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

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.

Keywords::

• anxiety disorders
• balance disorders
• migraine
• vestibular rehabilitation
• vestibular system

Acknowledgement

Carey Balaban gratefully acknowledges the long-term encouragement of these efforts by Dr Daniel Sklare and Dr Christopher Platt of the National Institute on Deafness and Other Communication Disorders (NIDCD).

Financial & competing interests disclosure

Carey Balaban gratefully acknowledges the support of this area of translational research by R01 DC000739 from the NIDCD. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.