Research in Vestibular Science

Review

Vestibular Migraine: A Recent Update on Diagnosis and Treatment: Young Seo Kim, Hak Seung Lee; Res Vestib Sci. 2022;21(3):67-74. Published online September 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.3.67

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Abstract PDF: Vestibular migraine (VM) is a variant of migraine resulting in vestibular symptoms in addition to symptoms typical of migraine. However, without a biomarker or a complete understanding of the pathophysiology, VM remains underrecognized and underdiagnosed. Therefore, the diagnosis of VM is still challenging. Meanwhile, VM should be clearly differentiated from other similar diseases. Here, we highlight these challenges, discuss common vestibular symptoms and clinical presentations in VM, and review the current aspects of its clinical diagnosis and evaluation. The concepts related to the treatment of VM are also discussed.

Original Article

Canal Dysfunction Detected by Video Head Impulse Test in Patients with Vestibular Migraine and Its Relationship with Symptomatic Improvement: Ji Won Choi, Won Sub Lim, Sung Seok Ryu, Yeonjoo Choi, Sang Hun Lee, Seung Cheol Ha, Hong Ju Park; Res Vestib Sci. 2022;21(2):46-52. Published online June 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.2.46

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Abstract PDF: Objectives
Video head impulse test (vHIT) can evaluate function of the vestibuloocular reflex for high frequency range of head rotation. We aimed to characterize the abnormal patterns of canal dysfunction by vHIT in vestibular migraine (VM) and evaluate the relationship between the presence of canal dysfunction and symptomatic improvement.
Methods
Eighty-seven patients with VM were included. Abnormality of vHIT at the initial examination was determined by the vHIT gain and the degrees of the corrective saccades at each canal and each side. The relationship between the abnormal patterns and the symptomatic improvement (no need for preventive medication) after modification of life styles and preventive medications for 1, 3, and 6 months was evaluated.
Results
Abnormal vHIT of the lateral canal was 13.8% when determined by the gain criteria and 31.0% when based on both gain and corrective saccade, regardless of the side. Abnormal vHIT of the superior and posterior canals were 18.4% and 27.6%, regardless of the side. Abnormal vHIT at any canal and side was observed in 47%. Patients showed symptomatic improvement in 29.9%, 71.3%, and 88.5% after modification of life styles and preventive medications for 1, 3, and 6 months. Abnormal vHIT results of canals were significantly related to the poor response to preventive mediations.
Conclusions
Prolonged preventive medication was required for symptomatic improvement in VM patients when vHIT results of any canals were abnormal, suggesting that peripheral vestibular abnormality is closely related to the pathophysiology of vestibular migraine.

Case Report

Endolymphatic Hydrops in Vestibular Migraine Associated with Menière’s Disease: A Report of Two Cases: Bit Na Lee, Seung-Bae Hwang, Jin-ju Kang, Sun-Young Oh; Res Vestib Sci. 2021;20(4):156-160. Published online December 15, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.4.156

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Abstract PDF

Vestibular migraine and Menière’s disease have similar clinical features which are recurrent dizziness or auditory symptoms, so it is challengeable to establish the correct diagnosis. Herein, a 31-year-old male and a 56-year-old female showed recurrent dizziness with auditory symptoms and suffered from vestibular migraine. They met the diagnostic criteria for vestibular migraine, but the Menière’s diagnostic criteria were not satisfied as there was no hearing loss. Delayed intravenous gadolinium enhanced magnetic resonance imaging of the inner ear was taken to find out of correlation of the inner ear and revealed endolymphatic hydrops. This case can improve the understanding of the pathophysiology of a vestibular migraine associated Menière’s disease.

Citations

Citations to this article as recorded by

Functional and Molecular Markers for Hearing Loss and Vertigo Attacks in Meniere’s Disease
Chao-Hui Yang, Ming-Yu Yang, Chung-Feng Hwang, Kuang-Hsu Lien
International Journal of Molecular Sciences.2023; 24(3): 2504. CrossRef

Original Article

Relationship between Chronological Orders of Symptoms and Vestibular Abnormality in Patients with Vestibular Migraine: Sae Eun YI, Jun Woo Park, Jang Wook Kwak, Yeonjoo Choi, Sang Hun Lee, Seung Cheol Ha, Hong Ju Park; Res Vestib Sci. 2021;20(2):51-57. Published online June 14, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.2.51

