Our findings support the notion that there is a slight but significant postural instability in migraineurs and it is of central vestibular origin.

Invasive fungal sinusitis can, rarely, occur in healthy individuals and should be suspected as a possible cause of a progressive orbital apex syndrome.

BACKGROUND: We assessed frequency of vestibular symptoms in Headache Clinic patients over 10 years. METHODS: A descriptive study of 5111 consecutive patients with tension-type headache or migraine, analyzed for dizziness/ vertigo accompanying headache and for a lifetime history of motion-sickness, cyclic vomiting, recurrent abdominal pain or atopy. Migraine patients were re-grouped as those with vestibular symptoms (dizziness/vertigo or motion sickness) and those without and their data then re-analyzed. RESULTS: There were 1880 migraine patients and 3231 tension-type headache patients. Significantly more migraine patients than tension-type headache patients experienced vestibular symptoms (p < 0.0001). The migraine with vestibular symptoms group was significantly younger (p < 0.05) had more aura, more phonophobia with migraine attacks (p < 0.0001). Menstruation and reported sleep problems impacted on headaches. While past history of cyclical vomiting, recurrent abdominal pain or atopy was about twice as common in migraine with aura and it was also more common in migraine with vestibular symptoms than migraine without vestibular symptoms. CONCLUSIONS: Vestibular symptoms are common in migraine patients. Migraine with vestibular symptoms might constitute a special group, one more likely to have had cyclic vomiting, recurrent abdominal pain or atopy.

After 1 year migraineurs showed a slight but statistically significant deterioration: in postural sway especially, when measured with eyes closed standing on a foam surface with the head extended backwards; in reaction time; and in maximal excursion on the limits of the stability test; and perhaps in walk speed and step width on the tandem walk test.

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