A clinical study on the quality of life and psychological and sleep status of vestibular migraine patients

doi:10.21203/rs.3.rs-4854940/v1

Objective

To explore the correlations and influencing factors between quality of life, anxiety, depression, and sleep disorders in patients with vestibular migraine (VM) and chronic migraine (CM).

Methods

The Dizziness Handicap Inventory (DHI), Migraine Disability Assessment (MIDAS), Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD), and Pittsburgh Sleep Quality Index (PSQI) were used to survey 71 patients with VM, 95 patients with CM, and 49 healthy controls, comparing their quality of life; the presence of anxiety, depression and sleep disorders; and related risk factors.

Results

The MIDAS score of the CM group was significantly greater than that of the VM group (P < 0.05). In the VM group, 51 patients (71.8%) had comorbid anxiety, 55 patients (77.5%) had comorbid depression, and 63 patients (88.7%) had comorbid sleep disorders. In the CM group, 66 patients (69.5%) had comorbid anxiety, 51 patients (53.7%) had comorbid depression, and 86 patients (90.5%) had comorbid sleep disorders. In the normal control group, 13 patients (26.5%) had comorbid anxiety, 13 patients (26.5%) had comorbid depression, and 14 patients (28.6%) had comorbid sleep disorders. There were significant differences in HAMA, HAMD, and PSQI scores among the three groups (P < 0.05). The MIDAS scores of patients with comorbid anxiety, depression, and sleep disorders in both the VM and CM groups were significantly greater than those of patients without comorbidities (P < 0.05). Multivariate stepwise regression analysis revealed that in VM patients, the MIDAS score was positively correlated with increased attack frequency, poor sleep quality, and comorbid anxiety (P < 0.05); in CM patients, the MIDAS score was associated with disease duration, headache severity, attack frequency, sleep quality, and comorbid anxiety (P < 0.05).

Conclusions

The quality of life of VM patients is related to attack frequency, sleep quality, and comorbid anxiety, whereas the quality of life of CM patients is associated with disease duration, headache severity, attack frequency, sleep quality, and comorbid anxiety.

vestibular migraine

chronic migraine

migraine

anxiety

depression

sleep disorders

Vestibular migraine (VM) is a recurrent condition characterized by episodes of vertigo accompanied by migraine symptoms, significantly impacting patients' work and quality of life. Most patients experience negative emotions such as depression and anxiety, and sleep disorders are also worth noting ^[1]. Chronic migraine (CM) often evolves from episodic migraine and is associated with higher rates of comorbid anxiety, depression, and sleep disorders, leading to a greater disease burden ^[2]. This study utilized survey questionnaires to explore the correlations between quality of life, psychological status, and sleep disorders in patients with VM and CM without vestibular symptoms. The aim of this study was to provide reliable evidence for the management and treatment of migraine patients.

2.1. Study Subjects

This study included 71 patients with vestibular migraine and 95 patients with chronic migraine who were treated at the Neurology Department outpatient clinic of Jiangyin Hospital affiliated with Nantong University from August 2020 to August 2023. The inclusion criteria for patients were as follows: (1) met the diagnostic criteria for chronic migraine/vestibular migraine according to the International Classification of Headache Disorders, 3rd edition (ICHD-3, 2018) ^[3]. (2) Patients with no evidence of structural brain lesions on imaging. (3) Patients aged between 16 and 65 years. (4) Patients capable of undergoing relevant assessments. (5) Patients who provided informed consent. The exclusion criteria were as follows: (1) history of head trauma. (2) Presence of brain or systemic diseases causing headaches and dizziness. (3) Presence of severe somatic diseases affecting the heart, liver, lungs, kidneys, etc. (4) Other primary headaches. (5) Patients with language or intellectual impairments unable to cooperate. Additionally, 49 healthy individuals who underwent routine health examinations at the hospital's health examination center were selected as the normal control group. The three groups were matched in terms of age, sex, and education level. This study was approved by the Ethics Committee of Jiangyin Hospital affiliated with Nantong University (Ethics Approval No. [2018] Lunsheyan No. 035).

