Evidence for common cervico-trigeminal and cervico-vestibular pathways in induced dizziness/vertigo and migraine in children


Principle Investigators:

Dr. med. Dipl.-Psych. Mirjam N. Landgraf MD
Prof. Dr. med. Florian Heinen MD
Prof. Dr. med. Rüdiger von Kries MD
Prof. Dr. med. Andreas Straube MD


The superordinate objective is to gain a better understanding of the interdependency of peripheral muscle sensation/tension/status and perception of dizziness/vertigo and headache. Such an interaction would support a functional loop within the hypothetical trigemino-vestibulo-cervical complex (TVCC).

Project description:

I.) Co-occurence of vertigo/dizziness, migraine and neck muscle tension

In order to assess the following questions 1400 school children at the age of 12-19 years were asked to fill in a questionnaire (MUKIS).

The resulting data of this epidemiological survey will be used for statistical analysis regarding:

1. Co-occurrence of vertigo/dizziness and migraine,

2. Inter-dependency of neck muscle tension reported by the school children and vertigo/dizziness

3. Inter-dependency of neck muscle tension reported by the school children and migraine

4. Association of the neck muscle tension-vertigo/dizziness/migraine–complex to a number of life style factors (e.g. intake of caffeine, nicotine, alcohol, medications, sports and activities)


II.) Provocation of vertigo/dizziness and/or migraine by manual pressure on tense areas of the cervico-cranial muscles

The aim is to show that pressure on tense areas in the cervico-cranial muscles can lead to an activation of reciprocal loops of the trigeminal pain system, the vestibular system and the neck muscle proprioception.


Figure 1:
Adapted model of the trigemino-vestibulo-cervical complex (TVCC) [9]

We suppose that episodes of vertigo/dizziness and migraine can be evoked via this reciprocal activation. To be able to comment on the specificity of pressure on tense areas in the neck muscles as a trigger for migraine or vertigo we perform a second stimulation with pressure on non-tense areas in the neck muscles as a control in the same patients 4 weeks later.

So a parallel group comparison will be combined with a longitudinal paired group comparison.


Figure 2:
Assessment procedure and time course of subproject 2


  • Epidemiological assessment (MCM-E)
  • Neurological and psychological assessment of adolescents with dizziness/vertigo or migraine
  • Establishment of a pathophysiological model for the assumed overlapping activation in cervico-trigemino-vestibular networks (MCM-M)

Relevant publications:

Khil L, Pfaffenrath V, Straube A, Evers S, Berger K. Incidence of migraine and tension-type headache in three different populations at risk within the German DMKG headache study. Cephalalgia. 2012;32(4):328-36

Kropp P, Meyer B, Landgraf M, Ruscheweyh R, Ebinger F, Straube A. Headache in children: update on biobehavioral treatments. Neuropediatrics. 2013;44(1):20-4.

Lehmann S, Milde-Busch A, Straube A, von Kries R, Heinen F. How specific are risk factors for headache in adolescents? Results from a cross-sectional study in Germany. Neuropediatrics. 2013 Feb;44(1):46-54.

Pfaffenrath V, Fendrich K, Vennemann M, Meisinger C, Ladwig KH, Evers S, Straube A, Hoffmann W, Berger K. Regional variations in the prevalence of migraine and tension-type headache applying the new IHS criteria: the German DMKG Headache Study. Cephalalgia. 2009;29(1):48-57.

Straube A, Aicher B, Förderreuther S, Eggert T, Köppel J, Möller S, Schneider R, Haag G. Period prevalence of self-reported headache in the general population in Germany from 1995-2005 and 2009: results from annual nationwide population-based cross-sectional surveys. J Headache Pain. 2013;14(1):11.

Von Stülpnagel C, Reilich P, Straube A, Schäfer J, Blaschek A, Lee SH, Müller-Felber W, Henschel V, Mansmann U, Heinen F. Myofascial trigger points in children with tension-type headache: a new diagnostic and therapeutic option. J Child Neurol. 2009 Apr;24(4):406-9.


 Landgraf-Mirjam-gr2 Langhagen-Inet2 hannibal-Iris
Mirjam Landgraf Thyra Langhagen Iris Hannibal   
Florian-Heinen-Mai15-1-gr rüdiger von kries straube-neu
Florian Heinen            Rüdiger von Kries Andreas Straube