Premorbid migraine history as a risk factor for vestibular and oculomotor baseline concussion assessment in pediatric athletes

2019 ◽  
Vol 23 (4) ◽  
pp. 465-470 ◽  
Author(s):  
Ryan N. Moran ◽  
Tracey Covassin ◽  
Jessica Wallace
Keyword(s):  
Risk Factor ◽  
Smooth Pursuit ◽  
Migraine Headache ◽  
Visual Motion ◽  
Assessment Tools ◽  
Motion Sensitivity ◽  
Ocular Reflex ◽  
Migraine Headaches ◽  
Vestibular Ocular Reflex ◽  
History Of

OBJECTIVEMigraine history has recently been identified as a risk factor for concussion and recovery. The authors performed a cross-sectional study examining baseline outcome measures on newly developed and implemented concussion assessment tools in pediatrics. The purpose of this study was to examine the effects of premorbid, diagnosed migraine headaches as a risk factor on vestibular and oculomotor baseline assessment in pediatric athletes.METHODSPediatric athletes between the ages of 8 and 14 years with a diagnosed history of migraine headache (n = 28) and matched controls without a history of diagnosed migraine headache (n = 28) were administered a baseline concussion assessment battery, consisting of the Vestibular/Ocular Motor Screening (VOMS), near point of convergence (NPC), and the King-Devick (K-D) tests. Between-groups comparisons were performed for vestibular symptoms and provocation scores on the VOMS (smooth pursuit, saccades, convergence, vestibular/ocular reflex, visual motion sensitivity), NPC (average distance), and K-D (time).RESULTSIndividuals diagnosed with migraine headaches reported greater VOMS smooth pursuit scores (p = 0.02), convergence scores (p = 0.04), vestibular ocular reflex scores (p value range 0.002–0.04), and visual motion sensitivity scores (p = 0.009). Differences were also observed on K-D oculomotor performance with worse times in those diagnosed with migraine headache (p = 0.02). No differences were reported on NPC distance (p = 0.06) or headache symptom reporting (p = 0.07) prior to the VOMS assessment.CONCLUSIONSPediatric athletes diagnosed with migraine headaches reported higher baseline symptom provocation scores on the VOMS. Athletes with migraine headaches also performed worse on the K-D test, further illustrating the influence of premorbid migraine headaches as a risk factor for elevated concussion assessment outcomes at baseline. Special consideration may be warranted for post-concussion assessment in athletes with migraine headaches.

scholarly journals Incremental Validity of Components of the Vestibular/Ocular Motor Screening for Concussion

2019 ◽  
Vol 34 (5) ◽  
pp. 769-769
Author(s):  
N Sandel Sherry ◽  
N Ernst ◽  
J Doman ◽  
C Holland ◽  
H Bitzer ◽  
...  
Keyword(s):  
Visual Motion ◽  
Symptomatic Patient ◽  
Incremental Validity ◽  
Ocular Motor ◽  
Final Model ◽  
Motion Sensitivity ◽  
Symptom Provocation ◽  
Ocular Reflex ◽  
Vestibular Ocular Reflex ◽  
Total Score Range

