Page 132 - Migraine, the heart and the brain

Chapter 7
migraine controls for: (i) ne motor speed and coordination as evaluated with the Purdue pegboard task; (ii) perceptual intelligence and motor function as evaluated with the WAIS-III block-design test; (iii) cerebellar motor coordination and learning of limb movements as evaluated with the prism adaptation test; (iv) associative cerebellar motor learning evaluated with the eyeblink conditioning paradigm; and (v) vestibular motor coordination and adaptation as evaluated with the body-sway test. Participants with migraine who had cerebellar ischaemic lesions performed worse on some parameters of the pegboard task, but not on the other cerebellar motor tasks.
Cerebellar function in migraine patients from the general population
The present study is the rst to assess cerebellar function in detail over a wide range of modalities in a large and unselected but clinically well-characterised group of migraine patients from the general population. Whereas previous studies suggested subclinical cerebellar dysfunction in migraine patients who were drawn from headache clinics (1,6,10), we failed to nd any evidence of impaired cerebellar function in the ‘average migraine patient’ from the general population despite using a diverse set of highly sensitive clinical tests.
We employed a wide array of tests, which together cover functions of all main parts of the cerebellar cortex including cerebrocerebellum (hemispheres; e.g. Purdue pegboard task, block-design test and eyeblink conditioning), spinocerebellum (vermis and paravermis; e.g. prism adaptation test and eyeblink conditioning) and vestibulocerebellum (flocculus and nodulus; e.g. bodysway test) (23–30). The cerebrocerebellum receives input from the cerebral cortex and mainly controls planning of movements, while the spinocerebellum and vestibulocerebellum receive inputs from spinal cord and brainstem regions involved in sensory proprioceptive, vestibular and visual processing and mainly control execution of limb, eye and head movements (31–33). Moreover, the tests probably also cover functions of both the anterior and posterior lobe (25,26,28–30). The posterior lobe may differ from the anterior lobe in that it may be more prominently involved in non-motor cognitive and autonomic functions (31,34–37), and/or visuomotor planning (32).
Our results diverge from those obtained in other studies (1,2,6,10). These studies were small and included migraine patients who were all selected from headache clinics. As a consequence, many of these patients most likely were on the more severe end of the clinical migraine spectrum and were using antimigraine medications potentially interfering with cerebellar functions. Moreover, the researchers in these studies were not blinded for diagnosis while using only single test paradigms such
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