Abstract
Previous studies have shown that vestibular migraine (VM) is a cerebral disease with recurrent vertigo. Vestibular rehabilitation (VR) is an effective type of physical therapy for minimizing vestibular symptoms, as it improves vestibular compensation in patients with VM. Currently, the cerebral regions that are associated with the pathogenesis of VM are largely unknown. To further understand the underlying mechanisms of VM, we performed resting-state functional magnetic resonance imaging (fMRI) before and after 1 month of VR in 14 patients with VM. The Dizziness Handicap Inventory (DHI), the 36-Item Short-Form Health Survey (SF-36), the Hamilton Depression Scale (HAMD) and the Hamilton Anxiety Scale (HAMA) scores were included as clinical outcomes. The amplitude of low-frequency fluctuation (ALFF) was assessed to characterize spontaneous brain activity. The correlations between the clinical characteristics and ALFF values were assessed. After 1 month of VR training, the DHI scores in patients with VM were significantly lower than those at baseline (p = 0.03), as were the HAMA scores (p = 0.02). We also found that the ALFF values in the left posterior cerebellum of VM patients increased significantly after 1 month of VR training. Moreover, the ALFF values in the left cerebellum were inversely correlated with the patients’ DHI scores. Overall, this study showed that VR exercise for 1 month has a positive effect on vestibular symptoms in patients with VM. Asymmetric cerebellar hyperactivity might be a functional compensation for vestibular dysfunction in patients with VM.
Highlights
Vestibular migraine (VM) is a subtype of migraine that commonly causes paroxysmal vertigo, and its prevalence has been reported to be as high as 1% in the general population (von Brevern et al, 2007)
The results showed that the Dizziness Handicap Inventory (DHI) scores of the patients after completing vestibular rehabilitation (VR) training were significantly lower than those at baseline (p = 0.03), and the Hamilton Anxiety Scale (HAMA) scores significantly decreased (p = 0.02), but there was no significant difference in the Hamilton Depression Scale (HAMD) scores before and after 1 month of VR training
This study demonstrated the clinical benefits of VR in improving vestibular symptoms, mood disorders, and quality of life
Summary
Vestibular migraine (VM) is a subtype of migraine that commonly causes paroxysmal vertigo, and its prevalence has been reported to be as high as 1% in the general population (von Brevern et al, 2007). The correlation between migraine and vestibular symptoms is not accidental; as many as 50% of patients with migraine experience dizziness or vertigo (Vukovic et al, 2007). The Barany Society and the International Headache Association have recently classified VM as a distinct entity: vestibular symptoms are viewed as symptoms associated with migraines. When vestibular symptoms recur frequently, patients are more inclined to develop psychological problems, such as anxiety and depression (Yardley, 2000), which seriously affect the quality of life (Jeong et al, 2010)
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