Abstract Purpose The Vestibular/Ocular Motor Screening (VOMS) tool for concussion evaluates symptom provocation (in a fixed order) across the following neuromotor tasks: smooth pursuits (SP), saccades-horizontal (Sac-H), saccades-vertical (Sac-V), near point of convergence (NPC), vestibular-ocular reflex-horizontal (VOR-H), vestibular-ocular reflex-vertical (VOR-V), and visual motion sensitivity (VMS). The current study evaluates the incremental validity of each VOMS component in consecutive order. Methods Retrospective record review of 193 subjects (49% male) aged 10–22 years old diagnosed with concussion (sport and non-sport injuries) and demonstrated an abnormal VOMS (defined by symptom provocation >2 or NPC >5cm) at initial evaluation in a specialty concussion clinic. Hierarchical regression was performed with VOMS total score (range: 0-320) as the dependent variable and each VOMS component as predictors in seven consecutive steps. Results The model was significant (p<.001) at each step; the final model including all seven VOMS components in order (SP, Sac-H, Sac-V, NPC, VOR-H, VOR-V, and VMS) was significant, F(7,185)= 6.87, p<.001 and accounted for 20.6% of the variance in total VOMS score. The only significant predictors in the final model included: SP (p=.01), NPC (p=.04), and VOR-H (p=.04). Conclusion Provocation of symptoms on SP, NPC, and VOR-H are the best predictors of total VOMS score. NPC and VOR-H symptom provocation provide unique value to vestibular screening beyond symptom provocation on SP and after completion of all other VOMS components. This information may be clinically useful when vestibular screening must be expedited (e.g., highly symptomatic patient, sideline assessment).

scholarly journals Influence of Pre-Morbid Migraine History on Baseline Vestibular/Ocular Motor Screening and King-Devick Test Performance

2019 ◽  
Vol 34 (5) ◽  
pp. 743-743
Author(s):  
R N Moran ◽  
J Wallace ◽  
T Covassin
Keyword(s):  
Smooth Pursuit ◽  
Test Performance ◽  
Visual Motion ◽  
Average Distance ◽  
Control Group ◽  
Ocular Motor ◽  
Cross Sectional ◽  
Motion Sensitivity ◽  
Youth Athletes ◽  
Migraine Headaches

Abstract Purpose To examine the effects of premorbid migraine history on baseline Vestibular/Ocular Motor Screening (VOMS) and King-Devick (KD) test performance in youth athletes. Methods This study implemented a cross-sectional design and was conducted at a series of youth sport venues in a designated research area. Youth athletes between the ages of 8 and 14 years with a diagnosed history of migraine headaches (n=28) and match controls (n=28) were administered a baseline VOMS and KD test. Between-group comparisons for provocation scores on the VOMS (smooth pursuit, saccades, convergence, vestibular-ocular reflex [VOR], and visual motion sensitivity [VMS]), Near-point of convergence [NPC] average distance (cm), and KD time (seconds) were conducted. Results Individuals diagnosed with migraine headaches reported greater VOMS scores compared to match controls on smooth pursuit (0.43±1.1 vs. 0.00±0.0; p=.02), convergence (0.46±1.2 vs. 0.04±0.1; p=.04), horizontal VOR (0.89±1.4 vs. 0.07±0.2; p<.001), vertical VOR (0.61±1.1 vs. 0.11±0.3; p=.04), and VMS (0.86±1.5 vs. 0.04±0.1; p=.01). Differences were also observed on the KD test with worse times in the diagnosed migraine group (54.33±11.8s) compared to match controls (47.17±8.9s; p=.02). No differences were reported on NPC distance between the migraine (2.22±3.1cm) and control group (0.83±1.2; p=.06). Conclusion Youth athletes with diagnosed migraine history reported higher baseline VOMS scores and worse KD time compared to match controls, further illustrating the influence of premorbid migraine headaches as a risk factor for elevated baseline concussion assessment. Special consideration may be warranted for post-concussion assessment in athletes with diagnosed migraine headaches.

Case Report: Management of a Patient with mTBI and Vestibular Hypofunction with the Binasal Occlusion Technique

2018 ◽  
pp. 87-90
Keyword(s):  
Case Report ◽  
Visual Motion ◽  
Hand Movement ◽  
Motion Sensitivity ◽  
Vestibular Hypofunction ◽  
First Case ◽  
Neurological Exam ◽  
History Of ◽  
Occlusion Technique ◽  
Visual Vertigo

