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Understanding black carbon (BC) levels and its sources in urban environments is of paramount importance due to the far-reaching health, climate, and air quality implications. While several recent studies have assessed BC concentrations at specific fixed urban locations, there is a notable lack of knowledge in the existing literature on spatially resolved data alongside source estimation methods. This study aims to fill this gap by conducting a comprehensive investigation of BC levels and sources in Modena (Po Valley, Italy), which serves as a representative example of a medium-sized urban area in Europe. Using a combination of multi-wavelength micro-aethalometer measurements and a hybrid Eulerian–Lagrangian modelling system, we studied two consecutive winter seasons (February–March 2020 and December 2020–January 2021). Leveraging the multi-wavelength absorption analyser (MWAA) model, we differentiate sources (fossil fuel combustion, FF, and biomass burning, BB) and components (BC vs. brown carbon, BrC) from micro-aethalometer measurements. The analysis reveals consistent, minimal diurnal variability in BrC absorption, in contrast to FF-related sources that exhibit distinctive diurnal peaks during rush hours, while BB sources show less diurnal variation. The city itself contributes significantly to BC concentrations (52 ± 16 %), with BB and FF playing a prominent role (35 ± 15 % and 9 ± 4 %, respectively). Long-distance transport also influences BC concentrations, especially in the case of BB and FF emissions, with 28 ± 1 % and 15 ± 2 %, respectively. When analysing the traffic-related concentrations, Euro 4 diesel passenger cars considerably contribute to the exhaust emissions. These results provide valuable insights for policy makers and urban planners to manage BC levels in medium-sized urban areas, taking into account local and long-distance sources.

VERT (Vehicular Emissions from Road Traffic) is an R package developed to estimate traffic emissions of a wide range of pollutants and greenhouse gases based on traffic estimates and vehicle fleet composition data, following the EMEP/EEA methodology. Compared to other tools available in the literature, VERT is characterised by its ease of use and rapid configuration, while it maintains great flexibility in user input. It is capable of estimating exhaust, non-exhaust, resuspension, and evaporative emissions and is designed to accommodate future updates of available emission factors. In this paper, case studies conducted at both urban and regional scales demonstrate VERT's ability to accurately assess transport emissions. In an urban setting, VERT is integrated with the Lagrangian dispersion model GRAMM–GRAL and provides NOx concentrations in line with observed trends at monitoring stations, especially near traffic hotspots. On a regional scale, VERT simulations provide emission estimates that are highly consistent with the reference inventories for the Emilia-Romagna region (Italy). These findings make VERT a valuable tool for air quality management and traffic emission scenario assessment.

Introduction: Long-term contamination of tap water and groundwater by perfluoroalkyl and polyfluoroalkyl substances (PFASs) has been documented in the Veneto region of northern Italy. This study aimed to assess the exposure of individuals residing in the contaminated area and to test several toxicokinetic (TK) models of varying complexities to identify an efficient method for predicting perfluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS) concentrations in human serum using observed data.The ultimate goal is to provide public health officials with guidance on selecting the appropriate TK model for specific contexts, a reliable and rapid tool to support human bio-monitoring (HBM) studies. Methods: Two simpler empirical TK models and a more complex multi-compartment physiologically based toxicokinetic (PBTK) model were compared with individual and aggregate data from an HBM study. In addition, the PBPK model was modified by adjusting input parameters and introducing new terms into the equations within the original model code. These modifications aimed to optimize the results compared to the original model, with some versions incorporating adjustments to account for the influence of menstruation in women. All models were evaluated to understand their strengths and weaknesses, providing guidance on the appropriate model to use according to specific scenarios. Results: The results obtained from the tested models were quite similar, with significant improvements observed only in the modified models. Simpler models also provided satisfactory results in scenarios involving low PFOS serum concentrations and recent exposure cessation. In many cases, predictions demonstrated high accuracy, particularly at the aggregate level and for women. Conclusions: These findings suggest that environmental protection agencies and health authorities may benefit from employing the tested models at the aggregate level as an initial step in HBM studies, rather than conducting more invasive and expensive screening campaigns.

