Virtual Roller Coasters Link Migraine and Motion Sickness

Migraine patients had different behavioral and neuronal responses to virtual roller coaster rides than other people, a small cross-sectional study in Germany showed.

Migraineurs experienced significantly more dizziness and motion sickness during a computer-simulated roller coaster ride than healthy controls, reported Arne May, MD, PhD, of University of Hamburg, and colleagues.

Migraine was related to abnormal processing of visual motion stimuli in the inferior and superior occipital gyrus, middle frontal gyrus, pontine nuclei, and cerebellar lobules V, VI, and VIIb, the researchers wrote in Neurology.

“Symptoms such as nausea, dizziness, and headache are common to motion sickness and migraine, thus it comes as no surprise that migraine sufferers are unusually susceptible to motion sickness,” noted Peter Drummond, PhD, of Murdoch University in Perth, Australia, who wasn’t involved with the study.

“Both maladies involve reflexes that relay in the brainstem, under the control of higher-order centers in the midbrain and cerebral cortex,” Drummond told MedPage Today.

“This study provides insights into the neural circuitry of motion sickness and offers tantalizing clues about the source of vulnerability to motion sickness in migraine,” he added. “Solving this puzzle is important as it might also explain vulnerability to migraine itself and open the door to new treatment opportunities.”

The study involved 20 migraine patients from a hospital headache clinic and 20 controls. Participants had an average age of 30 and 83% were women.

Migraine patients had an average of 3.7 migraine attacks per month with an intensity of 59.2 on a scale of 0-100. Half had migraine with aura. Mean migraine disability (MIDAS) score was 21.5, migraine onset was 12.5 years, and 15% used preventive migraine medication. Patients were migraine-free during the assessment; 40% reported a migraine attack within 48 hours and 15% within 48 hours after the roller coaster simulation.

All participants watched videos to experience virtual roller coaster rides during fMRI. Within each video, blocks of motion stimulation were interleaved randomly with low-speed upward motion. In the scanning intervals and after the experiment, participants rated their perceived level of vestibular symptoms and motion sickness during the videos.

Compared with controls, more migraine patients reported dizziness (65% versus 30% P=0.03) and perceived more motion sickness (47.3 versus 24.3 points on a 1-180 scale). Symptom duration was longer for migraine patients (01:19 min) than controls (00:27 min) during the virtual roller coaster ride. Migraine patients rated symptom intensity as 22.0 on a scale of 0-100; controls reported 9.9.

Neuronal activity in migraine patients were more pronounced in clusters in the superior and inferior occipital gyrus, pontine nuclei, and in cerebellar lobules V and VI. Decreased activity was observed in cerebellar lobule VIIb and middle frontal gyrus. These activations correlated with migraine disability (r -0.46, P=0.04) and motion sickness (r 0.32, P=0.04) scores.

The increased activity in the pontine nuclei, which helps regulate movement and other motor activity, “could relate to abnormal transmission of visual, auditory, and sensory information within the brain,” May said in a statement.

“Future research should now look at larger groups of people with migraine to see if our findings can be confirmed,” he added.