Vestibular Migraine Research Articles

Assessment of Sacculocollic and Vestibulomasseteric Reflex Pathways in Individuals With Migraine and Vestibular Migraine.

The study's objective was to evaluate the functioning of sacculocollic and vestibulomasseteric reflex pathways in individuals with vestibular migraine and migraine. Seventy-five participants aged 18-50 years were selected for the study. Participants were divided into three groups. Group 1 consisted of 25 healthy individuals, Group 2 consisted of 25 migraine individuals, and Group 3 consisted of 25 individuals with vestibular migraine. Cervical vestibular-evoked myogenic potential (cVEMP) and masseter vestibular-evoked myogenic potential (mVEMP) were recorded using a 500-Hz tone burst stimulus presented at 125 dB peSPL for all participants. The cVEMP test results showed a delayed p13 and n23 latency for both migraine and vestibular migraine individuals when compared to healthy individuals. Also, the amplitude of the p13-n23 peak was reduced compared to healthy individuals in both migraine and vestibular migraine. Similarly, the mVEMP test results showed a delayed p11 and n21 latency for both migraine and vestibular migraine individuals. No difference was observed in the amplitude of the p11-n21 peak complex between the three groups. Spearman's rho correlation revealed no significant (p > .05) correlation between cervical and masseter VEMP latency and amplitude parameters between healthy, migraine, and vestibular migraine individuals. The results of the study are suggestive of the pathology of the sacullocollic and vestibulomasseteric reflex pathways in individuals with migraine and vestibular migraine. Individuals with migraine and vestibular migraine should undergo a detailed vestibular evaluation.

Short-term effects of lifestyle modification on vestibular migraine

Objective Our primary purpose was evaluation of early benefits of lifestyle modification on symptoms of vestibular migraine. The secondary purpose was to determine if a patient’s global sense of coping relates to outcomes with lifestyle modification. Design Prospective observational cohort. Participants completed questionnaires related to dizziness handicap, headache disability, and adherence to lifestyle modifications at baseline and weekly over 30 d. Sense of coping was measured pre-intervention. Study sample Thirty-eight patients with vestibular migraine diagnosed in tertiary care setting between 2022 and 2023. Results Symptoms were better at all four weeks post-intervention than pre-intervention (p < 0.01), with no difference across weeks two through four (p > 0.10) when symptoms were lowest and stable. By week two, 52% and 18.5% of participants had significant improvement in dizziness and headache compared to published critical difference scores, respectively. Sense of coping was inversely correlated with dizziness (R = −0.53, p < 0.00001) and headache (R = −0.64, p < 0.0001). Conclusions Lifestyle modification reduced dizziness and headache in many vestibular migraineurs in the first two weeks following intervention. Improvement in restful sleep was associated with improvement in symptoms. Sense of coping did not predict improvement but was inversely related to symptoms. Lifestyle modification could be considered as sole management or in addition to pharmacological intervention.

Disrupted gray matter connectome in vestibular migraine: a combined machine learning and individual-level morphological brain network analysis

BackgroundAlthough gray matter (GM) volume alterations have been extensively documented in previous voxel-based morphometry studies on vestibular migraine (VM), little is known about the impact of this disease on the topological organization of GM morphological networks. This study investigated the altered network patterns of the GM connectome in patients with VM.MethodsIn this study, 55 patients with VM and 57 healthy controls (HCs) underwent structural T1-weighted MRI. GM morphological networks were constructed by estimating interregional similarity in the distributions of regional GM volume based on the Kullback–Leibler divergence measure. Graph-theoretical metrics and interregional morphological connectivity were computed and compared between the two groups. Partial correlation analyses were performed between significant GM connectome features and clinical parameters. Logistic regression (LR), support vector machine (SVM), and random forest (RF) classifiers were used to examine the performance of significant GM connectome features in distinguishing patients with VM from HCs.ResultsCompared with HCs, patients with VM exhibited increased clustering coefficient and local efficiency, as well as reduced nodal degree and nodal efficiency in the left superior temporal gyrus (STG). Furthermore, we identified one connected component with decreased morphological connectivity strength, and the involved regions were mainly located in the STG, temporal pole, prefrontal cortex, supplementary motor area, cingulum, fusiform gyrus, and cerebellum. In the VM group, several connections in the identified connected component were correlated with clinical measures (i.e., symptoms and emotional scales); however, these correlations did not survive multiple comparison corrections. A combination of significant graph- and connectivity-based features allowed single-subject classification of VM versus HC with significant accuracy of 77.68%, 77.68%, and 72.32% for the LR, SVM, and RF models, respectively.ConclusionPatients with VM had aberrant GM connectomes in terms of topological properties and network connections, reflecting potential dizziness, pain, and emotional dysfunctions. The identified features could serve as individualized neuroimaging markers of VM.

