Exploring the complex relationship between vestibular symptoms and migraine: a resting‑state functional MRI study

The aim of this study was to examine the temporal sequence of the appearance of vestibular symptoms and migraine, as well as whether they coexist or not, while assessing their influence on cerebral functional activity. The present investigation is a cross-sectional study. This study included 69 participants from the outpatient headache unit at our hospital who were divided into six groups: 33 patients with vestibular migraine (VM) (12 the onset of migraine was earlier than vertigo, 10 the onset of vertigo was earlier than migraine, 11 vertigo was accompanied with migraine), 9 patients with benign recurrent vertigo (BRV), 14 patients with migraine without aura (MoA), and 13 healthy controls. We compared the differences in spontaneous cerebral functional activity between groups, and used the bilateral thalamus as a seed point to analyze its functional connectivity with the whole brain. The relationship between changed cerebral functional activity and clinical features was compared. We have observed variations in the spontaneous functional activity of the right middle and inferior frontal gyrus among individuals in each group, as well as discrepancies in the functional connectivity of the right superior frontal gyrus with the bilateral thalamus. The severity of vertigo disability exhibits a negative correlation with the functional activity in the right inferior frontal gyrus, while the duration of vertigo demonstrates a positive correlation with the functional activity in the right inferior frontal gyrus. Furthermore, the severity of migraine disability displays a negative correlation with the functional connectivity between the bilateral thalamus and the right superior frontal gyrus. In patients with VM, the temporal relationship between vestibular symptoms and migraine did not have any impact on cerebral functional activity. The functional activity of the right middle and inferior frontal gyrus may be influenced by vestibular stimulation, while headache stimulation could potentially modify the functional connectivity between the bilateral thalamus and the right superior frontal gyrus. These findings suggest that VM may be considered as a distinct disease entity.