Self-motion perception is sensitized in vestibular migraine: pathophysiologic and clinical implications

Area of Science:

• Neuroscience
• Otolaryngology
• Neurology

Background:

• Vestibular migraine (VM) is a leading cause of spontaneous vertigo, yet its underlying pathophysiology is not fully understood.
• Understanding the neural mechanisms of VM is crucial for improving diagnosis and treatment.

Purpose of the Study:

• To investigate the hypothesis of central vestibular pathway sensitization in VM.
• To characterize vestibular perceptual thresholds, vestibulo-ocular reflex (VOR), and symptom severity in VM patients.

Main Methods:

• Measured self-motion perceptual thresholds in VM patients and controls.
• Assessed vestibulo-ocular reflex (VOR) dynamics.
• Correlated vestibular thresholds with symptom severity and VOR parameters.

Main Results:

• VM patients exhibited abnormal sensitivity to roll tilt, indicating impaired canal-otolith integration.
• VM patients segregated into two clusters based on tilt thresholds, symptom severity, and VOR time constant.
• Threshold abnormalities demonstrated frequency-dependence, aligning with brainstem velocity storage mechanisms.

Conclusions:

• Results support a model of vestibular nuclei sensitization by migraine-related brainstem regions in VM.
• Cerebellar feedback from the nodulus and uvula may modulate these vestibular symptoms.
• This framework may aid in the diagnosis and treatment of vestibular migraine.