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. 2011 Mar;11(3):379-94.
doi: 10.1586/ern.11.19.

Neurologic bases for comorbidity of balance disorders, anxiety disorders and migraine: neurotherapeutic implications

Carey D Balaban  1 , Rolf G Jacob, Joseph M Furman
Affiliations

Neurologic bases for comorbidity of balance disorders, anxiety disorders and migraine: neurotherapeutic implications

Carey D Balaban et al. Expert Rev Neurother. 2011 Mar.

Abstract

The comorbidity among balance disorders, anxiety disorders and migraine has been studied extensively from clinical and basic research perspectives. From a neurological perspective, the comorbid symptoms are viewed as the product of sensorimotor, interoceptive and cognitive adaptations that are produced by afferent interoceptive information processing, a vestibulo-parabrachial nucleus network, a cerebral cortical network (including the insula, orbitofrontal cortex, prefrontal cortex and anterior cingulate cortex), a raphe nuclear-vestibular network, a coeruleo-vestibular network and a raphe-locus coeruleus loop. As these pathways overlap extensively with pathways implicated in the generation, perception and regulation of emotions and affective states, the comorbid disorders and effective treatment modalities can be viewed within the contexts of neurological and psychopharmacological sites of action of current therapies.

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Figures

Figure 1
Figure 1. Neurological bases for the comorbidity between signs and symptoms of balance disorders, space and motion discomfort and migraine
Components related to sensorimotor (yellow), interoceptive (blue) and cognitive (light red) networks are color-coded. The boxes that represent brainstem sensorimotor structures include peripheral parallels between vestibular pathways and migraine mechanisms [6,8]. The cross-cutting modulatory noradrenergic contributions from LC and serotonergic contributions from the DRN are shown in gray and red, respectively. See text for further discussion. 5-HT1A,B,D or F : Serotonin receptors 1A, 1B, 1D or 1F; C1/C2: Cervical spinal cord segments C1 and C2; DRN: Dorsal raphe nucleus; LC: Locus coeruleus; N: Nucleus; PAG: Periaqueductal gray; PBN: Parabrachial nucleus; SMD: Space and motion discomfort.
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References

    1. Furman JM, Jacob RG. A clinical taxonomy of dizziness and anxiety in the otoneurologic setting. J Anxiety Disord. 2001;15:9–26. - PubMed
    1. Jacob RG, Furman JM, Balaban CD. Psychiatric aspects of vestibular disorders. In: Baloh RW, Halmagyi GM, editors. Handbook of Neurotology/Vestibular System. Oxford University Press; Oxford, UK: 1996. pp. 509–528.
    1. Staab JP. Chronic dizziness: the interface between psychiatry and neuro-otology. Curr Opin Neurol. 2006;19(1):41–48. - PubMed
    1. Staab JP, Ruckenstein MJ. Chronic dizziness and anxiety: effect of course of illness on treatment outcome. Arch Otolaryngol Head Neck Surg. 2005;131(8):675–679. - PubMed
    1. Staab JP, Ruckenstein MJ. Expanding the differential diagnosis of chronic dizziness. Arch Otolaryngol Head Neck Surg. 2007;133:170–176. - PubMed

Websites

    1. Facts for Physicians on mild TBI. 2010 www.cdc.gov/concussion/headsup/pdf/Facts_for_Physicians_booklet-a.pdf.
    1. Hoffer ME, Balaban CD. Neurotologic consequences of blast injury. IBIA NeuroTrauma Letter. 2010 www.internationalbrain.org/?q=node/151.

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