Study Summary: Vestibular Symptoms Related to Disability in Patients With Migraine

Background

Vestibular symptoms, including vertigo, dizziness, and symptoms related to motion, balance, and postural stability, are commonly associated with headaches. Vestibular symptoms are prevalent in patients who experience migraines, with approximately 58% of patients displaying vestibular dysfunction. The presence of vestibular symptoms in patients with migraine could be a result of activation of sensory neurons caused by an overlap between the trigeminal and vestibular pathways. Migraine neurotransmitters may also affect the activity of vestibular neurons.¹

In this cross-sectional study, Carvalho and colleagues sought to investigate the association between migraine and vestibular symptoms, and patient-reported handicap associated with dizziness, in patients with migraine with and without aura and chronic migraine.¹

Study Design

The investigators screened patients diagnosed with migraine from a tertiary headache clinic from February 2014 to March 2015. Patients were classified as experiencing migraine with aura (MA), migraine without aura (MoA), or chronic migraine (CM) according to the International Classification of Headache Disorders, 3rd edition. Patients were considered to have CM if they experienced at least 15 days with headaches, with at least 8 headaches fulfilling the migraine criteria, within a month during the previous 3 months. Patients who experienced fewer than 15 days with headache during the previous 3 months were diagnosed as having either MA or MoA. Subjects who did not experience headaches were also included to serve as a control group (CG).¹

Patients included in this study were female patients aged 18 to 55 years with a migraine diagnosis in the previous year and the presence of at least 3 attacks within a month during the previous 3 months. Exclusion criteria included patients with a diagnosis of any concomitant headache (posttraumatic headache, tension-type headache, or medication-overuse headache), any musculoskeletal impairment that could affect balance, or any rheumatic, cardiovascular, neurologic, or metabolic systemic disease. Patients were also excluded if they were pregnant, had a history of or had taken any medications for vertigo, or experienced a migraine during the interview.¹

The investigators used a questionnaire to obtain information on patients’ demographics, migraine onset, pain intensity, attack frequency and duration, and presence and description of vestibular symptoms (during and between migraine attacks). The Dizziness Handicap Inventory (DHI) questionnaire, which is a validated tool to measure self-perceived handicap associated with vestibular symptoms, was also administered by a headache specialist.¹

Results

This study included 240 patients evenly distributed among groups (MA, MoA, CM, CG; n = 60 for all groups). Baseline demographics were similar among groups; however, patients with MA had a higher body mass index compared with the CG and MoA groups (P <.05), and patients with CM had greater frequency of headache than those with MoA and MA (P <.05).¹

Migraine was associated with an increased risk of vestibular symptoms in each of the 3 test groups compared with CG (P <.0001). Moreover, patients with CM and MA reported vestibular symptoms more often than patients with MoA (P <.05), and they reported more frequent symptoms of vertigo compared with CG and patients with MoA (P <.0001 and P <.05, respectively). Postural symptoms were also reported in the MoA and MA patient groups more often than in the CG (P <.05) (Table).¹

In patients with vestibular symptoms, average DHI scores were higher in the MA, MoA, and CM groups compared with the CG (P <.0001). Although risk of any handicap was greater among patients with migraines, the presence of aura and chronic migraines was associated with greater risk of handicap due to dizziness (P <.04). Patients with MA and CM displayed more frequent moderate and severe handicap, whereas patients in the MoA group and CG presented with a higher frequency of no or mild handicap (P <.05) (Table).¹

Conclusions

The relationship between migraines and vestibular symptoms and perceived handicap in patients has not been previously explored. Although there were limitations to this study, including the source of data collection, which may reduce generalizability, the results from this study support a possible association between migraine and vestibular symptoms, particularly in patients who experience migraine with aura or chronic migraine. The presence of aura and frequent migraine were associated with greater handicap severity, which impacted patients both physically and functionally.¹

Evidence suggests that vestibular symptoms may be an inherent migraine feature since symptoms were present during periods without the presence of headache. To improve management in patients with migraines, it is important to understand the effects of vestibular symptoms and the self-perceived handicap that may be experienced by patients.

Reference

1. Carvalho GF, Vianna-Bell FH, Florencio LL, et al. Presence of vestibular symptoms and related disability in migraine with and without aura and chronic migraine [published online January 1, 2018]. Cephalalgia. doi: 10.1177/0333102418769948.