Increased Perception of Head Tilt to Galvanic Vestibular Stimulation Correlates to Motion Sickness Susceptibility in Vestibular Migraine.

Vestibular migraine is associated with vertigo, persistent swaying, tilting, and disorientation, which suggests a heightened sensitivity of the neural mechanisms subserving spatial orientation. Whether a heightened sense of motion to vestibular stimulation in vestibular migraine is associated with sensitivity to visual motion (visual dependency) or physical motion (motion sickness susceptibility) is unclear. The aim of this study was to explore whether a heightened sense of self-motion sensitivity in vestibular migraine is associated with visual dependency or motion sickness susceptibility. This is a prospective cross-over study. Fifteen participants with vestibular migraine and 20 healthy controls (all right handed) were included in this study. In the main experiment, participants were asked to align a rod to the perceived head position. Head tilt was generated by DC galvanic vestibular stimulation at 1 mA to produce head tilts to the right (left anodal/right cathodal stimulation, LA/RC) or left (right anodal/left cathodal, RA/LC). The perception of head tilt was measured in a dark room using laptop software that allowed participants to turn an illuminated rod to any angle about the midpoint. Participants were instructed to align the rod to the perceived head position before and during galvanic stimulation and the line angle was saved. Head position was objectively monitored with an ultrasound motion system. After completing the perceptual test, visual dependency was measured with a static and rotating background and the Motion Sickness Susceptibility Questionnaire (MSSQ) was completed. In an upright head position, without stimulation, the perceived head position was 1.1 degrees in controls and -0.69 degrees in vestibular migraine participants with no significant difference between groups. During galvanic vestibular stimulation, participants with vestibular migraine had an increased perception of head tilt compared with controls (RA/LC: controls -4.7 degrees and vestibular migraine -9.29, p = 0.002; and LA/RC: controls 6.5 degrees and vestibular migraine 11.12 degrees, p = 0.017), although the size of head movement was similar between groups. The average perception of head tilt correlated to the MSSQ score, but not to the degree of visual dependency in a static or moving background. A heightened sensitivity of the vestibular system to vestibular stimulation in vestibular migraine is consistent with reports of self-motion sensitivity in vestibular migraine.

Comparing saccades in Visually Enhanced Vestibular-Ocular Reflex and video head impulse test in vestibular assessment

ObjectiveThis study aimed to develop and evaluate a novel software tool for robust analysis of the Visually Enhanced Vestibular-Ocular Reflex (VVOR) and video head impulse test (vHIT) saccades. MethodsA retrospective study was conducted on 94 patients with Meniere's Disease (MD), unilateral vestibular hypofunction (UVH), and vestibular migraine (VM). The MATLAB-based VVOR Analysis System and Saccades All in One software were utilized for data processing. New techniques, VVOR_diff and VVOR_cycle, were deployed for saccade parameter extraction. ResultsSaccade incidence rates, examined through vHIT, VVOR_diff, and VVOR_cycle, exhibited distinct patterns in MD, UVH, and VM patients. Frequent instances of multiple saccades within a single cycle were noted on the affected side in MD and UVH patients. Statistically significant differences in saccade gain and incidence rates between the affected and unaffected sides were evident in MD and UVH patients. Notably, high inter-method and intra-method correlations suggested consistency across different methods and potential interactions within one. ConclusionThe software proved effective in extracting saccades and reducing noise in VVOR data, thereby enhancing the evaluation of vestibular function and potentially improving diagnostic accuracy for vestibular disorders.