Abstract Background The anticipatory prescribing of injectable controlled drugs (ICDs) by general practitioners (GPs) to care home residents is common practice and is believed to reduce emergency hospital transfers at the end-of-life. However, evidence about the process of ICD prescribing and how it affects residents’ hospital transfer is limited. The study examined how care home nurses and senior carers (senior staff) describe their role in ICDs prescribing and identify that role to affect residents’ hospital transfers at the end-of-life. Methods 1,440 h of participant observation in five care homes in England between May 2019 and March 2020. Semi-structured interviews with a range of staff. Interviews (n = 25) and fieldnotes (2,761 handwritten A5 pages) were analysed thematically. Results Senior staff request GPs to prescribe ICDs ahead of residents’ expected death and review prescribed ICDs for as long as residents survive. Senior staff use this mechanism to ascertain the clinical appropriateness of withholding potentially life-extending emergency care (which usually led to hospital transfer) and demonstrate safe care provision to GPs certifying the medical cause of death. This enables senior staff to facilitate a care home death for residents experiencing uncertain dying trajectories. Conclusion Senior staff use GPs’ prescriptions and reviews of ICDs to pre-empt hospital transfers at the end-of-life. Policy should indicate a clear timeframe for ICD review to make hospital transfer avoidance less reliant on trust between senior staff and GPs. The timeframe should match the period before death allowing GPs to certify death without triggering a Coroner’s referral.

Light-absorbing aerosols (LAAs) are short-lived climate forcers with a significant impact on Earth's radiative balance. LAAs include dust aerosols, black carbon (BC) and organic light-absorbing carbonaceous aerosol (collectively termed brown carbon, BrC), which have also been proven to be highly toxic. In this study, aerosol absorption at five wavelengths (ranging from ultraviolet to infrared) was monitored continuously using filter-based photometers during two winter seasons in 2020 and 2021 in the city of Modena (southern central Po Valley, northern Italy), at two regulatory air quality monitoring sites, along with other pollutants (coarse particulate matter, PM10; fine particulate matter, PM2.5; O3; NO; NO2; and C6H6) and the vehicular traffic rate. The aerosol optical depth (AOD) and other column aerosol optical properties were concurrently monitored at four wavelengths by an AErosol RObotic NETwork (AERONET) sun photometer under urban background conditions within Modena. In situ absorption levels were apportioned to both sources (fossil fuel and biomass burning) and species (BC and BrC), while columnar absorption was apportioned to BC, BrC and mineral dust. The combined analysis of the atmospheric aerosol and gas measurements and of the meteorological conditions (in situ and from the ERA5 reanalysis) identified the location of potential urban sources of BC and BrC, most likely related to traffic and biomass burning. In situ data show different diurnal/weekly patterns for BrC from biomass burning and BC from traffic, with minor differences between the background and the urban traffic conditions. AERONET version 3 absorption aerosol optical depth (AAOD) retrievals at four wavelengths allowed the estimation of the absorptive direct radiative effect due to LAAs over the same period under the reasonable assumption that the AOD signal is concentrated within the mixing layer. AERONET retrievals showed a modest correlation of columnar absorption with planetary boundary layer (PBL)-scaled in situ observations, although the correlation improved significantly during a desert dust transport event that affected both in situ aerosol and columnar absorption, particularly in the blue spectrum range. A low correlation occurred between the contribution of BrC to aerosol absorption for the in situ and the columnar observations, with the BrC contribution being generally larger for in situ observations. Finally, evidence of a highly layered atmosphere during the study period, featuring significant spatial mixing and modest vertical mixing, was shown by ERA5-based atmospheric temperature profiles and by the large correlation of concurrent AERONET AOD retrievals in Modena and in Ispra (on the northwestern side of the Po Valley, ca. 225 km from Modena).

Vestibular migraine (VM) is an increasingly recognized pathology yet remains as an underdiagnosed cause of vestibular disorders. While current diagnostic criteria are codified in the 2012 Barany Society document and included in the third edition of the international classification of headache disorders, the pathophysiology of this disorder is still elusive. The Association for Migraine Disorders hosted a multidisciplinary, international expert workshop in October 2020 and identified seven current care gaps that the scientific community needs to resolve, including a better understanding of the range of symptoms and phenotypes of VM, the lack of a diagnostic marker, a better understanding of pathophysiologic mechanisms, as well as the lack of clear recommendations for interventions (nonpharmacologic and pharmacologic) and finally, the need for specific outcome measures that will guide clinicians as well as research into the efficacy of interventions. The expert group issued several recommendations to address those areas including establishing a global VM registry, creating an improved diagnostic algorithm using available vestibular tests as well as others that are in development, conducting appropriate trials of high quality to validate current clinically available treatment and fostering collaborative efforts to elucidate the pathophysiologic mechanisms underlying VM, specifically the role of the trigemino-vascular pathways.