Background: Binasal Occlusion (BNO) is a clinical technique used by many neurorehabilitative optometrists in patients with mild traumatic brain injury (mTBI) and increased visual motion sensitivity (VMS) or visual vertigo. BNO is a technique in which partial occluders are added to the spectacle lenses to suppress the abnormal peripheral visual motion information. This technique helps in reducing VMS symptoms (i.e., nausea, dizziness, balance difficulty, visual confusion). Case Report: A 44-year-old AA female presented for a routine eye exam with a history of mTBI approximately 33 years ago. She was suffering from severe dizziness for the last two years that was adversely impacting her ADLs. The dizziness occurred in all body positions and all environments throughout the day. She was diagnosed with vestibular hypofunction and had undergone vestibular therapy but reported little improvement. Neurological exam revealed dizziness with both OKN drum and hand movement, especially in the left visual field. BNO technique resulted in immediate relief of her dizziness symptoms. Conclusion: To our knowledge, this is the first case that illustrates how the BNO technique in isolation can be beneficial for patients with mTBI and vestibular hypofunction. It demonstrates the success that BNO has in filtering abnormal peripheral visual motion in these patients.

Second Cervical Root Neurofibroma and Ipsilateral Migraine Headache

Cephalalgia ◽  
1993 ◽  
Vol 13 (2) ◽  
pp. 132-134 ◽  
Author(s):  
Leo Goldhammer
Keyword(s):  
Migraine With Aura ◽  
Case History ◽  
Migraine Headache ◽  
Surgical Removal ◽  
Migraine Headaches ◽  
Affected Side ◽  
History Of ◽  
Cervical Root

This is a case history of a 38–year-old woman with a dumbbell-shaped C2 neurofibroma associated with right-sided classic migraine headaches (migraine with aura) and cervical trigeminal signs on the affected side. Surgical removal of the tumor was followed by resolution of the migraine headaches and persistence of the signs of cervicotrigeminal involvement.

scholarly journals The Frequency of Food Allergy Among Children With Migraine Headache; A Descriptive Cross-Sectional Study

2020 ◽  
Vol 14 (1) ◽  
pp. 46-52
Author(s):  
Akefeh Ahmadiafshar ◽  
Mohammad Vafaee-Shahi ◽  
Saeide Ghasemi ◽  
Fariba Khosroshahi ◽  
Aina Riahi
Keyword(s):  
Food Allergy ◽  
Skin Test ◽  
Migraine Headache ◽  
Critical Role ◽  
Food Allergies ◽  
Cross Sectional ◽  
Positive Skin ◽  
Migraine Headaches ◽  
Allergy Test ◽  
History Of

Background: Headache and particularly migraine headaches are considered as a debilitating disease worldwide that can adversely affect the quality of life of children and adults. Various factors can play a critical role in the development of migraine headache attacks. The food allergens are considered as important factors. This study aimed to determine the frequency of food allergy in children with migraine headaches. Methods: Forty patients aged <16 years with a migraine headache were entered into the study. A questionnaire was provided in which data on demographic information and skin test results for various allergens were recorded. Dietary allergies were defined based on a positive skin test plus a patient's history of food allergies. The severity of migraine was evaluated using the Migraine disability assessment score (MIDAS) questionnaire. Results: The present study showed 32.5% of our participants had a food allergy. No significant association was detected between sex (p=58) and age (p=0.14) with food allergy. However, the frequency of food allergy was significantly higher in patients aged ≥12 years old (44.4%) than those aged <12 (22.7%). A significant relationship was found between the number of attacks after prophylaxis and the frequency of food allergies (p=0.032). Individuals with lower attacks had a lower food allergy. Conclusion: Our findings revealed that about one-third of children with a migraine headache had a food allergy. This frequency was significantly higher in children with migraines than that of the general population based on the results of previous studies. It is recommended that these patients receive a skin allergy test while preparing a strong history of food allergies or when the frequency of migraine attacks does not decrease significantly despite proper prophylaxis.