2.2. Assessment methods

2.2.1. General Information Questionnaire: This questionnaire includes demographic data and sections on headache diagnosis, such as age of onset, family history, nature, severity, frequency of headaches, accompanying symptoms, exacerbating and relieving factors, etc.

2.2.2. Assessment of quality of life: (1) Dizziness handicap inventory (DHI): This scale is widely used to assess the impact of dizziness on patients' quality of life. The inventory consists of 25 items, including functional (F, 9 items), emotional (E, 9 items) and physical (P, 7 items) aspects of impairment and quality of life. The degree of impact on quality of life is categorized as follows: 0–29 points: mild; 30–59 points: moderate; and 60–100 points: severe^[4]. (2) Migraine Disability Assessment Scale (MIDAS): Designed by Stewart et al., this scale is widely used worldwide to evaluate the quality of life of migraine patients. It comprises 5 questions assessing the time spent on activities related to school/work, household chores, and social/leisure activities over the past 3 months due to migraines. MIDAS scores classify disability into 4 levels: 0–5 points: little or no disability (Grade I); 6–10 points: mild disability (Grade II); 11–20 points: moderate disability (Grade III); and ≥ 21 points: severe disability (Grade IV)^[5].

2.2.3. Assessment of Psychological Status: (1) Hamilton Depression Scale (HAMD): This scale is used to evaluate patients' depressive mood. The HAMD consists of 7 dimensions, including anxiety/somatization, weight loss, cognitive impairment, and diurnal variation, with 24 items in total. A total score of ≥35 indicates severe depression; a score of ≥20 indicates mild to moderate depression; and a score of <8 indicates normal ^[6]. (2) Hamilton Anxiety Scale (HAMA): This scale assesses patients' anxiety levels. The HAMA comprises 14 items rated on a scale of 0--4, with a total score ≥29 indicating severe anxiety; ≥21 indicating definite anxiety; ≥14 indicating anxiety; ≥7 indicating possible anxiety; and <7 indicating normal ^[6].

2.2.4. Sleep assessment: The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate patients' sleep quality over the past month. It includes 19 self-rated items and 5 other-rated items. A higher total score indicates poorer sleep quality, with a score of 0–7 indicating normal sleep quality and a score >7 indicating poor sleep quality^[7].

2.3. Statistical analysis

SPSS Statistics 25.0 software was used for statistical analysis. For categorical data, the chi-square test was used, whereas for continuous data, the mean ± standard deviation (±s) was used for description. As the data followed a normal distribution, comparisons of means were conducted via t tests and ANOVA. Multiple factor analysis was performed via multivariate stepwise regression analysis. A significance level of P < 0.05 was considered statistically significant.

3.1. General characteristics of the study subjects

Vestibular Migraine Group: A total of 71 patients, including 11 males and 60 females, were included. The age range was 16–65 years, with a mean age of 38.5 ± 9.7 years. The duration of illness ranged from 1 to 20 years, with a mean of 9.5 ± 4.9 years. Onset age ranged from 16–42 years, with a mean of 29.1 ± 6.6 years. Education level: 55 patients had a college education or above, 11 had a high school education, and 5 had a primary school education. Occupation: Thirty-nine engaged in mental labor, and 32 engaged in physical labor.

Chronic Migraine Group: A total of 95 patients, including 24 males and 71 females, were included. The age range was 16–63 years, with a mean age of 35.3 ± 11.3 years. The duration of illness ranged from 1 to 20 years, with a mean of 10.1 ± 4.0 years. Onset age ranged from 16–45 years, with a mean of 25.2 ± 9.2 years. Education level: Seventy-three patients had a college education or above, 15 had a high school education, and 7 had a primary school education. Occupation: 55 engaged in mental labor, 40 engaged in physical labor.

Normal control group: A total of 49 patients, including 10 males and 39 females, were included. The age range was 20–52 years, with a mean age of 38.3 ± 8.2 years. Education level: 37 patients had a college education or above, 7 had a high school education, and 5 had a primary school education. Occupation: Twenty-nine engaged in mental labor, and 20 engaged in physical labor.