Background: Cystic echinococcosis (CE) cysts may persist for decades because of immune modulation mechanisms. Here, we characterize the cysts and the blood immune responses in patients with CE. Methods: We enrolled 61 patients with CE and 19 control subjects. We received tissue samples from seven patients with CE and a control subject requiring liver cystectomy. The immunohistochemistry evaluation of the immune cell subtypes and cytokines in the pericysts and surrounding liver and the antigen B (AgB)-specific response analysis of whole blood were performed. Results: In CE, the pericyst and the surrounding liver parenchyma showed aggregates of CD3+ T lymphocytes, mainly CD4+. B lymphocyte aggregates were present in the liver tissue. Monocytes/granulocytes were rarely observed. Th2 cytokine expression was scarce, whereas IFN-γ expression was present in the CE tissues. The control subject did not show an inflammatory infiltrate. The IL-4-specific response to AgB was increased in the patients with CE compared to the control, and this result was confirmed in a larger cohort (p = 0.003), whereas the IFN-γ-response was similar between the two groups (p = 0.5570). Conclusion: In patients with CE, CD4+ lymphocytes infiltrate the pericyst and the surrounding liver tissue with a low IL-4/IL-13 expression level and a moderate IFN-γ expression level; moreover, an IL-4 parasite-specific response is detected in the periphery. These results support adventitia involvement in CE immunopathogenesis.

Menière’s disease and vestibular migraine (VM) are two common inner ear disorders whose diagnoses are based on clinical history and audiometric exams. In some cases, patients have been reporting different episodes of vertigo for years but not fulfilling the Bárány Society criteria for either. These are called Recurrent Vestibular Symptoms—Not Otherwise Specified (RVS-NOS). It is still under debate if this is a single disease entity or a part of the spectrum of already established disorders. The purpose of our work was to establish similarities and differences with VM in terms of clinical history, bedside examination, and family history. We enrolled 28 patients with RVS-NOS who were followed for at least 3 years with stable diagnosis; results were compared with those of 34 subjects having a diagnosis of definite VM. The age of onset of vertigo was lower in VM than in RVS-NOS (31.2 vs. 38.4 years). As for the duration of attacks and symptoms, we detected no differences other than subjects with RVS-NOS reporting milder attacks. Cochlear accompanying symptoms were more frequently reported by VM subjects (one subject reporting tinnitus and another one reported tinnitus and fullness). Motion sickness was equally reported by subjects across two samples (around 50% for both). Bipositional long-lasting, non-paroxysmal nystagmus was the most common finding in the two groups, with no significant difference. Finally, the percentage of familial cases of migrainous headache and episodic vertigo did not differ between the two samples. In conclusion, RVS-NOS shares some common aspects with VM, including the temporal profile of attacks, motion sickness (commonly considered a migraine precursor), bedside examination, and family history. Our results are not inconsistent with the possibility that RVS-NOS may be a heterogeneous disorder, even if some of these subjects may share common pathophysiological mechanisms with VM.

Given the involvement of balance system abnormalities in the pathophysiology of panic disorder and agoraphobia (PD-AG), we evaluated initial evidence for feasibility, acceptability, and potential clinical usefulness of 10 sessions of balance rehabilitation with peripheral visual stimulation (BR-PVS) in an open-pilot 5-week intervention study including six outpatients with PD-AG who presented residual agoraphobia after selective serotonin reuptake inhibitor (SSRI) treatment and cognitive–behavioral therapy, dizziness in daily life, and peripheral visual hypersensitivity measured by posturography. Before and after BR-PVS, patients underwent posturography, otovestibular examination (no patients presented peripheral vestibular abnormalities), and panic-agoraphobic symptom and dizziness evaluation with psychometric tools. After BR-PVS, four patients achieved postural control normalization measured by posturography, and one patient exhibited a favorable trend of improvement. Overall, panic-agoraphobic symptoms and dizziness decreased, even though to a lesser extent in one patient who had not completed the rehabilitation sessions. The study presented reasonable levels of feasibility and acceptability. These findings suggest that balance evaluation should be considered in patients with PD-AGO presenting residual agoraphobia and that BR-PVS might be an adjunctive therapeutic option worth being tested in larger randomized controlled studies.