Measurement of oscillopsia induced by vestibular Coriolis stimulation

2008 ◽  
Vol 17 (5-6) ◽  
pp. 289-299
Author(s):  
Jeffrey Sanderson ◽  
Charles M. Oman ◽  
Laurence R. Harris
Keyword(s):  
Time Constant ◽  
Head Movement ◽  
Visual Motion ◽  
Visual Display ◽  
Illusory Motion ◽  
Time Constants ◽  
Ocular Reflex ◽  
Visual Elements ◽  
Vestibular Ocular Reflex ◽  
Complex Models

We demonstrate a new method for measuring the time constant of head-movement-contingent oscillopsia (HMCO) produced by vestibular Coriolis stimulation. Subjects briskly rotated their heads around pitch or roll axes whilst seated on a platform rotating at constant velocity. This induced a cross-coupled vestibular Coriolis illusion. Simultaneous with the head movement, a visual display consisting of either a moving field of white dots on a black background or superimposed on a subject-stationary horizon, or a complete virtual room with conventional furnishings appeared. The scene's motion was driven by a simplified computer model of the Coriolis illusion. Subjects either nulled (if visual motion was against the illusory body rotation) or matched (if motion was in the same direction as the illusory motion) the sensation with the exponentially slowing scene motion, by indicating whether its decline was too fast or too slow. The model time constant was approximated using a staircase technique. Time constants comparable to that of the Coriolis vestibular ocular reflex were obtained. Time constants could be significantly reduced by adding subject-stationary visual elements. This technique for measuring oscillopsia might be used to quantify adaptation to artificial gravity environments. In principle more complex models can be used, and applied to other types of oscillopsia such as are experienced by BPPV patients or by astronauts returning to Earth.

Age at menarche and risk of developing migraine or non-migraine headaches by young adulthood: A prospective cohort study

Cephalalgia ◽  
2016 ◽  
Vol 37 (13) ◽  
pp. 1257-1263 ◽  
Author(s):  
Nasim Maleki ◽  
Tobias Kurth ◽  
Alison E Field
Keyword(s):  
Cohort Study ◽  
Family History ◽  
Young Adulthood ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Migraine Headache ◽  
The United States ◽  
Age At Menarche ◽  
Migraine Headaches ◽  
History Of

Importance Migraine is a highly prevalent and disabling primary headache disorder that is two to three times more prevalent in young women. Among females, there is a steep increase in incidence from puberty to young adulthood, but the mechanisms for the increase are unknown. Objective To determine if age of menarche is a risk factor for developing migraine headache vs. non-migraine headache by young adulthood. Design A prospective cohort study, The Growing Up Today Study (GUTS), of adolescents who have been followed since 1996, when they were nine, to 14 years of age. Headache questions were included on the 2007 and 2010 surveys. Setting Youth from across the United States who are offspring of women participating in the Nurses’ Health Study II. Participants 6112 female participants who had provided data on headache symptoms, age at menarche and family history of migraine and were followed through 2007 or 2010 were included in this analysis. Main outcomes Migraine or non-migraine headache. Results Many females had a history of headaches, with approximately equal numbers reporting symptoms consistent with migraine (29.7%) and non-migraine headaches (25.3%). We found that, independent of age and family history of migraine, each one-year delay in onset of menarche decrease the odds of migraine by 7% (odds ratio (OR) = 0.93, 95% confidence interval (CI) 0.89–0.97), but was not related to non-migraine headaches. Conclusions and relevance The findings of this study suggest that early puberty increases the risk of developing migraines by young adulthood. As such, the study emphasizes the need for understanding the pathophysiological links between puberty and developmental changes that occur in the brain during that period and the mechanisms of onset of the migraine disease and its trajectory.