There were no statistically significant differences in age, sex, duration of illness, education level, or occupation among the three groups (P > 0.05), as shown in Table 1.

3.2. Assessment of quality of life between the vestibular migraine group and the chronic migraine group

The median Dizziness Handicap Inventory (DHI) score for vestibular migraine patients was 60 (29, 84). Among them, 3 cases (4.2%) had mild impacts on quality of life, 40 cases (56.3%) had moderate impacts, and 28 cases (39.4%) had severe impacts. The mean Migraine Disability Assessment Scale (MIDAS) score for vestibular migraine patients was 6.75 ± 3.307. Among them, 37 patients (52.1%) had mild disability, 24 patients (33.8%) had moderate disability, and 10 patients (14.1%) had severe disability. The mean MIDAS score for the chronic migraine group was 20.92 ± 8.53. Among them, 7 patients (7.4%) had mild disability, 9 patients (9.5%) had moderate disability, 34 patients (35.8%) had moderate disability, and 45 patients (47.4%) had severe disability.

The MIDAS score of the chronic migraine group was significantly greater than that of the vestibular migraine group (t = 13.272, P < 0.05).

3.3. Prevalence of Anxiety, Depression, and Sleep Disorders among the Three Groups

In the vestibular migraine group, 51 patients (71.8%) had anxiety, 55 patients (77.5%) had comorbid depression, and 63 patients (88.7%) had comorbid sleep disorders. In the chronic migraine group, 66 patients (69.5%) had comorbid anxiety, 51 patients (53.7%) had comorbid depression, and 86 patients (90.5%) had comorbid sleep disorders. In the control group, 13 patients (26.5%) had comorbid anxiety, 13 patients (26.5%) had comorbid depression, and 14 patients (28.6%) had comorbid sleep disorders. There were significant differences in HAMA, HAMD, and PSQI scores among the three groups (P < 0.05). See Table 2.

3.4. Factors related to quality of life in vestibular migraine and chronic migraine patients

Vestibular migraine patients and chronic migraine patients with concurrent anxiety disorders, depressive disorders, and sleep disorders had significantly higher MIDAS scores than did those without anxiety disorders, depressive disorders, and sleep disorders (P < 0.05), as shown in Table 3.

Multivariate stepwise regression analysis revealed that the MIDAS score of patients with vestibular migraine was positively correlated with a high frequency of attacks, poor sleep quality and accompanying anxiety (P < 0.05). The MIDAS scores of patients with chronic migraine were related to the course of disease, degree of headache, frequency of attack, quality of sleep and accompanying anxiety (P < 0.05).

Table 1

Basic Information of the Study Subjects (± s)
Group	Vestibular Migraine Group (n = 71)	Chronic Migraine Group (n = 95)	Control Group (n = 49)
Average Age (years)	38.5 ± 9.7	35.3 ± 11.3	38.3 ± 8.2
Duration of Illness (years)	9.5 ± 4.9	10.1 ± 4.0	/
Age of Onset (years)	29.1 ± 6.6	25.2 ± 9.2	/
Gender
Male	15.5% (n = 11)	25.3% (n = 24)	20.4% (n = 10)
Female	84.5% (n = 60)	74.7% (n = 71)	79.6% (n = 39)
Education
College or Above	77.5% (n = 55)	76.8% (n = 73)	75.5% (n = 37)
High School	15.5% (n = 11)	15.8% (n = 15)	14.3% (n = 7)
Elementary School	7.0% (n = 5)	7.4% (n = 7)	10.2% (n = 5)
Occupation
Mental Labor	54.9% (n = 39)	57.9% (n = 55)	59.2% (n = 29)
Physical Labor	45.1% (n = 32)	42.1% (n = 40)	40.8% (n = 20)

