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OBJECTIVE: To assess the balance sensory organization among patients with migraine, considering the influence of migraine subdiagnosis, otoneurological function, falls, and psychosocial factors. BACKGROUND: Migraine has been associated with vestibular symptoms and balance dysfunction; however, neither comprehensive balance assessment nor associated factors for greater impairment have been addressed thus far. METHODS: Patients from a tertiary headache clinic with a diagnosis of episodic migraine with aura (MWA), without aura (MWoA), and chronic migraine (CM) were included for this cross-sectional study (30 patients per group). Thirty headache-free controls (CG) were recruited. Participants underwent a comprehensive evaluation protocol, including the Sensory Organization Test (SOT) and otoneurological examination. Questionnaires about fear of falls, dizziness disability, and kinesiophobia were administered. RESULTS: All migraine groups presented lower composite SOT scores than controls (CG: 82.4 [95% confidence interval (CI): 79.5-85.3], MWoA: 76.5 [95% CI: 73.6-79.3], MWA: 66.5 [95% CI: 63.6-69.3], CM: 69.1 [95% CI: 66.3-72.0]; p < 0.0001). Compared to controls and to MWoA, MWA and CM groups exhibited greater vestibular (CG: 75.9 [95% CI: 71.3-80.4], MWoA: 67.3 [95% CI: 62.7-71.8], MWA: 55.7 [95% CI: 51.2-60.3], CM: 58.4 [95% CI: 53.8-63.0]; p < 0.0001) and visual functional impairment (CG: 89.6 [95% CI: 84.2-94.9], MWoA: 83.2 [95% CI: 77.9-88.6], MWA: 68.6 [95% CI: 63.3-74.0], CM: 71.9 [95% CI: 66.5-77.2], p < 0.0001). Fall events during the assessment were documented more often among patients with migraine (CG: 0.0, interquartile range [IQR], 0.0, 0.0); MWoA: 1.0 [IQR: 1.0, 1.0], MWA: 2.0 [IQR: 1.8, 4.3], CM: 1.0 [IQR: 1.0, 2.0]; p = 0.001). The SOT scores correlated with fear of falls (r = -0.44), dizziness disability (r = -0.37), kinesiophobia (r = -0.38), and migraine frequency (r = -0.38). There was no significant influence of the vestibular migraine diagnosis in the study outcomes when used as a covariate in the analysis (composite score [F = 3.33, p = 0.070], visual score [F = 2.11, p = 0.149], vestibular score [F = 1.88, p = 0.172], somatosensory score [F = 0.00, p = 0.993]). CONCLUSIONS: Aura and greater migraine frequency were related to falls and balance impairment with sensory input manipulation, although no otoneurological alterations were detected. The diagnosis of vestibular migraine does not influence the balance performance. The vestibular/visual systems should be considered in the clinical examination and treatment of patients with migraine.
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Epilepsia , Transtornos de Enxaqueca , Enxaqueca com Aura , Estudos Transversais , Tontura/diagnóstico , Tontura/etiologia , Epilepsia/complicações , Humanos , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/diagnóstico , Equilíbrio Postural , Vertigem/complicações , Vertigem/diagnósticoRESUMO
INTRODUCTION: Kinesiophobia is a common symptom associated with high disability, and has been observed in patients with migraine. However, the association between kinesiophobia and clinical factors in this population is unknown. OBJECTIVE: To assess the fear of falling, dizziness disability, and migraine disability in patients with migraine, considering the presence of kinesiophobia. METHODS: Eighty patients with migraine completed the Tampa Scale for Kinesiophobia and were divided into two groups according to the questionnaire cutoff point: migraine without kinesiophobia (MoK, n = 39) and migraine with kinesiophobia (MK, n = 41). Fear of falling, dizziness disability, and migraine disability were assessed in both groups using validated questionnaires. RESULTS: The MK group presented higher scores on dizziness disability, fear of falling, and migraine disability compared to the MoK (p < .05). Kinesiophobia can explain 29% of the variance in dizziness disability and 18% of migraine disability. Both kinesiophobia and the presence of dizziness can explain 14% of fear of falling variability. Also, kinesiophobia is associated with the risk of presenting fear of falling (Prevalence Ratio = 2.4, p = .012), and migraine disability (Prevalence Ratio = 2.6, p = .01). CONCLUSION: The presence of kinesiophobia should be considered in clinical practice when evaluating migraine, as it is associated with increased levels of fear of falling, dizziness disability, and migraine disability.