A placebo controlled, randomized clinical trial of galcanezumab for vestibular migraine: The INVESTMENT study.

To study if galcanezumab is effective for vestibular migraine (VM). There are currently no placebo-controlled trials showing that treatment is effective for VM. Therefore, we performed the first placebo controlled, randomized clinical trial of a calcitonin gene-related peptide-targeted monoclonal antibody for VM. This was a single site, prospective, double-blind placebo controlled randomized clinical trial. Key inclusion criteria were as follows: participants aged 18-75 years with a diagnosis of VM or probable VM per Barany Society criteria. The primary outcome was change in VM-PATHI (Vestibular Migraine Patient Assessment Tool and Handicap Inventory) score, and secondary outcomes included change in DHI (Dizziness Handicap Inventory) score, and count of definite dizzy days (DDDs). Participants were randomized 1:1 to 3 months of treatment with galcanezumab or placebo via subcutaneous injection with a pre-filled syringe, 240 mg the first month, and 120 mg for the second and third months. Forty participants were randomized, and 38 participants were in the modified intent to treat analysis. VM-PATHI score was reduced 5.1 points (95% confidence interval [CI] -13.0 to 2.7) for placebo (N = 21), and 14.8 points (95% CI -23.0 to -6.5) for galcanezumab (N = 17), a difference of -9.6 (95% CI -20.7 to 1.5, p = 0.044). DHI dropped 8.3 points in the placebo arm (95% CI -15.0 to 1.6), and 22.0 points in the galcanezumab arm (95% CI -31.9 to -12.1), a difference of -13.7 (95% CI -20.4 to -8.5, p = 0.018). The count of DDDs per month dropped from 18 days (standard deviation [SD] 7.6) in the baseline month to 12.5 days (SD 11.2) in month 4 for those in the placebo arm, and from 17.9 days (SD 7.9) in the baseline month to 6.6 days (SD 7.3) in month 4 for those in the galcanezumab arm, a difference of -5.7 days (95% CI -10.7 to -0.7, p = 0.026). No serious adverse events were observed. In this pilot study, galcanezumab was effective in treating VM.

Why is vestibular migraine associated with many comorbidities?

Why is vestibular migraine associated with many comorbidities?

VHIT and fHIT in Patients With Migraine, Vestibular Migraine, and Persistent Postural-Perceptual Dizziness.

Impairment in the integration of different vestibular stimuli is the proposed mechanisms in vestibular migraine (VM). In this study, it was aimed to assess the vestibulo-ocular reflex (VOR) and dynamic visual acuity (DVA) in patients with VM and to compare the results with migraine without vestibular symptoms (MwoV), and persistent postural-perceptual dizziness (PPPD) to find out if there are discriminative differences and search for a correlation with the levels of anxiety. Twenty-two patients with MwoV, 23 patients with VM, 22 patients with PPPD, and 23 healthy controls (HC) were studied. Video head impulse test (vHIT) and functional head impulse test (fHIT) without and with an optokinetic background (OB) were performed. Percentage of correctly identified optotypes (CA%) was considered for the fHIT test. Beck anxiety inventory (BAI) was used to assess anxiety. Lateral canal vHIT gain of the patient groups were not different from the healthy controls (p > 0.05). fHIT and fHIT/OB CA% results of all patient groups were lower than the HC (p < 0.005), and VM patients had the lowest scores for both tests. BAI scores of the PPPD patients were the highest and a correlation between anxiety levels, and fHIT results could not be identified (p > 0.05). Prominent CA% drop by the use of an OB was the main finding in patients with VM. This discriminative feature was not correlated with anxiety scores. Difficulty in resolving the conflict between visual and vestibular inputs seem to be the underlying mechanism. 3 Laryngoscope, 2024.

Imaging endolymphatic space of the inner ear in vestibular migraine

BackgroundVestibular migraine (VM), the most frequent episodic vertigo, is difficult to distinguish from Ménière’s disease (MD) because reliable biomarkers are missing. The classical proof of MD was an endolymphatic hydrops...

Psychiatric Comorbidities and Quality of Life in Patients with Vestibular Migraine and Migraine without Vertigo: A Cross-Sectional Study from a Tertiary Clinic.