Table 2

Comparison of anxiety, depression and sleep disorders among the three groups (± s)
Group	n	HAMA	HAMD	PSQI
Vestibular Migraine	71	11.30 ± 5.22	11.92 ± 5.67	13.97 ± 4.43
Chronic Migraine	95	10.23 ± 4.52	9.84 ± 4.62	12.38 ± 3.44
Control	49	4.78 ± 3.38	5.63 ± 3.31	5.47 ± 2.88
F values: 33.135 (HAMA), 25.666 (HAMD), 83.898 (PSQI); P values of the three groups: P < 0.05

Table 3

Comparison of MIDAS scores between the VM group and CM group (± s)
Item	n	Vestibular Migraine Group	t	P	n	Chronic Migraine Group	t	P
		MIDAS				MIDAS
Anxiety Status
Present	51	7.37 ± 3.45	2.663	0.01	66	23.45 ± 7.69	5.013	0.000
Absent	20	5.15 ± 2.25			29	14.86 ± 7.71
Depression Status
Present	55	7.38 ± 3.45	3.202	0.002	51	24.04 ± 5.98	4.241	0.000
Absent	16	4.56 ± 1.15			44	17.11 ± 9.73
Sleep Disorder
Present	63	7.02 ± 3.40	1.971	0.053	86	21.63 ± 8.42	2.889	0.005
Absent	8	4.63 ± 0.92			9	13.22 ± 6.96

Migraine is a common episodic and disabling condition, with its impact on patients' quality of life and work ability being most pronounced, especially in chronic migraine patients^[8]. Approximately 2.5% of migraine sufferers progress to chronic migraine each year^[2]. Vestibular migraine accounts for 10.3–21% of migraine cases^[9]. Notably, the relationship between vestibular symptoms and migraine is still uncertain, and the diagnosis of vestibular migraine does not consider the chronicization of migraine^[10]. Therefore, this study simultaneously included patients with vestibular migraine and chronic migraine without vestibular symptoms as research subjects.

This study revealed that 71.8% of the vestibular migraine group had comorbid anxiety, 77.5% had comorbid depression, and 88.7% had comorbid sleep disorders. In the chronic migraine group, 69.5% had comorbid anxiety, 53.7% had comorbid depression, and 90.5% had comorbid sleep disorders. The proportions of vestibular migraine and chronic migraine patients with comorbid anxiety disorders, depressive disorders, and sleep disorders were significantly greater than those in the normal control group. The degree of disability in patients with comorbid anxiety disorders, depressive disorders, and sleep disorders in the vestibular migraine and chronic migraine groups was significantly greater than that in those without comorbidities. The degree of disability in patients with vestibular migraine was associated with increased attack frequency, poorer sleep quality, and comorbid anxiety. In chronic migraine patients, longer disease duration, more severe headache, higher attack frequency, poorer sleep quality, and comorbid anxiety are associated with poorer quality of life. Luo Guogang et al. reported that the proportion of migraine patients with comorbid anxiety was 47.9%, that of those with comorbid depression was 50%, and that of those with comorbid sleep disorders was 58.5%, which was lower than the results of this study, possibly because of the inclusion of episodic migraine patients in their study^[11]. However, a study on the psychological status of vestibular migraine patients revealed that among 128 vestibular migraine patients, 71.9% had comorbid anxiety, 75.8% had comorbid depression, and 41.4% had comorbid anxiety and depression, which is similar to the results of this study^[12]. Wang Xiangming et al. reported that the quality of life of migraine patients was associated with headache severity, headache frequency, BMI, and anxiety^[13], which is generally consistent with the results of this study. A foreign study included 74 vestibular migraine patients and reported that 48.6% had anxiety and that 32.4% had signs of depression. Peripheral vestibular dysfunction and severe vestibular symptoms are significantly associated with anxiety and depression^[14]. Therefore, screening for vestibular symptoms and comorbid mental disorders is essential for the chronic disease management of migraine patients.

