Computerized Assessment Shows
Balance Dysfunction in Migraine

BY DIANA MAHONEY
Elsevier Global Medical News

BOSTON (EGMN) - Evidence of postural instability on computerized dynamic posturography in individuals with a history of migraine verifies the long-presumed anecdotal link between balance problems and migraine, Dr. Gulden Akdal said May 1 at the annual meeting of the American Academy of Neurology.

In a study designed to assess postural balance in migraineurs, Dr. Akdal of Dokuz Eylul University, Izmir, Turkey, and colleagues conducted standard computerized dynamic posturography (CDP) investigations of 25 patients with migraine and 25 age- and gender-matched unaffected controls. All of the migraineurs met criteria for migraine set forth in the second edition of the International Classification for Headache Disorders (ICHD-2) of the International Headache Society, and none manifested vestibulopathy.

An established test of postural stability, CDP assesses the three major senses involved in balance: the vestibular sense, vision, and proprioception and somatosensation. A force-plate system measures body sway under different visual and postural conditions. The system determines subjects' reliance on particular sensory information by comparing sway to normative values for each condition.

In the current investigation, the CDP sensory organization test measured subjects' stability under the following conditions: standing on a firm platform and on a foam platform with eyes open, with eyes closed, and with different head positions (neutral, retroflexed, turned to the right, turned to the left), and walking on the platform with eyes open and eyes closed. Additionally, CDP limits of stability testing - whereby subjects change their center of gravity over the base of support to reach eight different points without moving - was used to investigate subjects' control of the gravity center while maintaining an upright posture. Each test was conducted three times for 10 seconds, Dr. Akdal said.

The migraine group differed significantly from the control group in the mean on-platform and on-foam eyes-open and eyes-closed sway velocity, according to statistical analysis using the Mann-Whitney U test, Dr. Akdal reported. Additionally, there were significant differences for comprehensive sway velocity in the left head turn; in maximal excursion and reaction time limits of stability; and in tandem walking, he said.

The findings of disturbed balance in the migraineurs suggest that they have an underlying dysfunction in the vestibulospinal system, Dr. Akdal concluded. In terms of intervention, the CDP data can provide useful information for assessing the effect of migraine therapy on balance status and for customizing vestibular rehabilitation exercises to improve balance and decrease the subjective sensation of dizziness.

"Vertigo is common in migraineurs, and this can leave a mild permanent impairment of balance. Balance rehabilitation can be given to the patients who experience some balance problems during daily activities," Dr. Akdal noted.

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