A total of 104 participants were divided into 3 groups: dVM patients (19 participants), MO patients (22 participants), and HCs (63 participants). The scores of the three questionnaires across the three groups were compared using analysis of variance, and linear regression was used to examine the associations between the questionnaire scores within each group. Compared to MO patients and HCs, dVM patients had significantly higher total scores on the HADS (p < 0.0001) and DHI (p < 0.0001) scales, and lower scores for all nine components of the SF-36, indicating poorer health. In the vestibular migraine group, the DHI score was strongly negatively correlated with the Physical Functioning subscale of the SF-36. Anxiety and depression are more prevalent in patients with definite vestibular migraine compared to patients with migraine without vertigo and healthy controls. The physical functioning of patients with definite vestibular migraine is highly affected by their dizziness, resulting in a lower quality of life. Timely screening for psychiatric comorbidity in vestibular migraine patients is essential to prevent psychiatric consequences.

Association between sleep disorders and vestibular vertigo

Sleep disorders have a high comorbidity rate with vestibular diseases. The results of some small sample clinical studies have confirmed the effect of sleep deprivation on vestibular function. However, the mechanism of the effect of sleep disorder on vestibular system is still unclear. This article analyzes the possible mechanism of the effect of sleep disorders on vestibular function from the aspects of neuroanatomy and neurotransmitters, and summarizes the relationship between sleep disorder and benign paroxysmal positional vertigo, Meniere's disease, vestibular migraine and other diseases.

Dizziness and Imbalance Across the Lifespan: Findings of a Pediatric and Adult Vestibular Clinic.

To evaluate diagnostic trends in pediatric and adult patients presenting for multidisciplinary subspecialty evaluation of dizziness and imbalance across the lifespan. Retrospective chart review. Single pediatric and single adult academic tertiary care hospital. Retrospective review of electronic health record for patients presenting to an adult or pediatric multidisciplinary vestibular clinic from 2017 to 2020, including clinical data, physical therapy evaluation, and audiovestibular testing. A total of 1934 patients aged 1 to 95 were evaluated. Most patients were female (n = 1188, 61%); the largest cohort was in the fifth decade of life (n = 321, 17%). Seventy-six percent of patients (n = 1470) were assigned a pathologic diagnosis. Central causes of dizziness were most common in children and young adults, comprising 38% to 54% of all diagnoses in ages 1 to 30. The proportion of peripheral vestibular disorders increased with age, peaking at 32% in ages 61 to70. Vestibular migraine was the most common pathologic diagnosis in ages 6 to 20 (n = 110, 39%) and 31 and 50 (n = 69, 17%) regardless of gender, but was more prevalent in females (21% vs 14%; P < .0001). The prevalence of benign paroxysmal positional vertigo (BPPV) increased throughout the lifespan, peaking at age 71 to 80. Meniere's disease (MD) did not occur within the first decade of life, but increased thereafter, peaking at ages 51 to 60. Multidisciplinary vestibular evaluation resulted in a diagnosis for the majority of patients. Vestibular diagnoses vary across the lifespan however among most age groups, central disorders, including migraine disorders, outnumber peripheral vestibulopathies. The prevalence of peripheral vestibular disorders such as BPPV and MD increased with age. Level IV.

Bilateral vestibulopathy – Loss of vestibular function and experience of emotions

