Visually Evoked Postural Responses (VEPRs) in Children with Vestibular Migraine

Abstract

Vestibular migraine (VM) is the most common cause of episodic vertigo in children. Vertigo, nausea, dizziness and unsteadiness are often complained of by children with migraine, which can precede, follow or be present simultaneously with headache. The aim of this study was to use posturography to investigate the visually evoked postural responses (VEPRs) of children with VM and compare them to data obtained from children with primary headache (M) and controls (C). Twenty children diagnosed as affected by VM, nineteen children with M without aura and twenty healthy subjects were recruited in this cross-sectional study. Posturography was performed by a standardized stabilometric force-platform (Svep-Politecnica) in the following conditions: open eyes (OE), closed eyes (CE) and during full-field horizontal optokinetic stimulation (OKN-S). Electronystagmography was performed simultaneously to analyze optokinetic reflex parameters. In the OE condition, no difference was found between groups with respect to body sway area. In contrast, this parameter increased in the two pathological groups with respect to controls in the CE condition. The optokinetic stimulations also induced a similar increase of body sway area in the M group relative to controls, but a further increase was elicited in the VM group. Electronystagmographic recording also revealed different optokinetic reflex parameters in the latter groups. This study disclosed an abnormal sensitivity of children with M and VM to full-field moving scenes and a consequent destabilization of posture, as documented by the abnormal VEPRs. Children with VM were particularly exposed to this risk. Possible clinical implications of these findings are discussed.

Pathophysiology and Therapy of Associated Features of Migraine

“…Patients with migraines exhibit greater visual and vestibular functional impairment, as well as lower results in the sensory organization test [ 208 ]. VM patients may be more sensitive to moving scenes and find it harder to maintain their posture [ 209 , 210 , 211 , 212 ], as they may tend to rely more on visual cues [ 213 ], whereas changes in the position of the head or posture could also trigger vestibular symptoms in some migrainous patients [ 28 ].…”

Facts of Vertigo in Adolescents: Controversies and Challenges – A Narrative Review

“…It is possible that estrogen fluctuations could control inner ear homeostasis, regulation of the endolymphatic fluid, and changes in electrolytic ionic and anionic function [ 29 ]. These hormonal fluctuations in women occur mainly during the menstrual cycle, pregnancy, and menopause, in which changes in the homeostasis of labyrinthine fluids can be generated, with a direct influence on enzymatic processes and neurotransmitter action [ 30 ]. The variation in the behavior of the labyrinthine fluids, as well as the interference in the sensitivity of the enzymatic receptors, influences the basal metabolism of the inner ear, thus justifying otological symptoms in women [ 29 ].…”

“…Regarding migraine headache and vertigo characteristics, there is only one reported variation in presentation, where adolescents more often present with bilateral migraine headache than adults [ 28 ]. This disease may present some difficulties in its diagnosis because of overlapping symptoms and other comorbidities such as psychiatric disorders, exacerbation of PPPD, or generalized anxiety disorder, that also may cause autonomic and vestibular symptoms [ 30 ]. One of the most important challenges in adolescence besides the presence of vestibular migraine is the concomitant presentation of motion sickness which can also be misdiagnosed and superposed to the presentation of vestibular migraine [ 30 ].…”

“…This disease may present some difficulties in its diagnosis because of overlapping symptoms and other comorbidities such as psychiatric disorders, exacerbation of PPPD, or generalized anxiety disorder, that also may cause autonomic and vestibular symptoms [ 30 ]. One of the most important challenges in adolescence besides the presence of vestibular migraine is the concomitant presentation of motion sickness which can also be misdiagnosed and superposed to the presentation of vestibular migraine [ 30 ]. This usually happens due to disturbances in the visual system, cues for spatial orientation, and a disability to integrate multisensory input to resolve sensory conflicting situations that may provoke imbalance and vertigo [ 30 ].…”

Balance Disorders in Children and Adolescents

“…A cross-sectional analysis to investigate the visually evoked postural responses by means of posturography in children with vestibular migraine when exposed to full-field horizontal optokinetic stimulation comparing to children with primary headache and controls was performed by Nocini et al [ 3 ]. Static posturography was performed by a standardized stabilometric force platform.…”