Migraine and balance impairment: Influence of subdiagnosis, otoneurological function, falls, and psychosocial factors

• Published in: Headache Vol. 62; no. 5; pp. 548 - 557
• Main Authors: Carvalho, Gabriela F., Luedtke, Kerstin, Pinheiro, Carina F., Moraes, Renato, Lemos, Tenysson W., Carneiro, Camila G., Bigal, Marcelo E., Dach, Fabiola, Bevilaqua‐Grossi, Debora
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.05.2022
• Subjects: aura; Balance; computerized dynamic posturography; Confidence intervals; Diagnosis; Falls; Fear; Headache; Impairment; Migraine; Patients; postural balance; primary headache disorders; Psychological aspects; vestibular function tests; vestibular migraine; Vestibular system; postural balance; vestibular migraine; primary headache disorders; computerized dynamic posturography; aura; vestibular function tests
• ISSN: 0017-8748; 1526-4610
• DOI: 10.1111/head.14309

Objective To assess the balance sensory organization among patients with migraine, considering the influence of migraine subdiagnosis, otoneurological function, falls, and psychosocial factors. Background Migraine has been associated with vestibular symptoms and balance dysfunction; however, neither comprehensive balance assessment nor associated factors for greater impairment have been addressed thus far. Methods Patients from a tertiary headache clinic with a diagnosis of episodic migraine with aura (MWA), without aura (MWoA), and chronic migraine (CM) were included for this cross‐sectional study (30 patients per group). Thirty headache‐free controls (CG) were recruited. Participants underwent a comprehensive evaluation protocol, including the Sensory Organization Test (SOT) and otoneurological examination. Questionnaires about fear of falls, dizziness disability, and kinesiophobia were administered. Results All migraine groups presented lower composite SOT scores than controls (CG: 82.4 [95% confidence interval (CI): 79.5–85.3], MWoA: 76.5 [95% CI: 73.6–79.3], MWA: 66.5 [95% CI: 63.6–69.3], CM: 69.1 [95% CI: 66.3–72.0]; p < 0.0001). Compared to controls and to MWoA, MWA and CM groups exhibited greater vestibular (CG: 75.9 [95% CI: 71.3–80.4], MWoA: 67.3 [95% CI: 62.7–71.8], MWA: 55.7 [95% CI: 51.2–60.3], CM: 58.4 [95% CI: 53.8–63.0]; p < 0.0001) and visual functional impairment (CG: 89.6 [95% CI: 84.2–94.9], MWoA: 83.2 [95% CI: 77.9–88.6], MWA: 68.6 [95% CI: 63.3–74.0], CM: 71.9 [95% CI: 66.5–77.2], p < 0.0001). Fall events during the assessment were documented more often among patients with migraine (CG: 0.0, interquartile range [IQR], 0.0, 0.0); MWoA: 1.0 [IQR: 1.0, 1.0], MWA: 2.0 [IQR: 1.8, 4.3], CM: 1.0 [IQR: 1.0, 2.0]; p = 0.001). The SOT scores correlated with fear of falls (r = −0.44), dizziness disability (r = −0.37), kinesiophobia (r = −0.38), and migraine frequency (r = −0.38). There was no significant influence of the vestibular migraine diagnosis in the study outcomes when used as a covariate in the analysis (composite score [F = 3.33, p = 0.070], visual score [F = 2.11, p = 0.149], vestibular score [F = 1.88, p = 0.172], somatosensory score [F = 0.00, p = 0.993]). Conclusions Aura and greater migraine frequency were related to falls and balance impairment with sensory input manipulation, although no otoneurological alterations were detected. The diagnosis of vestibular migraine does not influence the balance performance. The vestibular/visual systems should be considered in the clinical examination and treatment of patients with migraine.