ObjectiveThe vestibular system is closely connected to emotion-processing neuronal circuits. Patients with bilateral vestibulopathy (BVP), a chronic loss of vestibular function, show remarkably lower rates of psychiatric comorbidities and vertigo-related anxiety (VRA) than those with episodic vertigo/dizziness (v/d). This study aimed to evaluate whether patients with BVP differ from those with episodic v/d in terms of VRA, general anxiety, and cognitions about body and health. MethodsThis cross-sectional study involved a subsample of 202 patients with episodic v/d (i.e., vestibular migraine, vestibular paroxysmia, or Menière's disease) and 43 patients with BVP. All patients underwent standardised neurological/neurotological examinations, structured clinical interviews (SCID-I), and self-report questionnaires, such as the Vertigo Handicap Questionnaire (VHQ), Beck Anxiety Inventory (BAI), Trait Anxiety from the State-Trait-Anxiety Inventory (STAI-T), and Cognitions About Body and Health questionnaire (CABAH). Non-parametric tests were used for analysis. Due to multiple testing, the significance level was set at p ≤ .008. ResultsPatients with episodic v/d exhibited higher VRA levels than those with BVP. However, this difference was not statistically significant (p = .04; r = 0.15, small effect). Additionally, patients with BVP reported more catastrophizing cognitions (p < .001; r = 0.25, small effect) and bodily weakness (p = .003; r = 0.22, small effect) compared to those with episodic v/d. There were no differences in general anxiety levels (BAI and STAI-T) between patients with v/d and those with BVP. ConclusionPatients with episodic v/d and BVP differed in their appraisal (cognition). The difference in VRA (subjective feeling) was not statistically significant. These preliminary results are discussed using a component approach to emotions.

The patterns of anti-compensatory saccades of the SHIMP paradigm can differentiate vestibular migraine from healthy individuals.

The aim of the present study was to characterize the HIMP and SHIMP test findings in individuals with vestibular migraine. The study comprised two groups- group I consisted of twenty five adults diagnosed with Vestibular migraine, and group II comprised twenty-five age matched healthy individuals. HIMP & SHIMP were administered using the ICS impulse system for both groups. Mann-Whitney U test revealed a significant difference (p< 0.05) in VOR gain and VOR suppression gain between the vestibular migraine and healthy individuals. All the subjects in the vestibular migraine group manifested either of the four patterns of anti-compensatory saccades (ACS): (a) bilaterally absent ACS, (b) bilaterally scattered ACS or (c) typical ACS on one side with scattered ACS on the other side (d) unilaterally absent ACS. On the other hand, all the healthy individuals exhibited the presence of an organised ACS bilaterally. VOR pathway is affected in individuals with vestibular migraine. Also, various patterns of ACS are more effective in identifying the subtle vestibular lesion in vestibular migraine. These patterns are useful in differentiating vestibular migraine from healthy individuals.

Motion sickness whilst reading as a passenger in the car is highly predictive of vestibular migraine.

Vestibular Migraine (VM) is a prevalent vestibular disorder, affecting up to 2.7% of the general population. Despite the establishment of diagnostic criteria by the Bárány Society and its inclusion in the International Classification of Headache Disorders, the clinical diagnosis of VM remains challenging due to its complex pathophysiology and symptom overlap with other dizziness disorders. Motion sickness is a core feature of migraine and can be interrogated through simple questionnaires. This study aims to identify to what extent motion sensitivity can predict VM compared to other causes of dizziness. We conducted a cross-sectional study involving 113 patients from the vestibular neurology clinics at University College London Hospitals. Participants were categorized into VM, Persistent Postural Perceptual Dizziness (PPPD), combined VM and PPPD, and 'other' dizziness etiologies. Data on motion sickness history and dizziness during car travel were collected through structured interviews and analyzed using logistic regression to assess the predictive value of these symptoms for VM. A substantial portion of patients with VM (91.2%) reported nausea or dizziness when reading as a passenger, a symptom significantly more prevalent than in those with PPPD or other dizziness diagnoses. Logistic regression indicated that VM patients are significantly more likely to experience these symptoms compared to non-VM patients, with an odds ratio suggesting a strong predictive value for this symptom in diagnosing VM. The findings highlight increased motion sensitivity while reading in a moving vehicle as a promising diagnostic tool for VM, offering a practical aid in clinical settings to distinguish VM from other vestibular disorders.

The dissociation between pathological caloric testing and a normal video head impulse test helps differentiate between Menière's disease, vestibular migraine, and other vestibular disorders: a confirmatory study in a large cohort of 2,101 patients.