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Medo , Transtornos de Enxaqueca , Humanos , Acidentes por Quedas/prevenção & controle , Avaliação da Deficiência , Tontura , Transtornos de Enxaqueca/complicações , VertigemRESUMO
Background: It is evidenced that migraineurs present balance deficits. However, the balance recovery following unexpected ground perturbations, which reflect conditions of everyday activities, has not been investigated in this population. Aim: We aimed to assess the reactive postural responses among patients with migraine with and without aura, chronic migraine, and controls. We further aimed to assess the factors associated with greater self-report of falls. Methods: Ninety patients diagnosed by headache specialists were equally classified into three migraine subgroups according to the presence of aura and chronic migraine. Thirty controls were also recruited. All participants underwent the motor control test (MCT) and adaptation test (ADT) protocols of dynamic posturography tests (EquiTest®, NeuroCom, USA). Clinical and headache features and information on falls in the previous year, fear of falling, and vestibular symptoms were also assessed. Results: Patients with aura presented a greater sway area in most of the MCT conditions than the other three groups (p = 0.001). The aura group also presented delayed latency responses after perturbations compared with controls and patients without aura (p < 0.03). In the ADT, a greater sway area was observed in patients with aura than in groups without aura, chronic migraine, and controls (p < 0.0001). The MCT and ADT sway area, the frequency of aura, and the fear of falling explained 46% of the falls in the previous 12 months. Conclusion: Patients with aura exhibited greater delay and sway area after unexpected ground perturbations than controls and other migraine subgroups, which are related to the reported number of falls.
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BACKGROUND: People with migraine exhibit postural control impairments. These patients also have an increased light sensitivity due to the disease, and it remains during the headache-free period. It is currently unknown if increased lighting levels can alter the balance control, especially in individuals with visual hypersensitivity, such as migraineurs. This study aimed to assess the balance and photophobia of women with migraine and non-headache controls under different light conditions. METHODS: This cross-sectional study consisted of 14 women with migraine (mean ± SD 30.6 ± 8.1 years old) and 14 women without any kind of headache (mean ± SD 27.2 ± 2.8 years old) screened from a tertiary headache clinical hospital and the local community. Quiet standing balance was evaluated during bipodal and unipodal support, under 3 light conditions: ambient (AMB) - 270 lx, visual discomfort threshold (VDT) - 400 lx, and intense visual discomfort (IVD) - 2000 lx. Sway area of the center of pressure was processed and compared between groups. The association of migraine with the risk of presenting a greater imbalance in the discomfort lighting conditions was verified. RESULTS: Compared to the non-headache controls, the migraine group presented greater sway area in bipodal stance under the 3 light conditions (mean difference (95% CI)): AMB 0.81 cm2 (0.19 to 1.43), P = .011; VDT 3.17 cm2 (0.74 to 5.60), P = .001; IVD 5.56 cm2 (2.75 to 8.37), P < .0001. Within-subject analysis showed increased sway area in bipodal stance among all lighting conditions for the migraine group only (mean difference (95% CI)): VDT-AMB 2.20 cm2 (0.23 to 4.18), P = .024; IVD-AMB 4.50 cm2 (2.38 to 6.62), P < .0001, IVD-VDT 2.29 cm2 (0.57 to 4.01), P = .005. The Prevalence Ratio (PR) analysis showed that migraine was associated with the risk of presenting greater imbalance in both bipodal and unipodal standing conditions for both VDT (PR value (95% CI) - bipodal: PR = 4.00 (1.02 to 15.59), P = .045; unipodal: PR = 4.00 (1.43 to 11.15), P = .008), and the IVD (bipodal: PR = 3.33 (1.13 to 9.58), P = .025; unipodal: PR = 5.50 (1.48 to 20.42), P = .010) lighting conditions. CONCLUSION: Photophobia might be a disturbing factor that worsens the balance of patients with migraine during the quiet standing posture.
