In patients with migraine (especially in the ones with aura and chronic migraine), vestibular symptoms and balance changes are common. However, it is doubtful whether the balance changes are determined by the presence of vestibular symptoms or migraine sub diagnosis. The study results illustrated that in migraine patients, the migraine sub diagnosis, instead of the presence of vestibular symptoms, can forecast balance dysfunction. Thus, balance instability is linked with the occurrence of migraine chronicity and aura. It should be taken into account even in patients without a self-report of vestibular symptoms.

This cross-sectional analysis was conducted in migraineurs to validate whether the migraine sub diagnosis and/or the presence of vestibular symptoms can aid the prediction of postural sway.

From a tertiary outpatient headache clinic in Brazil, a total of 153 migraineurs accepted to participate in the study. According to the ICHD-III (International Classification of Headache Disorders) criteria, these patients were classified into migraine with aura (n = 49), without aura (n = 53), and chronic migraine (n = 51). Furthermore, 54 headache-free participants were included as a control group. All the recruited participants responded to a structured questionnaire related to the occurrence of vestibular symptoms (such as vertigo and dizziness), and migraine features. On an AMTI© force plate, the participants executed the Modified Sensory Organization Test. Using a linear mixed-effect regression model, the data were analyzed.

The presence of vestibular symptoms was not a substantial predictor of postural control impairments. On the other hand, migraine sub diagnosis was a considerable predictor of postural sway. Migraineurs with aura demonstrated more sway in comparison with migraineurs without aura when the surface was unstable as depicted in Figure 1:

Figure 1: Predicted sway based on the model without and with vestibular symptoms. Left: Vestibular symptoms absent; Right: Vestibular symptoms present CG; control group, MoA; migraine without aura group, MA; migraine with aura group, CM; chronic migraine group

Moreover, high effect sizes (ES > 0.79) for postural sway differences were witnessed between patients with chronic migraine or with aura in comparison with controls or migraine without aura. Across sub diagnosis of migraine groups, remarkable differences were only witnessed under the foam, but not firm, surface condition.

In migraine patients, diagnosis, but not the presence of vestibular symptoms predicts postural sway.