Vestibular migraine (VM) and Menière's disease (MD) are characterized by episodes of vertigo of similar duration. It is well known that differentiation between both diseases is not always possible based only on the patient history, physical examination, and audiological testing. In addition, the quantification of the vestibular function can also be helpful since, among patients with MD, there is often a dissociation between a normal/pseudo-normal video head impulse test (vHIT) and reduced caloric testing. The goal of this confirmatory study was to determine the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of this dissociation to differentiate between MD and VM as well as between MD and other vestibular diseases. We performed a retrospective analysis of 2,101 patients. The examination group consisted of 1,100 patients; of these, 627 (57%) had MD according to the diagnostic criteria of the Bárány Society and 473 (43%) had VM. The comparison group consisted of 1,001 patients with other peripheral, central, or functional vestibular disorders. Statistical analysis revealed the following findings for the dissociation: MD vs. VM: specificity: 83.5%, sensitivity: 58.9%, PPV: 82.6%, and NPV: 60.5%, and MD vs. all other vestibular disorders (VM plus others): specificity: 83.5%, sensitivity: 58.9%, PPV: 60.3%, and NPV: 82.7%. The dissociation between a normal vHIT and a reduced caloric response is due to the high specificity and PPV suited for the differentiation between MD and VM. This part of the study confirms previous findings in a large cohort of patients. When it comes to differentiating between MD and all observed vestibular disorders, if there is no dissociation, the diagnosis of MD is unlikely.

Clinical Profile, Trends, and Management in Pediatric Patients with Audiovestibular Disorders: Can We Predict Emotional Disability in Pediatric Patients with Episodes of Vertigo and Dizziness?

Audiovestibular disorders in childhood occur with considerable frequency. However, the difficulty of obtaining medical history, the nonspecificity of symptoms, and the lack of cooperation during complementary tests often contribute significantly to diagnostic biases, attributing clinical presentations to psychosomatic disorders. The objectives of this work are, firstly, to characterize, from an auditory and vestibular perspective, the most frequent causes of vertigo in childhood and a possible relationship with emotional symptoms. On the other hand, to propose the usefulness of the MSSQ-Short questionnaire as a predictive variable in the evolution of children diagnosed with recurrent vertigo of childhood (RVC). An observational cross-sectional study was designed with retrospective data collection at three tertiary hospitals. Among the 117 patients recruited between 2016 and 2024, 32 patients (27.35%) were diagnosed with an anxious-depressive syndrome prior to audiovestibular testing. The mean age was 11.19 ± 5.61 years and the most frequent final diagnoses were vestibular migraine (VM) with 41.03% and RVC with 23.93%. Patients with VM, compared with RVC, are approximately 1.12 times more likely to have psychosomatic pathology (CI 0.39 to 3.25). The most sensitive and frequently altered test was VEMPS (39.32%), with statistical significance in VM and otic capsule dehiscence, while regarding the MSSQ-Short questionnaire, the linear regression of 0.28 indicates an increase in clinical duration with high questionnaire scores. Vestibular disorders causing dizziness and vertigo are challenging to diagnose, often due to lack of cooperation and/or symptom nonspecificity. A thorough medical history and complementary tests, including audiovestibular and imaging studies, are advisable, thus avoiding systematically attributing children's complaints to other psychosomatic disorders.

Current Demography and Treatment Strategy of Vestibular Migraine in Neurotologic Perspective.

This study aims to describe the demographic features of vestibular migraine (VM) compared to other common peripheral vestibulopathies, and to assess the efficacy of trigger management as primary VM treatment. Retrospective study. Tertiary referral medical center. A retrospective chart review was performed of patients presenting with dizziness in a tertiary neurotology clinic. Among the newly diagnosed dizzy patients, those with a diagnosis of either VM, Ménière's disease, benign paroxysmal positional vertigo, or vestibular neuritis/labyrinthitis were selected for comparisons of the disease demographics. VM patients with multiple clinic visits in the study period were included for the treatment strategy analysis. A total of 1285 patients met the study inclusion criteria. In the newly diagnosed dizzy group comprising 814 patients, VM patients accounted for the largest (25%) and youngest (mean age 47 years) cohort, showing an obvious female preponderance of approximately 3.3:1. Furthermore, prevalence of VM declined significantly with advancing age, from 69%, to 34%, to 11%, in age groups of ≤30, 31 to 60, and >60 years, respectively. Trigger management, when employed as the primary VM first-year treatment, was effective for both sexes. Notably, it was more effective for women aged over than under 45 years. In our tertiary referral neurotologic center, VM was the most common diagnosis in newly diagnosed dizzy patients aged under 60 years, especially in women. For primary VM treatment, trigger management is an effective option deserving consideration.