Urban surfaces play a crucial role in shaping the Urban Heat Island (UHI) effect by absorbing and retaining significant solar radiation. This paper explores the potential of high-resolution satellite imagery as an alternative method for characterizing urban surfaces to support UHI mitigation strategies in urban redevelopment plans. We utilized Landsat images spanning the past 40 years to analyze trends in Land Surface Temperature (LST). Additionally, WorldView-3 (WV3) imagery was acquired for surface characterization, and the results were compared with ground truth measurements using the ASD FieldSpec 4 spectroradiometer. Our findings revealed a strong correlation between satellite-derived surface reflectance and ground truth measurements across various urban surfaces, with Root Mean Square Error (RMSE) values ranging from 0.01 to 0.14. Optimal characterization was observed for surfaces such as bituminous membranes and parking with cobblestones (RMSE < 0.03), although higher RMSE values were noted for tiled roofs, likely due to aging effects. Regarding surface albedo, the differences between satellite-derived data and ground measurements consistently remained below 12% for all surfaces, with the lowest values observed in high heat-absorbing surfaces like bituminous membranes. Despite challenges on certain surfaces, our study highlights the reliability of satellite-derived data for urban surface characterization, thus providing valuable support for UHI mitigation efforts.

Benign paroxysmal positional vertigo (BPPV) usually has a favorable course, although it is possible to observe BPPV with a high recurrence rate. Previous studies suggested that vitamin D deficiency might affect BPPV recurrences, and oxidative stress might play a complementary role in BPPV pathogenesis. This multicentric trial aimed to evaluate the effectiveness of oral nutritional supplementation with a compound of alpha-lipoic acid, Carnosine, and Zinc (LICA® (Difass International, Coriano (RN), Italy)), vitamins of group B and vitamin D in preventing BPPV recurrences. A total of 128 patients with high recurrence-BPPV were randomized in three arms: Arm 1 consisted of subjects with “insufficient” or “deficient” vitamin D blood levels, treated with daily oral supplementation of LICA®, vitamins of group B and vitamin D3 (800 UI), Arm 2 included BPPV subjects with “sufficient” vitamin D who did not receive any nutritional support, and Arm 3 included subjects with a “sufficient” serum concentration of vitamin D who received supplementation with a compound of LICA® and Curcumin. After six months of follow-up, a significant reduction of BPPV relapses compared to the baseline was found only in Arm 1 (−2.32, 95% CI: 3.41–1.62, p-value < 0.0001). Study results suggested that oral nutritional supplementation with vitamin D3 plus antioxidants can prevent relapses in patients suffering from high recurrence-BPPV.

Background: Dementia is a neurological syndrome characterized by severe cognitive impairment with functional impact on everyday life. It can be classified as young onset dementia (EOD) in case of symptom onset before 65, and late onset dementia (LOD). The purpose of this study is to assess the risk of dementia due to light pollution, and specifically outdoor artificial light at night (LAN). Methods: Using a case-control design, we enrolled dementia patients newly-diagnosed in the province of Modena in the period 2017–2019 and a referent population from their caregivers. We geo-referenced the address of residence on the date of recruitment, provided it was stable for the previous five years. We assessed LAN exposure through 2015 nighttime luminance satellite images from the Visible Infrared Imaging Radiometer Suite (VIIRS). Using a logistic regression model adjusted for age, sex, and education, we calculated the risk of dementia associated with increasing LAN exposure, namely using

IntroductionVestibular impairment and vertigo in the pediatric population have an estimated prevalence ranging between 0.4% and 5.6% and are a topic of interest in recent years. The Bárány Society has recently reclassified migraine-related vertigo syndromes as vestibular migraine of childhood (VMC), probable vestibular migraine of childhood (probable VMC), and recurrent vertigo of childhood (RVC).MethodsApplying the criteria established by the Bárány Society, we retrospectively analyzed data on 95 pediatric patients suffering from episodic vertigo that were recruited from 2018 to 2022. In applying the revised criteria, 28 patients had VMC, 38 had probable VMC, and 29 had RVC.ResultsVisuo-vestibular symptoms (external vertigo) or internal vertigo were reported by 20 of 28 VMC patients (71.4%) compared to 8 of 38 probable VMC patients (21%) (P