The relationship between sleep disorders and migraines is well established. Poor sleep quality or short sleep duration can trigger migraine attacks, with migraine patients experiencing higher headache frequencies due to insufficient sleep. Additionally, certain coping behaviors of migraine patients may contribute to the onset and persistence of sleep disorders, such as attempting to alleviate migraine attacks by going to bed early^[15]. A prospective study suggested that sleep variables can trigger acute migraine, predict the onset of new headaches several years in advance, and that snoring and sleep disorders are risk factors for migraine chronification. The presence of sleep disorders is associated with more frequent and severe migraines, indicating a poorer prognosis for patients with headaches^[16]. Studies have shown that migraines significantly affect patients' sleep quality and alter their sleep recovery process, leading to daytime sleepiness and fatigue and affecting their cognitive function^[17]. The sleep management strategy for migraines should be personalized. Understanding the interaction between headaches and sleep requires assessing sleep quality, potential sleep breathing disorders, and the use of opioid medications. Experts recommend the use of the Pittsburgh Sleep Quality Index to facilitate timely identification and standardized diagnosis and treatment of comorbid sleep disorders in migraine patients, thereby improving their quality of life^[18].

Migraines are often accompanied by vestibular dysfunction, especially in chronic migraine patients. However, the pathogenesis of vestibular dysfunction leading to the chronicization of migraines is not fully understood^[19]. Clinical studies have shown that the progression of migraine may be due to the mechanisms underlying migraine attacks or the activation produced by these attacks. Modifying potentially reversible risk factors such as migraine attack frequency, BMI, medication overuse, depression, and sleep disorders can reduce the chronicization of migraine^[19]. Imaging studies have revealed that functional impairments caused by chronic migraines occur mainly in brain areas related to multisensory integration. Additionally, the resting-state functional connectivity of the left posterior cingulate cortex and left superior parietal gyrus can predict the frequency of migraines and the severity of vestibular dysfunction. Therefore, these neuroimaging features may be potential mechanisms and therapeutic targets for vestibular dysfunction in migraine patients^[20]. Chen et al. reported that local changes in brain volume associated with emotions, perceptions, and cognition may be related to migraine attacks^[21]. Further research is needed to explore the deeper pathophysiological mechanisms involved.

In conclusion, the quality of life of vestibular migraine and chronic migraine patients is related to headache frequency, sleep quality, comorbid anxiety, etc. Future research should focus on large-sample, multicenter clinical studies and utilize migraine animal models and neuroimaging techniques to further explore their pathophysiological mechanisms.

Ethics approval and consent to participate

Ethics approval was obtained from the ethics committee of the Jiangyin People's Hospital in China. All subjects provided written informed consent.

Consent for publication

I hereby declare that all of the authors agree to the publication of the research findings presented in this manuscript entitled "A clinical study on the quality of life and psychological and sleep status of vestibular migraine patients" in the BMC Neurology. I have carefully read and understood the submission guidelines and requirements of the journal. I certify that the data and tables presented in this manuscript are original or have been authorized and licensed legally. I guarantee that ethical standards have been followed in human experiments, and informed consent has been obtained from the subjects. I hereby declare that I have made every effort to avoid errors and misconduct in this research and that the results presented in this manuscript are truthful and reliable.

Availability of data and materials

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Competing interests

The authors declare that there are no competing interests regarding the publication of this article.

Authors' Contributions

Huiping Zhang and Jiangfang Miao wrote the main manuscript text and Qiangbin Lu and Yu Kong and Yanyan Bai prepared tables 1-3. All authors reviewed the manuscript.

Funding and Acknowledgments

This work was supported by the Medical Clinical Science and Technology Development Fund of Jiangsu University (JLY20180186). The authors would like to thank the associate editors and the reviewers for their useful feedback that improved this paper.

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No competing interests reported.

A clinical study on the quality of life and psychological and sleep status of vestibular migraine patients

Status:

Version 1

Abstract

Objective

Methods

Results

Conclusions

1. Introduction

2. Subjects and Methods

3. Results

3.1. General characteristics of the study subjects

3.3. Prevalence of Anxiety, Depression, and Sleep Disorders among the Three Groups

3.4. Factors related to quality of life in vestibular migraine and chronic migraine patients

4. Discussion

5. Conclusions and Future Directions

Declarations

References

Additional Declarations

Status:

Version 1