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.
Study Type
OBSERVATIONAL
Enrollment
126
Headache Assessment: Numerical Pain Scale
The numeric pain scale is used to assess the severity of a headache.The pain a person feels is evaluated on a scale from "0: no pain at all" to "10: I feel very severe pain."
Time frame: From August 2026 to January 2027
Movement Imagery Questionnaire-3
The Movement Imagery Questionnaire-3 is the most up-to-date version of the Movement Imagery Questionnaire and the Movement Imagery Questionnaire-Revised, Second Edition.The questionnaire consists of 12 items and separately evaluates external, internal, and kinesthetic imagery abilities. After each imagery task, individuals rate their experience on a scale from 1 to 7 (1 - very difficult to feel/see, 7 - very easy to feel/see).
Time frame: From August 2026 to January 2027
Motor Imagery Ability Test
The ability to imagine movement is used to test the controllability component of imagery (CC). It is defined as the ability to manipulate, transform, or maintain an imagined body movement over time
Time frame: From August 2026 to January 2027
Mental Chronometry
The administration of questionnaires is quite easy and quick. However, the subjectivity arising from individuals rating themselves in these questionnaires should not be overlooked. Mental chronometry can be defined as the time required by the neural system to process information. It is based on a different foundation than the questionnaires mentioned above. Mental chronometry is a parameter that measures the duration of motor imagery and is based on the assumption that the time required to perform a movement is the same as the time needed to imagine it. Compared to questionnaires, mental chronometry is a more objective measure; however, it does not evaluate the clarity or vividness of imagery. Mental chronometry measurements are planned to be carried out using the method described by Oostra et al.
Time frame: From August 2026 to January 2027
Mental Rotation Ability
Mental Rotation is one of the visuospatial abilities and can be simply defined as the mental rotation of objects in three dimensions. To evaluate mental rotation ability, three-dimensional objects such as cubes or body parts like the hands and feet can be used. Mental rotation ability is frequently assessed using hand images. The basic principle of hand mental rotation tests is to determine whether a hand image, presented from different angles and orientations, belongs to the right or left hand. In our study, since we focus on the neck region and balance ability, the Recognise Neck and Foot applications, which include images of the neck and feet, will be used.
Time frame: From August 2026 to January 2027
Assessment of motor imagery of different tasks using Functional Magnetic Resonance Imaging
The task is to perform visual motor imagery and kinesthetic motor imagery in accordance with the instructions, taking into account the tasks included in the Movement Imagery Questionnaire-3.The stimuli will be presented via projection onto a mirror mounted on the head coil of the Functional Magnetic Resonance Imaging scanner. All participants will first be instructed to perform visual motor imagery (first-person internal egocentric imagery) and then kinesthetic motor imagery. The procedure is planned to be carried out using the method applied by Kwon et al.
Time frame: From August 2026 to January 2027
The Montreal Cognitive Assessment
The Montreal Cognitive Assessment is a neuropsychological test used to evaluate cognitive domains such as memory, attention, executive functions, visuospatial abilities, language, abstraction, and orientation. The scale includes items assessing attention and concentration, executive functions, memory, language, visuospatial skills, abstract thinking, calculation, and orientation. The total score ranges from 0 to 30. In the standardization study conducted in our country, the cutoff score for distinguishing healthy individuals from those with mild cognitive impairment was determined as 21.
Time frame: From August 2026 to January 2027
The Migraine Disability Assessment
The Migraine Disability Assessment scale measures headache-related disability and includes five functional questions related to work, school, and household activities. The MIDAS score is calculated by counting the number of days in which the patient's performance is reduced or absent.
Time frame: From August 2026 to January 2027
Cervical Proprioception Assessment
The Cervical Joint Position Sense Test is used to assess cervical position sense. In this test, a laser pointer attached to the participant's head and a board with concentric circles drawn at 1 cm intervals are used. Participants are asked to sit on a chair with back support. The distance between the panel and the participant is set at 90 cm. The laser pointer is aligned with the center of the board. Participants are asked to close their eyes and memorize this central point.
Time frame: from August 2026 to January 2027
Trunk Proprioception Assessment
Proprioception measurement is planned using a Dualer IQ Pro Digital Inclinometer with a repositioning test during trunk flexion. A target angle of 30° flexion is used.
Time frame: from August 2026 to January 2027
Neck Awareness Assement
The Fremantle Neck Awareness Questionnaire is a 9-item questionnaire that evaluates attention, proprioceptive sensation (body awareness), neglect, and the perception of the neck's shape and size. A higher score on the Fremantle Neck Awareness Questionnaire indicates lower neck awareness.
Time frame: from August 2026 to January 2027
Balance Assessment
Balance assessment will be performed using the HUR Smart Balance device on both firm and soft surfaces, with eyes open and closed.
Time frame: from August 2026 to January 2027
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