Virtual roller coaster simulation shows impact of migraine on visual motion stimuli
Migraine correlated with “abnormal modulation” of visual motion stimuli in different areas of the brain that further related to migraine disability and motion sickness susceptibility, according to findings published in Neurology.
“Millions of people regularly experience painful and debilitating migraine headaches that can reduce their quality of life,” Arne May, MD, PhD, of the University of Hamburg in Germany, said in a press release. “People with migraine often complain of dizziness, balance problems and misperception of their body’s place in space during migraine. By simulating a virtual roller coaster ride, our study found that some of these problems are not only magnified in people who experience migraine, but they are also associated with changes in various areas of the brain.”
May, along with Gabriela Carvalho, PhD, of the department of orthopedics and trauma surgery at the University of Luebeck and the department of systems neuroscience at University Medical Center Eppendorf, both in Germany, and colleagues aimed to determine how behavioral and neuronal responses of patients with migraine were impacted by a visual stimulation of self-motion using a virtual roller coaster ride in comparison with controls. The researchers enrolled 20 consecutive patients with migraine from a university-based headache clinic and 20 control participants. They conducted an experiment in which patients experienced a visual self-motion paradigm based on customized roller coaster videos during functional MRI.
In each video, the researchers weaved blocks of motion stimulation in with upward motion at low speeds in a random sequence. Participants rated their perceived level of vestibular symptoms and motion sickness during the videos at two time points — in the scanning intervals and following the experiment. May, Carvalho and colleagues hypothesized that patients with migraine would experience increased motion sickness and that this would correlate with different central processing and brain responses, according to the study results.
Both groups included mostly women (80% in the migraine group and 85% in the control group). Participants in the migraine group were slightly older than participants in the control group (mean age, 30.2 years vs. 29.5 years). Half of the participants in the migraine group (50%) reported experiencing aura, with a mean of 2.1 aura attacks and 3.7 migraine attacks in the preceding month. May, Carvalho and colleagues reported that all patients were free from migraine during the assessment, while 40% reported a migraine attack in the preceding 48 hours and 15% reported one within the ensuing 48 hours.
The researchers found that, compared with controls, patients with migraine reported higher levels of dizziness (65% vs. 30%; P = .03) and motion sickness (simulator sickness questionnaire score, 47.3 vs. 24.3). Patients with migraine also experienced longer duration of symptoms (1 hour and 19 minutes vs. 27 minutes) and intensity (visual analog scale: 0-100, 22 vs. 9.9) during the virtual roller coaster ride.
Patients with migraine experienced more distinct neuronal activity in clusters within the superior (contrast estimate, 3.005; 90% CI, 1.817-4.194) and inferior occipital gyrus (contrast estimate, 1.759; 90% CI, 1.062-2.456), pontine nuclei (contrast estimate, 0.665; 90% CI, 0.383-0.946) and cerebellar lobules V/VI (contrast estimate, 0.672; 90% CI, 0.38-0.964). Conversely, the researchers reported diminished activity in the cerebellar lobule VIIB (contrast estimate, 0.787; 90% CI, 0.444-1.13) and the middle frontal gyrus (contrast estimate, 0.962; 90% CI, 0.557-1.367). These activations correlated with migraine disability (P = .04) and motion sickness scores (P =.04), according to the study results. May, Carvalho and colleagues also observed greater connectivity between the pontine nuclei, cerebellar areas V/VI, interior and superior occipital gyrus with numerous cortical areas in patients with migraine but not in controls.
“The pontine nuclei ... helps regulate movement and other motor activity,” May said in the press release. “This increased activity could relate to abnormal transmission of visual, auditory and sensory information within the brain.”
May also pointed to directions for future research.
“By identifying and pinpointing these changes, our research could lead to a better understanding of migraine, which could, in turn, lead to the development of better treatments,” she said. “Future research should now look at larger groups of people with migraine to see if our findings can be confirmed.”
American Academy of Neurology. What does a virtual roller coaster ride tell us about migraine? Available at: https://www.aan.com/PressRoom/Home/PressRelease/4910. Accessed July 23, 2021.