motion sickness

11 August 2021

This Is Your Migraine Brain. On A Roller Coaster.

Yes, this is indeed a serious article about a clinical trial that was published in the journal Neurology this summer. What happens when migraine patients go on a (virtual) roller coaster?

You may be thinking – why would someone with migraine go on a roller coaster anyway? You can set your mind at ease. Not of these patients was actually having a migraine attack at the time. Which is the whole point.

Migraine brains are simply different – even between attacks.

This was a small study with 40 people, 20 of whom suffer from migraine. During the roller coaster ride, migraine patients did experience more discomfort. They were:

far more likely to experience motin sickness
far more likely to be dizzy

…and their symptoms were more intense and lasted longer than the control group.

Researchers also measured brain activity of the people in the clinical trial and found that they were able to “see” differences in brain activity between the migraineurs and the controls. Some of the differences in brain activity matched what we already have seen in migraine, and parts of the brain that regular movement were also affected.

Study author Dr. Arne May discussed the purpose of the study:

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. 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.
Arne May, MD, PhD quoted in ScienceDaily

We’ve already seen connections between motion sickness and migraine, and dizziness and migraine – and of course there’s vertigo and cyclic vomiting syndrome. Motion sickness may be a warning sign for other conditions later in life, and should never be ignored. And, of course, we’ve talked about vestibular migraine before.

This study is another reminder that migraine affects all of life, not just those times when the patient is having a migraine attack. It also strengthens the link between migraine and other motion-related conditions.

For those who do suffer from dizziness, or motion sickness, but not from migraine – be sure to talk to your doctor. These symptoms may be a sign that you’re more susceptible to migraine. Paying attention and even finding treatment early on may be a major help later in life.

For more, read the study abstract here: Brain Processing of a Visual Self-Motion Study in Patients With Migraine: An fMRI Study

24 August 2020

Just Car Sickness?

James Discoveries & Stats 0

We’ve talked about the connection between migraine and car sickness or motion sickness before. Many migraine patients suffered from motion sickness as children.

It’s interesting to look back to see possible roots of our migraine condition in childhood – but what about children who have motion sickness now?

A study published this year in the European Journal of Paediatric Neurology reviewed the cases of 23 patients who suffered from motion sickness under the age of 18. Almost half were diagnosed with migraine (47.8%). (Abstract: Severe motion sickness in infants and children)

But there were other issues as well. Recurrent/chronic otitis media was diagnosed in 39.1%. There was a history of motor delay in 30.4%. And “vestibular deficits” were diagnosed in 23.5%.

Otitis media refers to an inflammation or infection of the middle ear, which can come from a variety of causes.

Motor delay refers to childhood development. The most commonly discussed is the age at which someone learns to walk – if there’s a delay beyond a certain typical age, that’s a motor delay.

Vestibular deficits are issues with the vestibular system in particular, which can lead directly to dizziness or balance problems.

The study was not trying to necessarily find the cause of motion sickness. It simply points out connections between motion sickness and other conditions.

Sometimes these are hard to diagnose. In fact, patients who have vestibular conditions have often been referred to a psychiatrist. Why? Because of the way these disorders can make it difficult to function. For example, they may become anxious in a crowd, or in wide open spaces (an interesting discussion here – Visual Preference and Vestibular Deficiency).

So what do we learn from the study? Although we cannot prove direct causation here, we can see that there are a variety of things that may be connected to – and may cause – motion sickness.

It’s easy to just say, “Well, Emma gets car sick, but Aiden doesn’t. It’s just the way they are.” But in fact, car sickness may be a clue that can help us diagnose a condition early, before things get worse.

Of course diagnosing migraine early can make all the difference – and that includes what is sometimes called vestibular migraine. Infections of the ear are, of course, very important to treat. And other vestibular problems can cause long term issues because of the way the body may try to compensate for the issue. Motor delay as well can come from a number of causes, but it’s likely to be the issue that parents are most aware of already.

So don’t ignore motion sickness in children – especially if it’s severe or consistent (we’re not talking about too much candy on a 5 hour trip while playing Minecraft upside down). It can actually help avoid more problems throughout life if we use it as a clue to solve a mystery.

4 August 2014

Having Trouble Seeing “Up Close”? Just can’t focus?

James Information, Treatments 0

Your overall vision may be good or bad. But when it comes to doing “up close” work, you have a problem. Maybe you haven’t even thought about it much. But it could be bringing on unwanted headaches.