BackgroundCystic echinococcosis (CE), caused by Echinococcus granulosus sensu lato, is a neglected zoonosis. Its diagnosis relies on imaging, supported by serology, while only imaging is useful for staging and follow-up. Since diagnostic tools and expertise are not widely available, new accurate and easily implementable assays for the diagnosis and follow-up of CE are highly needed.Methodology/principal findingsWe aimed to identify new E. granulosus antigens through a bioinformatics selection applied to the parasite genome, followed by peptide microarray screening and validation in ELISA, using independent panels of sera from patients with hepatic CE and clinically relevant controls. From 950 proteins selected in silico, 2,379 peptides were evaluated by microarray for IgG reactivity and eight candidates selected for validation. Reactivity to one peptide was significantly higher in the CE group (p = 0.044), but had suboptimal diagnostic accuracy.Conclusions/significanceHere we performed bioinformatics analysis and peptide microarray for antigen discovery, useful for the diagnosis of CE. Eight candidates were selected and validated. Reactivity to one peptide associated to CE but had suboptimal diagnostic accuracy. Importantly, the database developed in this study may be used to identify other antigenic candidates for CE diagnosis and follow-up.

Understanding black carbon (BC) levels and its sources in urban environments is of paramount importance due to the far-reaching health, climate, and air quality implications. While several recent studies have assessed BC concentrations at specific fixed urban locations, there is a notable lack of knowledge in the existing literature on spatially resolved data alongside source estimation methods. This study aims to fill this gap by conducting a comprehensive investigation of BC levels and sources in Modena (Po Valley, Italy), which serves as a representative example of a medium-sized urban area in Europe. Using a combination of multi-wavelength micro-aethalometer measurements and a hybrid Eulerian–Lagrangian modelling system, we studied two consecutive winter seasons (February–March 2020 and December 2020–January 2021). Leveraging the multi-wavelength absorption analyser (MWAA) model, we differentiate sources (fossil fuel combustion, FF, and biomass burning, BB) and components (BC vs. brown carbon, BrC) from micro-aethalometer measurements. The analysis reveals consistent, minimal diurnal variability in BrC absorption, in contrast to FF-related sources that exhibit distinctive diurnal peaks during rush hours, while BB sources show less diurnal variation. The city itself contributes significantly to BC concentrations (52 ± 16 %), with BB and FF playing a prominent role (35 ± 15 % and 9 ± 4 %, respectively). Long-distance transport also influences BC concentrations, especially in the case of BB and FF emissions, with 28 ± 1 % and 15 ± 2 %, respectively. When analysing the traffic-related concentrations, Euro 4 diesel passenger cars considerably contribute to the exhaust emissions. These results provide valuable insights for policy makers and urban planners to manage BC levels in medium-sized urban areas, taking into account local and long-distance sources. [ABSTRACT FROM AUTHOR]

VERT (Vehicular Emissions from Road Traffic) is an R package developed to estimate traffic emissions of a wide range of pollutants and greenhouse gases based on traffic estimates and vehicle fleet composition data, following the EMEP/EEA methodology. Compared to other tools available in the literature, VERT is characterised by its ease of use and rapid configuration, while it maintains great flexibility in user input. It is capable of estimating exhaust, non-exhaust, resuspension, and evaporative emissions and is designed to accommodate future updates of available emission factors. In this paper, case studies conducted at both urban and regional scales demonstrate VERT's ability to accurately assess transport emissions. In an urban setting, VERT is integrated with the Lagrangian dispersion model GRAMM–GRAL and provides NO x concentrations in line with observed trends at monitoring stations, especially near traffic hotspots. On a regional scale, VERT simulations provide emission estimates that are highly consistent with the reference inventories for the Emilia-Romagna region (Italy). These findings make VERT a valuable tool for air quality management and traffic emission scenario assessment. [ABSTRACT FROM AUTHOR]

Background: Vestibular migraine (VM) and Menière’s disease (MD) are the two most frequent episodic vertigo apart from Benign Paroxysmal Positional Vertigo (BPPV) differential diagnosis for them may be troublesome in the early stages. SVINT is a newly proposed vestibular test, which demonstrated to be fast and reliable in diagnoses above all of peripheral vestibular deficits. Methods: We retrieved clinical data from two groups of subjects (200 VM and 605 MD), enrolled between 2010 and 2020. Among others, these subjects were included when performing a SVINT. The purpose of the study is to assess if SVINT can be useful to differentiate the two episodic disorders. Results: 59.2% of MD subjects presented as positive with SVINT while only 6% did so with VM; among other tests, only video HIT demonstrated a different frequency in the two groups (13.1% and 0.5%, respectively), but the low sensitivity in these subjects makes the test unaffordable for diagnostic purposes. Conclusions: Since SVINT demonstrated to be positive in a peripheral vestibular deficit in previous works, we think that our data are consistent with the hypothesis that, in the pathophysiology of VM attacks, the central vestibular pathways are mainly involved.

