Investigation of Imagery Abilities in Individuals With Migraine

Investigation of Imagery Abilities in Individuals With Migraine and the Relationship Between Imagery Abilities and Proprioception, and Balance

The aim of this study is to compare the motor imagery abilities of patients with migraine to those of healthy individuals, and to examine the relationship between motor imagery and proprioception (cervical and trunk), balance, body awareness, anxiety, and depression levels. Additionally, the study aims to investigate the relationship between proprioception and balance in patients with migraine. Motor imagery abilities of patients with migraine and healthy control subjects (aged 18-65 years; planned sample size: 68 individuals in each group, 68 migraine patients and 68 healthy participants) will be assessed using the Movement Imagery Questionnaire-3, the Motor Imagery Ability Test, mental chronometry, mental rotation tasks, and functional MRI (fMRI) during motor imagery of different tasks. Additionally, in patients with migraine, cervical and trunk proprioception, balance, body awareness, the Tampa Scale for Kinesiophobia, the Vertigo Symptom Scale, the Dizziness Handicap Inventory, and the Hospital Anxiety and Depression Scale will be evaluated.

1. Hypothesis H0: There is no difference in motor imagery abilities between patients with migraine and healthy controls.

   H1: There is a difference in motor imagery abilities between patients with migraine and healthy controls.

2. Hypothesis H0: There is no relationship between motor imagery abilities and proprioception in patients with migraine. H1: There is a relationship between motor imagery abilities and proprioception in patients with migraine.

3. Hypothesis H0: There is no relationship between proprioception (cervical/trunk) and balance in patients with migraine.

   H1: There is a relationship between proprioception (cervical/trunk) and balance in patients with migraine.

4. Hypothesis H0: There is no relationship between motor imagery abilities and body awareness, anxiety, and depression in patients with migraine.

H1: There is a relationship between motor imagery abilities and body awareness, anxiety, and depression in patients with migraine.

Motor imagery is defined as the mental simulation of a movement without its physical execution. During motor imagery, brain regions activated during actual motor performance are similarly engaged. Motor imagery can be divided into visual (external or internal perspective) and kinesthetic (internal sensation of movement) components, and it activates several cerebral regions, including the premotor cortex, supplementary motor area, primary motor cortex, parietal lobe, cerebellum, and basal ganglia.

Migraine is a complex neurological disorder that can lead to impairments in emotional, cognitive, and sensory functions. Migraine symptoms are not limited to pain and are associated with alterations in thalamic activity, as well as connections involving trigeminal-cortical or intracortical networks and interactions between the thalamus and the limbic system. Despite being relatively young and not exhibiting significant motor control deficits, recent evidence suggests that patients with migraine may present with balance impairments. These individuals may experience impaired postural stability during quiet standing under altered surface and visual input conditions, and their limits of stability tend to decrease during dynamic tasks such as walking, obstacle negotiation, and sit-to-stand transitions.

Motor imagery-based exercises have been shown to be effective in reducing pain, improving motor control, and regulating psychological status in pain syndromes such as fibromyalgia, chronic low back pain, and neck pain. These effects highlight the potential role of motor imagery in pain perception, body awareness, and cognitive-emotional regulation. Furthermore, several studies have demonstrated that motor imagery training has positive effects on balance and mobility in older adults, walking performance, fatigue, and quality of life in patients with multiple sclerosis, and trunk muscle control and proprioception in individuals with stroke.

There is a lack of comprehensive research on motor imagery in patients with migraine in the current literature. Therefore, the aim of this study is to compare the motor imagery abilities of patients with migraine to those of healthy individuals and to investigate the relationships between motor imagery and proprioception (cervical and trunk), balance, body awareness, anxiety, and depression. Additionally, the study aims to examine the relationship between proprioception and balance in patients with migraine.

Inclusion Criteria:

Migraine Patients:

• Diagnosed with migraine by a neurologist according to ICHD-3 criteria
• Aged 18-65 years
• Score greater than 21 on the Montreal Cognitive Assessment (MoCA)

Healthy Participants:

• Aged 18-65 years
• Score greater than 21 on the Montreal Cognitive Assessment (MoCA)

Exclusion Criteria:

(for both migraine and healthy control groups):

• Presence of additional neurological or orthopedic disorders
• Current use of psychiatric medications
• Severe musculoskeletal, cardiovascular, pulmonary, metabolic, or other medical conditions that would prevent participation in the study
• Significant visual or hearing impairments
• Severe cognitive impairment, as determined by a physician, that would interfere with the administration of tests.