CLINICAL AND OBJECTIVE TEST CHARACTERISTICS OF VESTIBULAR MIGRAINE: IMPLICATIONS FOR DIAGNOSIS AND MANAGEMENT

Area of Science:

• Neurology
• Ophthalmology
• Vestibular System Disorders

Background:

• Vestibular migraine (VM) is a common cause of recurrent vertigo.
• Diagnostic criteria for VM often rely on episodic vertigo and migraine symptoms.
• The role of specific eye movements and vestibular function in VM diagnosis requires further elucidation.

Purpose of the Study:

• To define vestibular migraine (VM) by examining factors like age, unilateral testing, and squinting during ictal and interictal periods.
• To evaluate the characteristics of spontaneous and positional nystagmus in patients with VM.
• To assess the utility of standard audio vestibular function tests in diagnosing VM.

Main Methods:

• One hundred and ten adults with recurrent vertigo underwent diagnostic evaluation for VM.
• Data collected included patient demographics, vertigo characteristics, and eye movement recordings (squinting, nystagmus).
• Standard vestibular tests such as video head impulse tests (vHIT), caloric tests, and audiometry were performed.

Main Results:

• Headache (85.3%), spinning vertigo (76.2%), and Mal de Débarquement (60.2%) were common complaints.
• Spontaneous squinting was observed in 75.2% of VM patients after an episode, significantly more than during attacks (16.5%).
• Standard audio vestibular tests, including vHIT, caloric, and audiometry, were largely normal in VM patients (98.6% normal vHIT, 86.4% symmetrical caloric, 89.3% normal audiometry).

Conclusions:

• Low-velocity eye movements, including horizontal, vertical, or torsional squinting, occur during vestibular migraine events.
• Patients with vestibular migraine frequently exhibit normal findings on standard audio vestibular function tests.
• These findings highlight the importance of specific eye movement analysis and suggest that normal vestibular test results do not exclude VM.