Vestibular sensitivity in vestibular migraine: VEMPs and motion sickness susceptibility

Vestibular migraine (VM) has gained recognition as a distinct clinical entity in recent years. The pathophysiology is unclear. Vestibular evoked myogenic potential (VEMP) is a validated method to test the vestibulocollic reflex and peripheral vestibular hypersensitivity to noise. The aim of our study was to evaluate the vestibular function and sensitivity in a series of VM patients in comparison to ordinary migraine (M) patient and healthy controls.

Thirty-seven patients diagnosed with VM according to the Neuhauser criteria, 32 migraineurs, and 30 healthy persons underwent VEMP testing (response and sound intensity threshold) and a motion sickness susceptibility questionnaire.

We found absence of unilateral or bilateral VEMP response at 90  dB normal hearing level (nHL) in 44% of the VM patients, in 25% of the migraineurs, as compared to in 3% of the healthy controls (p  =  0.001). The sound intensity threshold and latencies were similar in all the groups. Migraineurs (VM > M) reported more motion sickness than healthy controls (p  =   0.006).

The results indicate more pathology in the VEMP circuitry in migraineurs than in healthy controls. We did not find support for peripheral vestibular hypersensitivity in terms of lower VEMP threshold among VM patients, but they are more sensitive for motion triggers than other migraineurs.