BackgroundExposure to pesticides has been suggested as a risk factor for childhood leukemia, but definitive evidence on this relation and the specific pesticides involved is still not clear.ObjectiveWe carried out a population-based case-control study in a Northern Italy community to assess the possible relation between passive exposure to agricultural pesticides and risk of acute childhood leukemia.MethodsWe assessed passive pesticide exposure of 111 childhood leukemia cases and 444 matched controls by determining density and type of agricultural land use within a 100-m radius buffer around children's homes. We focused on four common crop types, arable, orchard, vineyard and vegetable, characterized by the use of specific pesticides that are potentially involved in childhood induced leukemia. The use of these pesticides was validated within the present study. We computed the odds ratios (OR) of the disease and their 95% confidence intervals (CI) according to type and density of crops around the children's homes, also taking into account traffic pollution and high-voltage power line magnetic field exposure.ResultsChildhood leukemia risk did not increase in relation with any of the crop types with the exception of arable crops, characterized by the use of 2.4-D, MCPA, glyphosate, dicamba, triazine and cypermethrin. The very few children (n=11) residing close to arable crops had an OR for childhood leukemia of 2.04 (95% CI 0.50-8.35), and such excess risk was further enhanced among children aged

The aim of this paper was to investigate the role of the psychological variable of alexithymia both as a risk factor for the development of Ménière’s disease (MD) and as a component that influences the personal experience of MD and the individual quality of life. We collected data from 179 Italian patients who fulfilled criteria for definite MD. Patients filled out validated self-rating questionnaires to assess alexithymia (TAS-20), quality of life (WHOQOL-BREF), anxiety and depression (HADS), perception of stress (PSS) and coping strategies (COPE). Socio-demographic data and MD clinical features were collected using a specific rating form. Subjects affected by MD showed higher levels of alexithymia compared to general population. Among MD patients, those characterized by high levels of alexithymia revealed a significant increase in anxiety and depression, greater perceived stress, a lower quality of life in psychological health and social relationships domains and the use of less mature coping strategies in comparison with MD patients with low or absent alexithymia. Our preliminary data could help in hypothesizing a role of psychological functioning in MD development and in the adaptation to the disease. The presence of alexithymia in patients suffering from MD may constitute a risk factor for the development of anxiety and depression symptoms; greater perceived stress and for poorer psychological and relational quality of life. Therefore, our study design did not allow causal inferences and further studies are needed.

Abstract Background Vestibular symptoms and balance changes are common in patients with migraine, especially in the ones with aura and chronic migraine. However, it is not known if the balance changes are determined by the presence of vestibular symptoms or migraine subdiagnosis. Therefore, the aim of this study was to verify if the migraine subdiagnosis and/or the presence of vestibular symptoms can predict balance dysfunction in migraineurs. Methods The study included 49 women diagnosed with migraine with aura, 53 without aura, 51 with chronic migraine, and 54 headache-free women. All participants answered a structured questionnaire regarding migraine features and presence of vestibular symptoms, such as dizziness/vertigo. The participants performed the Modified Sensory Organization Test on an AMTI© force plate. The data were analysed using a linear mixed-effect regression model. Results The presence of vestibular symptoms did not predict postural sway, but the subdiagnosis was a significant predictor of postural sway. Migraine with aura patients exhibited more sway than migraine patients without aura when the surface was unstable. Additionally, we found high effect sizes (ES > 0.79) for postural sway differences between patients with chronic migraine or with aura compared to controls or migraine without aura, suggesting that these results are clinically relevant. Conclusions The subdiagnosis of migraine, instead of the presence of vestibular symptoms, can predict postural control impairments observed in migraineurs. This lends support to the notion that balance instability is related to the presence of aura and migraine chronicity, and that it should be considered even in patients without vestibular symptoms.