title: Balance Impairments in Different Subgroups of Patients With Migraine.
abstract: 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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation - Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto-SP, Brazil.
authors.forename: Gabriela F
authors.initials: GF
authors.lastname: Carvalho
authors.affiliation: Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, MA, USA.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bonato
authors.affiliation: Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation - Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto-SP, Brazil.
authors.forename: Lidiane L
authors.initials: LL
authors.lastname: Florencio
authors.affiliation: Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation - Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto-SP, Brazil.
authors.forename: Carina F
authors.initials: CF
authors.lastname: Pinheiro
authors.affiliation: Department of Neurosciences and Behavioral Sciences - Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto-SP, Brazil.
authors.forename: Fabiola
authors.initials: F
authors.lastname: Dach
authors.affiliation: Research and Development Department, Teva Pharmaceuticals, Frazer, PA, USA.
authors.forename: Marcelo E
authors.initials: ME
authors.lastname: Bigal
authors.affiliation: Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation - Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto-SP, Brazil.
authors.forename: Debora
authors.initials: D
authors.lastname: Bevilaqua-Grossi
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000145:classification* / Q000150:complications*; D004856:Postural Balance / Q000502:physiology*; D012189:Retrospective Studies; D012678:Sensation Disorders / Q000175:diagnosis / Q000209:etiology*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: balance; chronic migraine; migraine with aura; postural control