Altered functional connectivity of parietal opercular 2 in patients with vestibular migraine: a resting-state fMRI study

Objective: To investigate the differences in resting-state functional connectivity (FC) between patients with vestibular migraine (VM) and migraine without aura (MwoA) in order to infer the possible neuroimaging mechanisms of VM. Methods: Thirty VM patients admitted to the Department of Neurology of the Second Affiliated Hospital of Xuzhou Medical University from December 2019 to December 2022 were selected as the experimental group (EG) (6 males and 24 females, with mean age of 38.3 years) and 26 MwoA patients as the control group (7 males and 19 females, mean age 35.5 years). General demographic and clinical data such as gender, age, year of education, course of disease and frequency of attacks were collected for all the patients, as well as data of Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Montreal Cognitive Assessment (MoCA), headache Visual Arialogue Scale (VAS), Headache Impact Test 6 (HIT-6) and Migraine Disability Assessment Questionnaire (MIDAS). VM patients were also assessed by Dizziness Handicap Inventory (DHI), dizziness VAS and Vestibular Disorders Activities of Daily Living (VADL) scales. All patients underwent resting-sate functional Magnetic Resonance Imaging (fMRI) scans. Bilateral parietal opercular cortex 2 (OP2) and primary visual cortex (V1) were used as regions of interests (ROIs). Differences in FC between ROIs and other brain regions were calculated between the two groups. In view of the brain regions with significant differences, z-values of FC were extracted for each subject in the EG, and Pearson partial correlation analysis was conducted between z-values of FC and clinical characteristics of patients, P<0.05 was considered to have significant correlation. SPSS 22.0 was used for statistical analysis. Results: There was no significant difference in gender, age, years of education, course of disease, frequency of attack and scores of MoCA, HAMA and HAMD between the two groups (P>0.05). Headache VAS, HIT-6 and MIDAS scores in VM patients were significantly lower than those in MwoA patients (P<0.05). Compared with MwoA patients, the FC between left OP2 and bilateral precuneus and left thalamus was significantly increased in VM patients, and the FC between right OP2 and left thalamus and right anterior cingulate gyrus were significantly increased (P<0.05, False Discovery Rate correction). Correlation analysis showed that the FC between left OP2 and left precuneus was positively correlated with DHI score in VM patients (P=0.007, r=0.480), and the FC between right OP2 and left thalamus was positively correlated with the disease course in VM patients (P=0.015, r=0.439). Conclusions: The pathogenesis of VM may be related to the altered FC of vestibular, pain and visual-motor networks, abnormalities of these neural pathways may be important imaging biomarkers of VM pathogenesis.

A Month of Vestibular Migraine: Symptom Characterization Using Ecological Momentary Assessment.

This study investigated the frequency and intensity of vestibular migraine (VM) symptoms using Ecological Momentary Assessment (EMA). This approach was intended to provide insights into the day-to-day experiences of individuals with VM, contributing to a more comprehensive understanding of this condition. Participants reported symptoms to an automated text system, rating their dizziness over the prior 24 h as none, mild, moderate, or severe. Definitive Dizzy Days (DDDs) were defined as days with moderate or severe dizziness. A student's independent group t-test was used to compare the number of DDDs between VM and probable VM subjects. Sixty-six subjects were included, with an average of 29 days of pre-intervention data (SD = 1.4). The average number of days with no dizziness was 3.5 (SD = 6.5), mild dizziness was 9.1 (SD = 6.7), moderate dizziness was 11 (SD = 6.1), and severe dizziness was 5.4 (SD = 6.3). Out of the 66 patients, 52 were classified as VM and 14 as pVM. The average number of DDDs was not significantly different between VM (17.0, SD = 8.3) and pVM (15.3, SD = 10.0) patients, with a two-tailed p-value of 0.44. With EMA, we found that the average subject with VM had some degree of dizziness almost every day, and more than 15 DDDs per month. III Laryngoscope, 2024.