Migraine Frequency and Aura Impacts Sensory Organization

Gabriela F. Carvalho, PT, PhD

After undergoing a comprehensive evaluation protocol that included the Sensory Organization Test (SOT) and otoneurological examination, newly published data suggests the presence of aura and greater migraine severity are related to falls and balance impairments. No otoneurological alterations were detected among the cohort, and the diagnosis of vestibular migraine did not influence balance performance.

To the authors’ knowledge, this was the first publication showing lower composite SOT scores among patients with migraine compared with headache-free controls. This was observed across all migraine groups, including those with a diagnosis of episodic migraine with aura (MWA: 66.5; 95% CI, 63.6-69.3), without aura (MWoA: 76.5; 95% CI, 73.6-79.3), and chronic migraine (CM: 69.1; 95% CI, 66.3-72.0). For reference, the control group (CG) had composite SOT scores of 82.4 (95% CI, 79.5-85.3).

Lead author Gabriela F. Carvalho, PT, PhD, University of Luebeck, and colleagues concluded that these results "point toward a need for a more tailored rehabilitation to restore the sensory systems responsible for postural control in patients with migraine, especially with aura or a high frequency of attacks are reported." In total, the cross-sectional study included 120 women, aged 18-55 years with and without migraine, who were screened at a tertiary headache clinical at the Ribeirao Preto Clinics Hospital in Brazil. As part of their evaluation protocol, individuals underwent computerized dynamic posturography and electronystagmography, along with SOT and otoneurological examination.

FIGURE. Sensory Organization Test Protocol.
(click to enlarge)

The SOT protocol was composed of 6 assessment conditions (FIGURE). Each of the represented groups—MWA, MWoA, CM, and CG—had 30 individuals included in the analysis. While all patients with migraine had lower SOT composite scores than controls, the MWA and CM groups also had lower scores than those with MWoA. Additionally, lower scores in the visual and vestibular symptoms were found in the groups with CM and MWA compared with the MWoA and CG.

Patients were classified with vestibular migraine if they presented with at least 5 episodes of vestibular symptoms lasting 5 minutes to 72 hours that are associated with migraine features such as migraine headache, visual aura, or photo- and phonophobia. When vestibular migraine diagnosis was plugged as a covariate, results of the composite score (F = 3.33; P = .70), visual score (F = 2.11; P = .149), vestibular score (F = 1.88; P = .172), and somatosensory score (F = 0.00; P = .993) did not significantly change.

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On SOT, there were several significant negative correlations between headache and psychosocial features that ranged from weak to moderate. They included the Falls Efficacy Scale-International (r = –0.44; 95% CI, –0.57 to –0.30), Dizziness Handicap Inventory (r = –0.37; 95% CI, –0.54 to –0.19), Tampa (r = –0.38; 95% CI, –0.46 to –0.06), Patient Health Questionnaire-Ninth Edition (r = –0.25; 95% CI, –0.53 to –0.22), migraine frequency (r = –0.38; 95% CI, –0.54 to –0.22), aura frequency (r = –0.26; 95% CI, –0.38 to –0.13) and age (r = –0.21; 95% CI, –0.37 to –0.05).

Patients with aura showed greater sway area than controls and patients with MWoA for all 6 SOT conditions. Between the MWA and CM groups, there were differences in SOT conditions 3 and 4. In conditions 4, 5, and 6, patients with CM had greater sway area than controls. The results of the sway area in all conditions were not influenced by diagnosis of vestibular migraine (F range, 0.00-0.71; P values range, 0.791-0.987).

At the conclusion of the analysis, there was a higher occurrence of falls among patients with migraine than HC. Self-reported falls occurred in 60% (n = 18) of those with CM, 73% (n = 22) in MWA, 30% (n = 9) in MWoA, and 3% (n = 1) of those in the CG. All 4 groups included in the study did not differ regarding abnormalities in the caloric testing, rotatory chair testing, and the presence of nystagmus or asymmetrical gain during the optokinetic test.

REFERENCE
1. Carvalho GF, Luedtke K, Pinheiro CF, et al. Migraine and balance impairment: influence of subdiagnosis, otoneurological function, falls, and psychosocial factors. Headache. Published online May 20, 2022. doi:10.1111/head.14309