A study published in the December 2016 issue of Headache concluded that people with migraine have poorer balance control that those without migraine. Poor balance and dizziness are often reported by patients and earlier studies have confirmed the existence of such impairments. Based on previous studies the team of researchers expected to see impaired balance control in patients with chronic migraine and those with migraine with aura. They did not expect to find balance impairment in patients with migraine without aura. Despite this assumption, their results showed that all three types of migraine can negatively impact balance.
The study was designed to test balance in four population groups: migraine without aura, migraine with aura, [chronic migraine](<a%20href=), and a control group of healthy volunteers. Thirty-five volunteers were recruited for each group, for a total of 140 subjects.
Volunteers were excluded if they had any other health problems that might contribute to poor balance control. Patients with other headache disorders, a body mass index (BMI) greater than 30, any musculoskeletal disability or vestibular disease, fibromyalgia, uncontrolled hypertension, rheumatoid arthritis, or diabetes were excluded from the test group. None of the subjects tested had taken any pain relieving medications 24 hours prior to the assessment and no migraine patient was tested during an attack.
Each participant was given a questionnaire to identify specific characteristics that were also being tested. Subjects were asked about the time of first migraine onset, frequency and intensity of pain, BMI, medication use, physical activity levels, and whether they experienced any dizziness during or between migraine attacks.
The evaluator who performed all tests was not informed of any participant’s diagnosis. Each subject was asked to perform two tests.
The first test was designed to test a person’s stability while standing upright, feet about 15 cm apart and arms at their side. Subjects were asked to stand for 30 seconds in this position on a firm surface, first with eyes open and then with eyes closed. Next, each person was asked to stand on a foam block (20x50x50 cm) for 30 seconds with eyes open and then again for 30 seconds with eyes closed. Each step was repeated three times.
The second test evaluated a person’s ability to maintain balance while leaning in various directions and recovering to a standing position. Detailed measurements were recorded on reaction time, how fast each subject leaned and how far they leaned. Like the first test, each step was repeated three times.
Subjects in all three migraine groups showed impairments in balance control, regardless of age, activity level, intensity or duration of attacks, or the presence of dizziness. Their reaction times and speed were slower than the healthy control group, too. Subjects with chronic migraine and migraine with aura performed the worst, but even those with migraine without aura showed impairment when compared to those without migraine at all. Balance control impairments were worse for those with chronic migraine and migraine with aura. Subjects who reported more frequent attacks, and long disease duration also performed worse.
Thirty-eight percent of migraine patients report dizziness, even between attacks, yet the study results showed that this symptom had no impact on the presence of balance control impairment. These impairments appear to be linked to migraine itself. Feeling dizzy is not a reliable sign of balance problems. Even patients who reported no dizziness still showed impairment. Subjects who reported longer disease duration showed more impairment, so it is possible that balance impairment could worsen over time in patients with migraine. Impairments were found to be more severe for those with chronic migraine and migraine with aura, too.
Suggestions for future research
This study did not attempt to explain how balance is impaired or why it occurs. Researchers suggested that the white matter lesions present in many with migraine may be involved and should be studied for a possible link. They recommended that future studies explore how this balance impairment affects daily life and identify appropriate interventions to prevent deterioration in balance control over time. Additionally, they encouraged routine balance evaluations for all migraine patients.
What it means for you
If you have migraine, it is important to know that your balance could be impaired even between attacks. According to this study, feeling dizzy is not a reliable sign of impairment. We need to take precautions to prevent falls all the time, not just during a migraine attack or when we feel dizzy. Talk to your migraine and headache specialist and ask for an objective balance evaluation to understand your individual risk.
1 Carvalho, G; Bonato, P; Florencio, L; Pinheiro, C; Dach, F; Bigal, M; Bevilaqua-Grossi, D. Balance Impairments in Different Subgroups of Patients With Migraine. Headache. December 19, 2016. 10.1111/head.13009
Reviewed by David Watson, MD.
© Tammy Rome, 2017.
Headache disorders advocate, blogger, and mental health therapist, Tammy maintains a private practice specializing in behavioral pain management, as well as writing for her own blog, Brain Storm. She also volunteers as Vice Chair of the American Headache and Migraine Association and as President of The Cluster Headache Support Group. You can read more of Tammy’s work on her blog and follow her on Facebook, Twitter, StumbleUpon, Pinterest, LinkedIn, and Google+.