A case-control study of visually evoked postural responses in childhood with primary headaches

  • Carlo BaraldiEmail author
  • Chiara Gherpelli
  • Matteo Alicandri Ciufelli
  • Daniele Monzani
  • Luigi Alberto Pini
  • Luca Pani
  • Simona Guerzoni
Original Article



Disorientation, nausea, confusion, dizziness, and displacement are frequently complained by headache-suffering children. Anyhow, the cause of these symptoms is still unclear, and a dysfunction of vestibular pathways or their alteration due to central pain pathways hyper-activation, has been proposed. The aim of this study is to use posturography to explore the balance function of headache-suffering children during pain-free periods.


Posturography was performed on 19 migraineurs, 11 tension-type headache sufferers, and 20 healthy controls. Posturographic measures were performed during headache-free periods under different conditions: with eyes opened, eyes closed, and during right and left optokinetic stimulation. The last 2 conditions were used to mimic unreliable visual signals that can confound vestibular system.


During eyes-closed conditions, headache-suffering children displayed higher displacements than healthy controls, since statokinesiogram surface was higher in tension-type headache sufferers and migraineurs compared with controls (P value = 0.0095). Romberg’s index, indicating the overall stability of the subject, was lower in healthy controls than in headache sufferers (P = 0.0139), thus suggesting a vestibular impairment in the seconds. Moreover, both during right and left optokinetic stimulation, the statokinesiogram length was higher in headache-suffering children (P < 0.0001). Thereafter, statokinesiogram surface was higher in migraineurs during right optokinetic stimulation (P = 0.0388) than in tension-type headache sufferers when stimulation was directed on the opposite side (P = 0.0249).


These results suggest a central alteration of vestibular pathways in headache-suffering children, that makes balance function more dependent from visual inputs than healthy subjects, even in inter-ictal phases.


Children Migraine Visually evoked postural response Statokinesiogram Optokinetic stimulation 





center of pressure


eye closed


eyes open


child behavior checklist


International Classification of Headache Disorders Third Edition-Beta version




square millimeters






Romberg’s index


standard deviations




statokinesiogram length


statokinesiogram surface


Tension-type headache


visually evoked postural response


visual vestibular miss-match


Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Authors contributions

DM and MAC conceived the study and performed otoneurological measures. CG helped to perform otoneurological measures. CB, SG, LP, and LAP recruited headache patients, made statistical calculations, and helped in the draft of the manuscript. All authors read and approved the final version of the manuscript.

Compliance with ethical standards

Ethic approval and consent to participate

The present study was approved by the provincial ethical committee of Modena (protocol number: 1921, study code NOC09). Every patient’s parents signed written informed consent for the participation of their son/daughter in the study. All procedures in the study were in accordance with the ethical standards of the University of Modena and Reggio Emilia and with the latest version of the declaration of Helsinki.

Consent for publication

Not applicable.

Conflict of interest

The authors declare that they have no competing interests.

Supplementary material

10072_2019_4072_MOESM1_ESM.docx (14 kb)
ESM 1 (DOCX 13 kb)


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Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  1. 1.School of Pharmacology and Clinical Toxicology, Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
  2. 2.Otolaryngology UnitUniversity of Modena and Reggio EmiliaModenaItaly
  3. 3.Medical Toxicology Unit- Headache and Drug Abuse Research Center, Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
  4. 4.Section of Pharmacology, Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly

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