Subclinical audiovestibular abnormalities in children with migraine without vestibular symptoms: A prospective case-control study

Migraine has been associated with subclinical vestibular and auditory dysfunction in adults, but comprehensive assessment across multiple audiovestibular domains in children with migraine who lack overt vestibular symptoms remains limited. In this prospective case-control study, we evaluated audiovestibular function in 29 children with migraine without aura (ages 7-18 years) and 27 age- and sex-matched healthy controls using extended high-frequency audiometry, distortion product otoacoustic emissions, video head impulse testing, cervical and ocular vestibular evoked myogenic potentials, and computerized dynamic posturography. Mean values for continuous measures, including video head impulse test gain and vestibular evoked myogenic potential latencies, did not differ significantly between groups after correction for multiple comparisons. However, categorical abnormalities were significantly more frequent in the migraine group, including video head impulse test hypofunction (52% versus 11% of controls), an abnormal posturographic vestibular ratio (38% versus 4%), and elevated extended high-frequency hearing thresholds (38% versus 7%). The total number of abnormal test domains was greater in children with migraine (median 2 versus 1 in controls) and provided the highest discriminatory accuracy of any single measure (area under the curve 0.799), with a cutoff of two or more abnormal domains yielding 93% specificity and 55% sensitivity. These findings indicate that children with migraine without aura who report no vestibular or auditory symptoms nonetheless carry a greater burden of audiovestibular abnormality than healthy children, distributed across multiple functional domains rather than confined to a single test. Multidomain audiovestibular assessment may reveal subclinical abnormalities in children with migraine who do not report vestibular or auditory symptoms.