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Transtornos de Enxaqueca/fisiopatologia , Fotofobia/fisiopatologia , Equilíbrio Postural/fisiologia , Adulto , Estudos Transversais , Feminino , Humanos , Transtornos de Enxaqueca/complicações , Fotofobia/etiologia , Adulto JovemRESUMO
OBJECTIVE: To assess the presence and handicap due to vestibular symptoms in three subgroups of patients with migraine and controls. METHODS: Women between 18-55 years old were diagnosed by headache specialists and stratified as migraine with aura (n = 60), migraine without aura (n = 60), chronic migraine (n = 60) and controls (n = 60). Information regarding demographics, headache and vestibular symptoms were collected in this cross-sectional study. The self-perceived handicap related to vestibular symptoms was assessed through the Dizziness Handicap Inventory questionnaire. RESULTS: A total of 85% of women with migraine with aura and chronic migraine had vestibular symptoms contrasted to 70% of the migraine without aura group ( p < 0.05), and 12% of the control group reported symptoms ( p < 0.0001). Patients with migraine exhibited greater Dizziness Handicap Inventory scores than controls ( p < 0.001); and migraine with aura and chronic migraine groups reached greater scores than migraine without aura ( p < 0.01). Presence of migraine is associated with a greater risk of vestibular symptoms (migraine without aura: 5.20, migraine with aura: 6.60, chronic migraine:6.20, p < 0.0003) and with a greater risk of moderate-to-severe handicap (migraine without aura: 20.0, migraine with aura: 40.0, chronic migraine: 40.0, p < 0.0003). The presence of aura and greater migraine frequency adds to the risk of any handicap (migraine with aura: 1.9, chronic migraine: 1.7, p < 0.04) and to the risk of moderate-to-severe handicap (migraine with aura: 2.0, chronic migraine: 2.0, p < 0.0003). Migraine aura, intensity and frequency predict 36% of the dizziness handicap. CONCLUSION: The prevalence of vestibular symptoms is increased in migraine during and between headache attacks, particularly in migraine with aura and chronic migraine along with an increased handicap due to those symptoms. Vestibular symptoms among subgroups of migraine should be considered when evaluating the functional impact of migraine.
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Transtornos de Enxaqueca/complicações , Transtornos de Sensação/etiologia , Adolescente , Adulto , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: Patients with migraine often experience balance impairments. However, the relationship between clinical features - like aura and chronicity - and the severity of balance impairments is not well established. The objective of this study was to assess balance impairments in different subgroups of migraine patients. METHOD: One hundred five subjects diagnosed according to the ICHD-III were recruited in the study. They were uniformly distributed among three groups: migraine with aura, migraine without aura, and chronic migraine. Thirty-five controls were also recruited in the study. Balance impairments were assessed in all subjects via the modified Sensory Organization test and the Limits of Stability test. The results in the four groups were compared using ANCOVA tests with age, BMI, presence of dizziness, level of physical activity, time of migraine onset, and medication intake as covariates. RESULTS: Subjects in the migraine with aura and the chronic migraine groups showed poorer balance control than control subjects in three of the four conditions tested using the modified Sensory Organization test: FirmCE: CG: 1.5 cm2 , 95%CI 1.3 to 1.7; M: 2.1 cm2 , 95%CI 1.6 to 2.6; MA: 4.5 cm2 , 95%CI 3.2 to 5.8; CM: 4.5 cm2 , 95%CI 3.0 to 6.0; P < .027; FoamOE: CG: 5.1 cm2 , 95%CI 4.6 to 5.6; M: 5.6 cm2 , 95%CI 5.0 to 6.1; MA: 8.8 cm2 , 95%CI 7.3 to 10.2; CM: 8.8 cm2 , 95%CI 7.7 to 10.0; P < .018; FoamCE: CG: 14.8 cm2 , 95%CI 13.7 to 15.9 cm2; M: 17.3 cm2 , 95%CI 15.4 to 19.1; MA: 21.9 cm2 , 95%CI 19.1 to 24.7; CM: 22.4 cm2 , 95%CI 19.9 to 24.9; P < .0001. In the FoamOE and FoamCE conditions, both groups also showed poorer postural control than subjects in the migraine without aura group (P < .01). Differences between control subjects and subjects in all the migraine groups were found in the reaction time, movement velocity, endpoint excursion, and maximal excursion parameters (P < .04) in all the directions tested during the Limits of Stability test. None of the covariates appeared to affect the balance parameters (P > .05). CONCLUSION: There is evidence of balance control impairments in subjects with all subtypes of migraine compared to control subjects. The presence of aura and frequent migraine attacks reflect negatively in the postural control performance and may have a significant clinical impact in patients with migraine that should be addressed with appropriate clinical interventions.
