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RESUMO
ABSTRACT
Keywords: Individual susceptibility, Motion sensitivity, Motion sickness,
Migraine.
ORIGINAL ARTICLE
Motion Sickness in Headache Patients
Cinetose em pacientes com cefaleias
Marina Olivier
1
Sol Cavanagh
1
Lucas Bonamico
1
Francisco Gualtieri
2
María Teresa Goicochea
1
1
Se
cción Cefaleas. Sector Dolor.
Departamento
de Neurología.
Argentina
2
Sección Neurootología. Departamento de
Neurología. Argentina
*Correspondence
Marina Olivier
E-mail: marinaolivier@hotmail.com
Received: June 5, 2019.
Accepted: June 12, 2019.
Introdução: Dor de cabeça é uma das razões mais frequentes de consultas
em neurologia. Alguns pacientes com dor de cabeça relatam intolerância à
mobilização passiva, associada a tontura, náusea, vômito, conhecida como
cinetose. Esses sintomas são causados por um conito entre os sistemas: visual,
vestibular e somatossensitivo. Objetivo: Determinar a prevalência de cinetose
em pacientes consultados por dor de cabeça. Método: Estudo transversal,
retrospectivo e descritivo. Foram incluídos pacientes com idade superior
a 18 anos, consultados para dor de cabeça na Clínica de Dor de Cabeça, do
Hospital Fleni, Buenos Aires, Argentina, no período de 2 de janeiro a 30 de
junho de 2017, por meio de entrevista estruturada. Resultados: Do total de 266
pacientes: 62 (23,3%) apresentaram cinetose (idade média de 41,5 anos; 80,6%
eram mulheres), 14 descreveram-na apenas na infância e 48 persistiram com
sintomas até o momento da consulta. Entre os pacientes com dor de cabeça
e cinetose 52 (83,9%) apresentaram enxaqueca, 7 pacientes apresentaram
cefaléia tensional, 2 cefaleia em salvas. A prevalência de enxaqueca foi maior
naqueles que relataram cinetose apenas na infância em comparação aos que
continuaram com ela (85,7 vs. 56,2%, p = 0,045), 12,5% dos pacientes com
cinetose atual relataram isso como um gatilho para enxaqueca. 204 pacientes
não apresentaram cinetose (76,7%). Conclusão: Consideramos que em
pacientes com dor de cabeça é importante identicar a cinetose, pois pode ser
limitante e também desencadear uma enxaqueca. Seu diagnóstico e tratamento
melhorariam a qualidade de vida de nossos pacientes.
Descritores: Susceptibilidade individual, Sensibilidade a movimentos, Cinetose,
Enxaqueca.
Introduction: Headache is one of the most frequent consultations in neurology.
Some patients with headache report intolerance to passive mobilization,
associated with dizziness, nausea, vomiting, known as motion sickness. These
symptoms are caused by a conict between the systems: visual, vestibular and
somatosensitive. Objective: To determine the prevalence of motion sickness in
patients who consult due to headache. Method: Cross-sectional, retrospective
and descriptive study. It included patients over 18 years of age, who consulted
for headache at the Headache Clinic, during the period from January 2 to June
30, 2017, through a structured interview. Results: Of a total of 266 patients:
62 (23.30%) presented motion sickness (mean age 41.5 years; 80.6% were
women). 14 described motion sickness only in childhood and 48 persisted with
symptoms until the time of consultation. Among the patients with headache
and motion sickness 52 (83.87%) presented migraine; 7 patients presented
tension headaches; 2 in salvos; 1 undetermined The prevalence of migraine was
higher in those who reported motion sickness only in childhood compared to
those who continued with motion sickness (85.7 vs. 56.25%, p = 0.045), 12.5%
of patients with current motion sickness reported it as a migraine trigger, 204
patients did not have motion sickness (76.7%). Conclusion: We consider that
in patients with headache it is important to identify motion sickness as it can
be limiting and also be a migraine trigger. Its diagnosis and treatment would
improve the quality of life of our patients.
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INTRODUCTION
Headache is one of the most frequent causes for
consultations in neurology. Headache represents a broad
and heterogeneous group of clinical entities; being
tension-type headache the most prevalent in the general
population; followed by migraine.
Migraine prevalence varies between 10-16%, with
female predominance of 3/1; representing a signicant
socio-economic and personal impact (1). It is among
the ten most prevalent disorders and is classied as the
second cause of disability of all diseases worldwide (2).
Migraine is characterized by recurrent attacks of moderate
to severe pain, of pulsatile characteristic, associated
with photophobia or, phonophobia, nausea and / or
vomiting, which sometimes becomes incapacitating for
the individual’s daily life, in both social and labor aspects.
Some patients who consult for headache also report
intolerance to passive mobilization; known as motion
sickness. More than two thousand years ago Hippocrates
observed that “…. Sailing in the sea caused movement
disorder ... (Reason and Brand, 1975), The term “nausea”
derives from the Greek root “Naus” which means a ship
(3). Motion sickness is a syndrome present in healthy
subjects, triggered by passive movement (car trips,
trains, airplanes, ships) or by the illusion of movement
(environmental movement surrounding it; exposure to
3D movies, virtual reality). Active movement of the head
during a trip in a means of transport (passive movement)
can cause or worsen it (3).
