Tetra-ataxiometric Posturography in Patients
with Migrainous Vertigo
Authors: Ongun Dr. Nedim 
Published: February 2021

Background: Migraine is a common disorder characterized by headache attacks frequently accompanied
by vestibular symptoms like dizziness, vertigo, and balance disorders. Clinical studies support a strong link
between migraine and vertigo rather than between other headache types and vertigo or nonvertiginous
dizziness. There is a lack of consensus regarding the pathophysiology of migrainous vertigo. Activation of central
vestibular processing during migraine attacks and vasospasm-induced ischemia of the labyrinth are reported
as the probable responsible mechanisms. Because vestibular examination alone does not provide enough
information for diagnosis of migrainous vertigo, posturography systems which provide objective assessment of
somatosensory, vestibular, and visual information would be very helpful to show concomitant involvement of
the vestibular and somato-sensorial systems. There are few posturographic studies on patients with migraine
but it seems that how balance is affected in patients with migraine and/or migrainous vertigo is still not clear.
We want to investigate balance function in migraineurs with and without vertigo with a tetra-ataxiometric
posturography system and our study is the first study in which tetra-ataxiometric static posturography was used
to evaluate postural abnormalities in a well-defined population of patients with migrainous vertigo.
Objective: To investigate balance functions in migraineurs with and without vertigo with a tetra-ataxiometric
posturography system.
Study Design: Prospective, nonrandomized, controlled study.
Setting: Pamukkale University Hospital, Neurology and Physical Therapy and Rehabilitation outpatient
clinics.
Methods: Sixteen patients with migrainous vertigo, 16 patients with migraine without aura and no vestibular
symptoms, and 16 controls were included in the study. Computerized static posturography system was
performed and statistical analyses of fall, Fourier, Stability, and Weight distribution indexes were performed.
The tetra-ataxiometric posturography device measures vertical pressure fluctuations on 4 independent
stable platforms, each placed beneath 2 heels and toe parts of the patient; inputs from these platforms are
integrated and processed by a computer digitally. Four separate plates are used and perpendicular pressures
of the anterior and posterior feet are measured. Pressure of each force plate is measured and data was
analyzed by the software program.
Limitations: A very small, non-randomized, and controlled study with the inability to find an answer to the
mechanism of involvement of the somatosensorial system and vestibular system in migrainous headaches.
Results: The distribution of patients with posturographical abnormalities in the migrainous vertigo
group was significantly different than the control group. Distribution of the patients with posturographical
abnormalities in the high frequencies of the head-right position was significantly different in the migrainous
vertigo group than in the control group and distribution of the patients with posturographical abnormalities
in high frequencies of the head-right position was significantly different in the migraine group than in the
controls groups. The stability index of the migrainous vertigo group was significantly higher than in the
control group when tested on in the neutral-head position with open eyes.
Conclusion: In this first study of tetra-ataxiometric static posturography evaluating postural abnormalities
in a well-defined population of patients with migrainous vertigo, the central part of the vestibular apparatus
would be responsible of postural abnormalities in patients with migraine and migrainous vertigo.
Key words: Fall index, migraine, migrainous vertigo, static posturography