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Transtornos de Enxaqueca/classificação , Transtornos de Enxaqueca/complicações , Equilíbrio Postural/fisiologia , Transtornos de Sensação/etiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transtornos de Sensação/diagnóstico , Índice de Gravidade de Doença , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVES: The aim of this study was to assess differences in the levels of hyperalgesia and cutaneous allodynia (CA) among women with migraine, temporomandibular disorders (TMD), or both. MATERIALS AND METHODS: Eighty women participated in the study. Mean ages for the control group, TMD group, migraine group, and migraine+TMD group were 26.15 (95% confidence interval [CI], 28.73 to 23.57), 31.65 (95% CI, 37.82 to 25.48), 35.05 (95% CI, 40.37 to 29.73), and 34.20 (95% CI, 37.99 to 30.41) years, respectively. The 12-item Allodynia Symptom Checklist was administered to assess CA. All participants underwent the Quantitative Sensory Test to determine the cold-pain and heat-pain thresholds. Mechanical pain thresholds were assessed using Semmes-Weinstein monofilaments. One-way analysis of variance and χ tests were used for statistical analysis. Alpha was set at 0.05 level for statistical significance. RESULTS: For all sites evaluated, the mean cold-pain threshold values were significantly lower in the TMD, migraine, and TMD+migraine groups compared with the control group. However, the mean heat-pain threshold values in the extracephalic region were significantly smaller only for the TMD+migraine group compared with the control group (41.94°C; 95% CI, 40.54 to 43.34 vs. 44.79°C; 95% CI, 43.45 to 46.12; P=0.03). Mechanical hyperalgesia in orofacial and neck sites was significantly lower in the TMD and TMD+migraine groups compared with the control group. Mean total 12-item Allodynia Symptom Checklist score in the TMD+migraine group was significantly higher than in the migraine group (9.53; 95% CI, 7.45 to 11.60 vs. 6.95; 95% CI, 5.35 to 8.55; P=0.02). CONCLUSIONS: More pronounced levels of hyperalgesia and CA were found in patients with both TMD and migraine. Thus, it is suggested that the concomitant presence of TMD and migraine may be related to intensification of central sensitization.
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Temperatura Alta , Hiperalgesia/complicações , Transtornos de Enxaqueca/complicações , Transtornos da Articulação Temporomandibular/complicações , Adulto , Análise de Variância , Temperatura Baixa , Feminino , Humanos , Hiperalgesia/fisiopatologia , Transtornos de Enxaqueca/fisiopatologia , Limiar da Dor , Transtornos da Articulação Temporomandibular/fisiopatologia , TatoRESUMO
OBJECTIVE: To evaluate the use of analgesics in headache diagnosed in Outpatients Headache Clinic (ACEF), as well as his involvement in the activities of the patients. METHOD: 145 patients with headache seen at ACEF during the period August/July 2009/2010 underwent a questionnaire and interview with neurologist responsible for the final diagnosis according to ICHD-II. RESULTS: Relationship Women:Men 7:1. 1) Prevalence: Migraine without aura (52.4%), migraine with aura (12.4%), chronic migraine (15.2%) and medication overuse headache (MOH) (20%). 2) Analgesic drugs used: Compounds with Dipyrone (37%), Dipyrone (23%), Paracetamol (16%) compound with Paracetamol (6%), triptans (6%) and non steroidal anti-inflammatory drugs (12%). There was a significant decrease in the duration of pain and less interference in the activities of the headache patients after the use of analgesics. CONCLUSION: Prevalence of MOH has been increasing in population level and specialized services. New studies emphasizing the MOH are needed to assist in the improvement of their diagnostic and therapeutic approach.