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Abstract PDF: Objectives
Pathophysiology of vestibular migraine (VM) is still controversial. Vertigo may act as a trigger for migraine or there might other mechanisms which cause migraine and dizziness. VM patients have headaches and dizziness simultaneously or sequentially. Therefore, we hypothesized that the sequence of symptoms might suggest different mechanisms and compared the results of vestibular function tests (VFTs) according to chronological order of headache and vertigo.
Methods
Forty-two patients with VM were included. They were divided into three subgroups according to the chronological orders of headache and vertigo, and the results of VFTs and the symptomatic improvement were compared between each group.
Results
Dizziness appeared first in 15 patients (35.7%), both symptoms appeared simultaneously in 20 patients (47.6%), and headaches appeared first in 7 (16.7%). There were no significant differences in symptom duration among the groups. Fourteen (33.3%) showed abnormal caloric results, 7 (16.7%) in head impulse test, 16 (38.1%, vestibular score) and 19 (45.2%, composite score) in sensory organizing test, and 13 (31.0%) in vestibular evoked myogenic potential test. Abnormal rate of the caloric test in the simultaneous group was significantly lower than those of the other two groups. Nineteen (45.2%) showed complete remission in 3 months after preventive medication with no significant difference between each group.
Conclusions
VM patients whose vertigo occurred with headache simultaneously showed lower incidence of caloric abnormality, suggesting that they have abnormality in central vestibular system rather than peripheral vestibular organs.

Review

Dizziness after Traumatic Brain Injury: Neurological Aspects: Young Seo Kim, Seon Jae Im, Hak Seung Lee; Res Vestib Sci. 2019;18(3):59-63. Published online September 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.3.59

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Abstract PDF: Vertigo, dizziness, and disequilibrium are common symptoms following concussion or traumatic brain injury. Dizziness and vertigo may be the result of trauma to the peripheral vestibular system or the central nervous system, or, in some cases, may be due to anxiety, depression, or posttraumatic stress disorder; these mechanisms are not mutually exclusive. While most peripheral vestibular disorders can be identified by testing and examination, those without inner ear causes that have persisting complaints of dizziness and motion sickness are more difficult to understand and to manage. Some of these patients exhibit features compatible with vestibular migraine and may be treated successfully with migraine preventative medications. This paper reviews the neurological causes of persisting dizziness, the possible mechanisms, and the pathophysiology, as a framework for patient management and for future research.

Original Article

Characteristics of Nystagmus during Attack of Vestibular Migraine: Soyeon Yoon, Mi Joo Kim, Minbum Kim; Res Vestib Sci. 2019;18(2):38-42. Published online June 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.2.38

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Abstract PDF

Objectives
The purpose of this study is to investigate characteristics of nystagmus during attacks of vestibular migraine (VM), and to find a distinct clinical feature compared to other migraine and peripheral vestibular disorders.
Methods
This study is a retrospective chart review of 82 patients satisfied with VM criteria, which is formulated by the new Bárány Society. Spontaneous and positional nystagmus provoked by various head positions were examined with video-nystagmography in all patients. Bithermal caloric test and cervical vestibular evoked myogenic potential test (cVEMP) were also performed. The direction and peak slow-phase velocity (SPV) of nystagmus, unilateral caloric weakness and interaural difference of cVEMP were analyzed. Control groups were lesion side in acute VN for nystagmus results and healthy side in the patients with benign paroxysmal positional vertigo of posterior semicircular canal for caloric and cVEMP results. Chi-square test and Mann-Whitney U-test were used for statistical analysis.
Results
During the acute attack, nystagmus was seen in 71.9% (59 of 82) of patients. Horizontal nystagmus was the predominant type. Peak SPV in VM patients was much slower than in the control group (2.37±1.73 °/sec vs. 17.05±12.69 °/sec, p＜0.0001). There was no significant difference on the result of both caloric and cVEMP test, compared to those of control groups.
Conclusion
Nystagmus with horizontal directions and low SPV was dominant form in the attack of VM. Close observation of nystagmus can be helpful to make a correct diagnosis and to understand the pathomechanism of vertigo in VM.

Citations

Citations to this article as recorded by

Vestibular Migraine: A Recent Update on Diagnosis and Treatment
Young Seo Kim, Hak Seung Lee
Research in Vestibular Science.2022; 21(3): 67. CrossRef

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