Vestibular Neuroscience for the Headache Specialist

Abstract

Background.-The vestibular system is a multifaceted, integrative sensory system that is often referred to as the "multi-sensory" sense. There is an extensive literature about the vestibular sensory organs and afferent nerve pathways; however, this rich resource is often unknown to the headache specialist.Aims.-In this review, we highlight the significance of vestibular sensory processing beyond its role in the maintenance of balance. The role of the vestibular system in migraine pathophysiology is emphasized, not just in how it impacts dizziness or nausea, but also in its higher order effects on mood and cognition. How the vestibular system responds to current and new migraine therapies, such as anti-CGRP (calcitonin gene-related peptide) antibodies, is also discussed.Conclusions.-The vestibular system is not just about balance; this should be taken into account by clinicians as they assess their patients' associated non-headache symptoms. There is a co-occurrence of migraine and vestibular-based problems and a confluence of disciplines relevant to vestibular migraine.Abbreviations: 5-HT receptors (5-hydroxytryptamine), (serotonin receptors) class of G protein coupled receptor and ligandgated ion channels. The subscript designations refer to specific receptor types, ATPase adenosine triphosphatase, an enzyme that catalyzes the hydrolysis or decomposition of ATP (adenosine triphosphate) into ADP (adenosine diphosphate) and a free phosphate ion, BOLD fMRI blood oxygen level-dependent functional magnetic resonance imaging, Cav2.1 voltage-dependent calcium channel, c-FOS protein that is often used as an indirect marker of neuronal activity, ICHD-3 International Classification of Headache Disorders, NaKA sodiumpotassium ATPase, SSRI selective serotonin reuptake inhibitor, Substance P neuropeptide that may affect vasodilation, inflammation, pain expression, and other regulated processes, TRPV1 transient receptor potential cation channel subfamily V, member 1, UCP2, 3 mitochondrial uncoupling protein 2 (or 3) HEADACHE CURRENTS Headache CurrentsHeadache Headache Currents mismatch") 20 can result in motion sickness, simulator sickness, and cybersickness. [21][22][23][24][25][26] Other somatic, non-vestibular signals that are involved in balance control and spatial orientation have been reviewed elsewhere 7 Since every tissue in the body has mass (including blood), linear acceleration (including gravity) alters sensory signals from baroreceptors, visceral pressure receptors, and somatic proprioceptors. These multiple sensory inputs simultaneously coordinate motor and autonomic responses during movement and changes in posture, particularly during unusual conditions (eg, swimming underwater). Vestibular Sensory PeripheryBody and head movements produce inertial and gravitational forces that are detected by vestibular sensory organs. 27 Since these organs are embedded in the temporal bone of the skull, the sensory information is "head-referenced." These organs are similar in structure in all vertebrates with jaws. 28 There are...

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