Prevalence, Clinical Correlates, and Functional Implications of Vestibular Symptoms in Patients With Migraine

Vestibular symptoms (VS) in migraine are underinvestigated, and vestibular migraine (VM) remains underdiagnosed. This study aimed to determine the prevalence, clinical correlates, and functional impact of VS and VM among migraine patients.

This cross-sectional study recruited newly diagnosed migraine patients from a tertiary medical center and a community hospital between August 2020 and October 2023. Questionnaire-based interviews were carried out to collect headache characteristics, Migraine Disability Assessment (MIDAS), Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), including anxiety (HADS-A) and depression (HADS-D) subscales, and VS, as defined by the International Classification of Vestibular Disorders. The diagnosis of VM was based on the International Classification of Headache Disorders, 3rd edition.

In total, 2,801 patients with newly diagnosed migraine (2,147F/654M, mean age 37.8 ± 12.5 years) were recruited, including 1,916 (1,548F/368M, mean age 36.9 ± 12.3 years) with VS (68.4%), and external and internal vertigo was the most common. Overall, 426 (347F/79M, mean age 36.6 ± 12.6 years) fulfilled the criteria for VM (15.2%). When compared with patients without VS (group I), those with non-VM VS (group II) or VM (group III) had greater disability associated with headache (MIDAS: 23.6 ± 36.4 vs 33.8 ± 45.8 vs 40.9 ± 48.9), poorer sleep (PSQI: 8.6 ± 3.9 vs 10.1 ± 4.0 vs 10.6 ± 4.0), and more symptoms of anxiety (HADS-A: 6.9 ± 4.3 vs 9.0 ± 4.1 vs 9.1 ± 4.1) or depression (HADS-D: 5.8 ± 4.2 vs 6.9 ± 4.2 vs 7.1 ± 4.5) (all p < 0.001 vs group I), although the difference between groups II and III was significant only for MIDAS (p < 0.001), but not PSQI, HADS-A, or HADS-D (all p > 0.100).

VS are very common in patients with migraine and are associated with significant disability, even when the criteria for VM are not met. VS should be screened for in the clinical evaluation of migraine. The current diagnostic criteria of VM may not be able to capture all of the patients suffering from substantial impact associated with VS. It remains to be determined whether VS in migraine could respond to migraine treatment.