decrease heterogeneity in methodology and explore the role of subdiagnosis on the balance of patients with headache.

Effectiveness of cerebellar vermis intermittent theta-burst stimulation in improving trunk control and balance function for patients with subacute stroke: a randomised controlled trial protocol

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Diagnosis of comorbid migraine without aura in patients with idiopathic/genetic epilepsy based on the gray zone approach to the International Classification of Headache Disorders 3 criteria

“…Vertigo/dizziness is one of the most frequent migraine accompaniments and was reported between 30 and 54% of the patients with migraine ( 33 – 36 ). Although the underlying mechanisms are still not conclusively highlighted, it is speculated that vertigo and dizziness in patients with migraine may primarily be related to the functional changes in the central structures (the inner ear, brainstem, cerebellum, basal ganglia, and the hemispheres) because vestibular and trigeminal pathways overlap each other ( 37 – 39 ).…”

Association between central sensitization, pain sensitivity and balance control in patients with migraine

“…Further than signs and symptoms of central sensitization, patients with migraine often experience the presence of vestibular symptoms (Calhoun et al, 2011;Carvalho et al, 2017) and alterations in balance control during simple tasks such as quiet standing (Carvalho et al, 2017(Carvalho et al, , 2018Carvalho, Becnel, et al, 2022), as well as in functional activities such as walking, bypassing obstacles or sit to standing tasks (Carvalho et al, 2018). Similarly to the cutaneous allodynia phenomenon, greater alterations in balance control are reported for patients with chronic migraine and migraine with aura (Carvalho et al, 2017;Zorzin et al, 2020).…”