Gaze-Related Response Properties of DLPN and NRTP Neurons in the Rhesus Macaque

2004 ◽  
Vol 91 (6) ◽  
pp. 2484-2500 ◽  
Author(s):  
Seiji Ono ◽  
Vallabh E. Das ◽  
Michael J. Mustari
Keyword(s):  
Smooth Pursuit ◽  
Significant Proportion ◽  
Large Field ◽  
Pontine Nucleus ◽  
Response Properties ◽  
Ocular Reflex ◽  
Visual Inputs ◽  
Vestibular Ocular Reflex ◽  
Vestibular Testing ◽  
Linear Regression Modeling

The dorsolateral pontine nucleus (DLPN) and nucleus reticularis tegmenti pontis (NRTP) are basilar pontine nuclei important for control of eye movements. The aim of this study was to compare the response properties of neurons in DLPN and rostral NRTP (rNRTP) during visual, oculomotor, and vestibular testing. We tested 51 DLPN neurons that were modulated during smooth pursuit (23/51) or during motion of a large-field visual stimulus (28/51). Following vestibular testing, we found that the majority of smooth pursuit–related neurons in DLPN were best classified as gaze (13/23) or eye velocity (7/23) related. Only a small percentage (3/51) of DLPN neurons responded during vestibular ocular reflex in the dark (VORd). We tested rNRTP neurons as described above and found the majority of neurons (35/43) were modulated during smooth pursuit or during motion of a large-field stimulus only (4/43). A significant proportion of our rNRTP gaze velocity neurons (10/18) were also modulated during VORd. We found that the majority of smooth pursuit related neurons in rNRTP were best classified as gaze velocity (18/35) or gaze acceleration (11/35) sensitive. The remaining neurons were classified as eye position or eye/head related. We used multiple linear-regression modeling to determine the relative contributions of eye, head and visual inputs to the responses of DLPN and rNRTP neurons. Our results support the suggestion that both DLPN and rNRTP play significant roles not only in control of smooth pursuit but also in control of gaze.

Headache and psychiatry

2020 ◽  
pp. 475-483
Author(s):  
Maurizio Pompili ◽  
Dorian A. Lamis ◽  
Frank Andrasik ◽  
Paolo Martelletti
Keyword(s):  
Mental Illness ◽  
Chronic Migraine ◽  
Migraine With Aura ◽  
Migraine Headache ◽  
Migraine Without Aura ◽  
Psychiatric Comorbidity ◽  
Somatic Symptoms ◽  
Migraine Aura ◽  
Migraine Headaches ◽  
History Of

Patients suffering from different types of headache typically complain of numerous associated symptoms (e.g. behavioural and somatic), which may be partially related to psychiatric comorbidity. Somatic symptoms have been demonstrated to be more common in patients with chronic migraine, especially for severe headaches with accompanying depression or anxiety. Moreover, chronic migraine may be considered as distinct from an episodic type of migraine with aura, migraine without aura, and migraine aura without headache (without a history of characteristic migraine headaches). Accordingly, the present chapter explores the prevalence and impact of mental illness in patients diagnosed with migraine headache.

scholarly journals From Childhood Migraine Headache to Pheochromocytoma

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Y. M. Hazimeh ◽  
M. Luidens ◽  
M. E. Ehlers ◽  
V. Sharma
Keyword(s):  
Migraine Headache ◽  
Multiple Endocrine Neoplasia ◽  
Medullary Thyroid Cancer ◽  
Multiple Endocrine Neoplasia Type ◽  
Clinical Manifestations ◽  
Medullary Thyroid ◽  
Childhood Migraine ◽  
Migraine Headaches ◽  
History Of ◽  
Men 2A

Pheochromocytoma may have multiple clinical manifestations including paroxysmal hypertension, tachycardia, sweating, nausea, and headache (Phillips et al., 2002). Migraine has some of the manifestations seen with pheochromocytoma. We describe a patient who had a history of migraine headaches since childhood and was found to have pheochromocytoma. Resection of her tumor significantly improved her headache. The diagnoses of pheochromocytoma subsequently lead to diagnosing her with medullary thyroid cancer (MTC) and multiple endocrine neoplasia type 2A (MEN-2A).

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