Here’s what happens. Normally if you’re looking at something up close, your eyes turn closer together (converge). But some people’s eyes don’t seem to want to converge, or they don’t want to stay that way. So whatever you’re looking at becomes unclear, and/or you start seeing double.

This is called convergence insufficiency (or convergence disorder), and it’s surprisingly common. It’s considered by some to be a leading cause of eye strain. And guess what? It can also lead to headaches.

Even if you have 20/20 vision, convergence insufficiency (CI) can be an issue. It may not be something that you are tested for at the optometrist. Sometimes there are no other symptoms at all. But sometimes it leads to misdiagnosis, which can be a particular problem in childhood.

Think about how some of these symptoms might be diagnosed: trouble catching balls, tripping and lack of coordination. Obviously, CI is not the first thing you would think of.

How about these symptoms: Difficulty reading, short attention span, trouble remembering what was read. A learning disability comes to mind, doesn’t it? Or perhaps ADHD? But what if it’s CI?

Finally, for our purposes you’ll be familiar with symptoms such as headache, motion sickness, and vertigo, which are common in various headache disorders.

Diagnosis of Convergence Insufficiency

So with all these possible symptoms which could lead to the wrong diagnosis, how do you find out if you (or your child) has CI?

If you’re reading this article and you realize you have vision problems up-close, that’s half the battle. If you’re curious about symptoms in someone else, of course you could ask them. But also watch for things like problems reading, covering or closing one eye when trying to see things up close, or avoidance of activities which require up-close work.

Once CI is suspected, a proper examination is needed. This should include taking a medical history, discussing symptoms, and especially doing tests such as convergence tests (how the eyes work together) and accommodation tests (how the eyes focus). Again, a routine exam may not find the problem.

Treatment

The good news is that proper treatment can usually solve the problem without a need for surgery, drugs, or special glasses.

However, the treatment will take time. A popular home treatment, known as “pencil push-ups”, is generally not recommended today (unless it is very closely monitored by a professional). Instead, a treatment schedule both in the clinic and at home is the first treatment to try.

In very rare cases, special glasses or surgery may be recommended. But because these treatments carry significant problems of their own, they are not used until many weeks of treatment with your doctor and at home are tried.

Remember, this may be one of many things contributing to your headaches. For some, treatment of CI may result in no more headaches. For others, headaches will continue because they are triggered by other issues.

However, because of the possible symptoms of CI and even possible future complications, as well as a possibly underlying disorder, it is wise to be tested as soon as possible if you suspect CI.

For more information:

Convergence insufficiency article at the Mayo Clinic
What is Convergence Insufficiency (CI)? (with links to past studies)
The Ultimate Guide to Convergence Insufficiency (written by an optometry student, more references included)
If you’re in the United States and have a child with CI, a study offering therapy is currently looking for participants. For more information, see Office-based Vision Therapy for Improving Reading and Attention in Children With Convergence Insufficiency

6 October 2010

Migraine and Severe Motion Sickness

James Discoveries & Stats, Medications 6

Migraine and motion sickness and dizziness often go together – that’s no secret. Many migraineurs suffered from motion sickness when they were younger, many experience it now.

That doesn’t mean that the motion sickness is going on at the same time as a typical migraine attack. Of course, nausea is a very common migraine symptom.

But migraineurs actually often experience motion sickness when they’re not having a migraine attack.

Or… are they?

Just how and how much migraine impacts all of our lives is a matter of a lot of discussion. But an interesting new study, though small, may provide another answer to that question, and it may help those migraineurs who experience extreme motion sickness.

A group of doctors in Pittsburgh, USA, ran a study to see if they could help migraineurs who had motion sickness with…

A common migraine drug.

In this case, it was rizatriptan (Maxalt), one of many triptan type drugs which are abortives for migraine.

Almost 87% of the migraineurs tested responded to the rizatriptan treatment.

So… could it be that the migraine symptoms are really more spread out in our lives that we think?

More tests need to be done (again, this was a very small study), but it looks very likely that not just Maxalt but other triptans will help patients with motion sickness.

Now, there are a couple more things you need to be aware of. First, the ultimate goal is not to have you take more and more medication. You will have to talk this over very carefully with a specialist to see if this is the answer for you.

Second, these patients were pretreated with rizatriptan. This is for patients with severe motion sickness that have unavoidable travel, to take something before they go.

Migraine is not just a once-in-a-while-headache. It has an impact on your whole life. Making the connection between migraine and motion sickness will help us understand both conditions better, and help us treat them both.

Study Rizatriptan reduces vestibular-induced motion sickness in migraineurs.
Comments from Dr. A Mauskop