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Analgésicos/uso terapêutico , Transtornos da Cefaleia Secundários/epidemiologia , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/epidemiologia , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Doença Crônica , Feminino , Humanos , Atividades de Lazer , Masculino , Pessoa de Meia-Idade , Clínicas de Dor/estatística & dados numéricos , Medição da Dor , Qualidade de Vida , Automedicação , Distribuição por Sexo , Inquéritos e Questionários , Fatores de Tempo , Trabalho , Adulto JovemRESUMO
Objective : To evaluate the use of analgesics in headache diagnosed in Outpatients Headache Clinic (ACEF), as well as his involvement in the activities of the patients. Method : 145 patients with headache seen at ACEF during the period August/July 2009/2010 underwent a questionnaire and interview with neurologist responsible for the final diagnosis according to ICHD-II. Results : Relationship Women:Men 7:1. 1) Prevalence: Migraine without aura (52.4%), migraine with aura (12.4%), chronic migraine (15.2%) and medication overuse headache (MOH) (20%). 2) Analgesic drugs used: Compounds with Dipyrone (37%), Dipyrone (23%), Paracetamol (16%) compound with Paracetamol (6%), triptans (6%) and non steroidal anti-inflammatory drugs (12%). There was a significant decrease in the duration of pain and less interference in the activities of the headache patients after the use of analgesics. Conclusion : Prevalence of MOH has been increasing in population level and specialized services. New studies emphasizing the MOH are needed to assist in the improvement of their diagnostic and therapeutic approach. .
Objetivo : Avaliar a utilização de analgésicos nas cefaleias diagnosticadas no Ambulatório de Cefaleias (ACEF), bem como a sua intervenção nas atividades dos pacientes. Método : 145 pacientes com cefaleia atendidos no ACEF durante o período entre Agosto/2009 a Julho/2010 foram submetidos a um questionário e à entrevista com médico neurologista responsável pelo diagnóstico final, segundo a ICHD-II. Resultados : Relação Mulheres:Homens de 7:1. 1) Prevalência: Migrânea sem aura (52,4%), migrânea com aura (12,4%), migrânea crônica (15,2%) e CEM (20%). 2) Analgésicos utilizados: Compostos com Dipirona (37%), Dipirona (23%), Paracetamol (16%), compostos com Paracetamol (6%), triptanos (6%) e drogas antiinflamatórias esteroidais (12%). Houve uma diminuição significativa da duração da dor e menor interferência da cefaleia nas atividades dos pacientes após o uso dos analgésicos. Conclusão : Prevalência da cefaleia por uso excessivo de medicamento (CEM) vem aumentando em nível populacional e em serviços especializados. Novos estudos enfatizando a CEM são necessários para auxiliar na melhora da sua abordagem diagnóstica e terapêutica. .
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Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Analgésicos/uso terapêutico , Transtornos da Cefaleia Secundários/epidemiologia , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/epidemiologia , Brasil/epidemiologia , Doença Crônica , Atividades de Lazer , Medição da Dor , Clínicas de Dor/estatística & dados numéricos , Qualidade de Vida , Automedicação , Distribuição por Sexo , Inquéritos e Questionários , Fatores de Tempo , TrabalhoRESUMO
OBJECTIVE: To describe patterns of psychosocial adjustment and psychological attributes in preadolescent children as a function of headache status in univariate and adjusted analyses. METHODS: Target sample of children (n = 8599) was representative of Brazil by demographics. Parents were interviewed using validated headache questionnaires and the "Strengths and Difficulties Questionnaire," which measures behavior in 5 domains. One-year prevalence estimates of headaches were derived by demographics. Relative risk of abnormal Strengths and Difficulties Questionnaire scores were separately modeled in children with episodic migraine and episodic tension-type headache using logistic regression. RESULTS: Sample consisted of 5671 children (65.9% of the target sample), from 5 to 12 years old (49.3% girls). Prevalence estimates in children were 20.6% for "no headache," 9% for episodic migraine, and 12.8% for episodic tension-type headache. Abnormal scores in psychosocial adjustment were significantly more likely in children with episodic migraine, relative to children without headaches and children with episodic tension-type headache, and was significantly influenced by frequency of headache attacks, nausea, school performance, prenatal exposure to tobacco, as well as by phonophobia and photophobia. CONCLUSIONS: Children with migraine are at an increased risk of having impairment in psychosocial adjustment, and the factors associated with this impairment have been mapped. Future studies should address the directionality of the association and putative mechanisms to explain it.