This syndrome is characterized by a group of signs
and symptoms, among which are mentioned, dizziness,
nausea, vomiting, drowsiness, yawns, irritability, paleness,
bradycardia, palpitations, ataxic gait, arterial hypotension,
apathy, headache. (4). The severity of symptoms varies
according to individual susceptibility and the intensity of
the stimulus to which the subject is exposed. Increased
susceptibility has been suggested in women, the
menstrual cycle being implicated as a trigger; In addition
to some evidence of genetic contribution, variables such
as anxiety or fear and sleep deprivation may contribute;
reason why the prevalence described in the literature is
very variable (1-90%) (5). Susceptibility begins around 6
or 7 years of age; with a peak between 9 and 10 years;
which implies that hormonal changes per se would not
have a direct effect. These symptoms are caused by
incongruous sensory interactions; a conict between the
visual, vestibular and somatosensitive systems. Before
an acute trigger the symptoms last for hours to a day
after the stimulus is suspended; If the stimulus continues,
such as a boat trip, relief occurs by central adaptation
(habituation) in approximately 3 days.
OBJECTIVES
The primary objectives of this study were to
determine the prevalence of motion sickness in patients
who consulted a neurology service due to headache;
and identify what type of headache is most frequently
associated with motion sickness. Secondary objectives,
to determine the severity of motion sickness and identify
motion sickness as a possible migraine trigger.
METHODS
A cross-sectional, retrospective and descriptive
study was carried out; which included patients over 18
years of age, who consulted for headache as the primary
complaint in the Headache Section of Pain Clinic, Hospital
Fleni, Buenos Aires, Argentina, during the period from
January 2 to June 30, 2017. A structured questionnaire
was used for the interview and the data were analyzed.
Headache diagnoses were made applying the
criteria of the International Classication of Headache
Disorders, 2013. Motion sickness was classied using the
Motion sickness susceptibility questionnaire short-form
(MSSQ-Short) (6) according to the stimulus that triggers
the symptom in Mild: terrestrial trigger , Moderate:
acquatic trigger; Severe: aerial and visual trigger.
The STATA v13 program was used. Quantitative
data were expressed in means +/- SD or numbers and
their percentages. Normality was evaluated according to
asymmetry, kurtosis and Z test. For the comparison of
proportions, a non-parametric Wilcoxon rank-sum test
was used.
Study approved by the Research and Ethics
Committee, given the exception of taking informed
consent.
RESULTS
Of a total of 266 patients who consulted Fleni Hospital
due to headache, 62 (23.3%) presented motion sickness,
mean age was 41.5 years; 80.6% were women. Of which
14 patients described motion sickness exclusively during
childhood and 48 patients reported persisting with the
symptoms until the time of consultation (Graph 1). The
latter were classied according to the intensity of motion
sickness in: mild 64.5%; moderate 16.7% and severe 18.8%.
From the group of patients with headache and
motion sickness; 52 (83.9%) met diagnostic criteria
for migraine (62.9% episodic, 9.7% with aura and 11.3%
chronic); 11.3% of patients had tension headache; 3.2%
cluster headache and 1.6% headache of undetermined
characteristic (Graph 2).
The prevalence of migraine was higher in those
patients who reported motion sickness only in childhood
compared to those who continued with motion sickness
(85.7 vs. 56.2%, p = 0.045). 12.5% of patients with current
motion sickness reported it as a migraine trigger.
204 patients did not have motion sickness (76.7%);
the average age was 43.5 years; and 81.8% were women.
83.33% presented migraine (67.6% episodic; 17.6%
chronic; 14.7% with aura), 9.3% had tension headache,
2.9% cluster headache, 1.5% had undetermined headaches
and 2% cranial neuralgia (Graph 3).
DISCUSSION
Reports in the literature describes the association
between migraine and motion sickness may reache up
to 50%; also 20% of patients with tensión-type headache
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also experience motion sickness (7). Our study revealed a
prevalence of motion sickness in patients with headache
of 23.3%; of these, 84% suffered some type of migraine;
and 11% had tension headache; 12.5% reported motion
sickness as a trigger for a migraine attacks.
Motion sickness not only interferes with long-
distance trips such as pleasure trips; but also in those of
short distance, such as daily transfers to work, activities
such as going to a shopping, supermarket or cinema.
It affects both adults and children. At present, the use
of mobile devices during the trips, possibly facilitates
the increase of this symptom; since performing active
movements during a passive movement favors its
presentation.
Given that it is a frequent condition, which can
become disabling and even trigger a migraine attack, it
must be taken into account in the medical consultation,
in order to indicate the appropriate treatment, both non-
pharmacological and pharmacological (scopolamine,
promethazine, anti-histamines). Rizatriptan was studied
as a preventive treatment (prior to the exposure of stimuli)
of motion sickness (8) showing clinical improvement.
A group of patients identied motion sickness
as a trigger for a migraine attacks. This information
could be useful to evaluate the clinical behavior of the
migraine attacks, so recognizing it may be helpful in its
managament.
CONCLUSION
Motion sickness is an important issue in migraine
management, causing limitations in daily life activities.
In rst consultations, headache patients should be asked
about it, since proper diagnosis and timely treatment
would make it possible to improve patients’ quality of life.
Future research should be done to better clarify motion
sickness as a migraine trigger.
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