Vestibular Migraine Research Articles

Rizatriptan vs Placebo for Attacks of Vestibular Migraine: A Randomized Clinical Trial.

Vestibular migraine has no established treatments. To test the efficacy of rizatriptan for treating vestibular migraine attacks. This double-blind, randomized clinical trial of rizatriptan vs placebo was conducted from December 2014 through July 2020 (data analyses in 2021 and sensitivity analyses in 2022 and 2024) at 2 tertiary neurotologic centers. Adults with vestibular migraine were included. All participants underwent prospective observation to confirm diagnosis and illness activity and were then randomized in a 2:1 ratio to receive rizatriptan 10 mg or placebo to treat up to 3 vestibular migraine attacks per participant. Participants rated symptoms as absent, mild, moderate, or severe at scheduled intervals. Primary outcomes were the percentage of attacks with reductions in vertigo and unsteadiness/dizziness from moderate or severe to absent or mild at 1 hour. Secondary outcomes were the percentage of attacks with complete resolution of vestibular symptoms at 1 hour; reductions in headache and associated symptoms at 1 hour; use of rescue medications after 1 hour; reductions in vestibular, headache, and associated symptoms at 24 hours without rescue medications; treatment satisfaction and quality of life at 48 hours; and rates of serious adverse effects and discontinuation due to adverse effects. Of 222 total participants (mean [SD] age, 42.3 [11.7] years; 70.7% were women), 134 (60.4%) with active illness treated 307 attacks. Efficacy was tested using 240 attacks with vestibular symptoms rated as moderate or severe when participants took study drug. At 1 hour, rizatriptan did not differ from placebo for reducing vertigo (73/151 [48.3%] vs 50/88 [56.8%] attacks; odds ratio [OR], 0.71 [95% CI, 0.42-1.21]), unsteadiness/dizziness (29/151 [19.2%] vs 11/89 [12.4%] attacks; OR, 1.69 [95% CI, 0.80-3.57]), or any secondary outcomes. Similar percentages of participants in rizatriptan and placebo groups (26.4% for both groups) added rescue remedies after 1 hour. At 24 hours, rizatriptan had medium effects over placebo for unsteadiness/dizziness (OR, 2.65) and motion sensitivity (OR, 3.58). Post hoc analyses of all treated attacks found a medium effect favoring rizatriptan for headache and photophobia or phonophobia at 24 hours. Treatment satisfaction was equivocal. Quality of life was mixed. No participants experienced serious adverse effects or discontinued treatment for adverse effects. In this study, rizatriptan was ineffective at 1 hour for treating vestibular migraine attacks and had limited benefit on symptoms at 24 hours. Findings do not support using rizatriptan for vestibular migraine attacks. ClinicalTrials.gov Identifier: NCT02447991.

Influence of vestibular migraine on cognition: a questionnaire-based study

IntroductionThis study hypothesized a link between cognitive abilities and vestibular migraine. The vestibular system connects the inner ear to the midbrain and subcortical structures, and abnormalities in this system can cause vestibular problems. Recent findings suggest that individuals with vertigo often experience cognitive issues, such as problems with attention, memory, and spatial perception. Despite growing interest in the relationship between vestibular disorders and cognition, specific disorders like vestibular migraine remain underexplored.MethodsA non-experimental group comparison was conducted with 65 participants. Group I (n = 25, mean age 32.68 years) included clinically normal individuals, and Group II (n = 40, mean age 40.35 years) comprised participants with vestibular migraine. An online questionnaire based on the Neurobehavioral Cognitive Status Examination (NCSE) assessed cognition. Scores ranged from 0 (most cognitive issues) to 20 (few cognitive issues).ResultsMann–Whitney U tests revealed significant differences between groups (p < 0.05), with Group II displaying more cognitive problems. Chi-square tests showed cognition-related responses were dependent on group type. There were no significant differences between groups for associated conditions like hypertension, hearing loss, or diabetes.ConclusionsA significant association between vestibular migraine and cognitive issues was found. These findings emphasize the vestibular system’s influence on cognition and suggest that better diagnostic and rehabilitation strategies could improve patient outcomes.

Comparison of clinical features and associated comorbidities of vestibular migraine in Taiwan

Comparison of clinical features and associated comorbidities of vestibular migraine in Taiwan

Multidimensional Feature Analysis of Meniere's Disease and Vestibular Migraine: Insights from Machine Learning and Vestibular Testing.

Differentiating between Meniere's disease (MD) and vestibular migraine (VM) is challenging due to overlapping symptoms and limited diagnostic tools. Traditional statistical methods often rely on physician judgment and struggle with complex, high-dimensional data. This study applies the random forest (RF) machine learning algorithm to enhance the clinical differentiation between MD and VM. We retrospectively analyzed data from 36 VM (26 female) and 100 unilateral MD patients (51 female). The data were anonymized and labeled. Symptomatic and examination parameters were selected as features, and exploratory data analysis identified key parameters for diagnosis. An RF model was used to rank these features. MD patients more commonly experienced ear-related symptoms, while VM patients reported more headaches and dizziness. Examination findings showed greater asymmetry in vHIT saccade latency in MD patients, particularly on the affected side. A total of 40 key parameters were identified. Heatmap and clustering analysis revealed that time constant (Tc) in velocity step test (VST) correlated more strongly with headache and other symptoms, while saccade latencies and velocities correlated with pure tone averages. The RF model selected 27 parameters for prediction, achieving 91.86% accuracy (95% confidence interval [85.37%, 95.18%]). Tc and saccade velocity were among the top 10 contributing features. Additionally, MD patients had earlier saccades and shorter Tc values on the affected side compared to both healthy controls and VM patients. Machine learning successfully classified MD and VM patients, with Tc and saccade velocity identified as key diagnostic indicators alongside symptoms.

Audiometry as a predictive proxy for balance dysfunction

Dizziness and vertigo are common complaints, often linked to inner ear or neurological issues. Although inner ear houses both the cochlea and vestibule, the relationship between hearing loss and vertigo is still a longstanding controversy. Here, we probed systematic audiometry and vestibular function on 1115 patients, attending consultation for dizziness and vertigo. Peripheral vestibular pathologies accounted for 49.3% of the diagnoses, while 41.1% were attributed to central pathologies. Principal component analysis identified six distinct audiometric phenotypes, which were then correlated with vestibular test outcomes. Caloric irrigation results demonstrated a correlation with hearing loss in the more affected ear. Rotatory chair testing was associated with overall hearing loss. Head impulse testing revealed that lateral and posterior semicircular canal function were age-dependent and correlated with high-frequency hearing loss. Notably, anterior semicircular canal function was independent of both audiometric phenotypes and age. We subsequently analyzed the distribution of audiometric phenotypes across diagnostic categories. Vestibular migraine (15.5% of the cohort) primarily affected younger women with normal hearing. Bilateral vestibulopathy (16.7% of the cohort), benign paroxysmal positional vertigo (9.7%), and dementia (2.2%) were more frequently observed in older patients and those with hearing loss. Ménière’s disease (4%) and vestibular neuritis/labyrinthitis (3.9%) were associated with younger patients and unilateral or asymmetrical hearing loss. Our findings suggest that audiometric assessments can provide predictive insights into vestibular dysfunction. These audiometric phenotypes represent valuable tools for refining diagnoses and facilitating personalized management of patients with balance disorders.

Diagnosis and treatment of vertigo and dizziness : Interdisciplinary guidance paper for clinical practice. German version

Vertigo and dizziness belong to the most common leading symptoms in clinical practice. Their differential diagnosis, however, often poses achallenge. This work aims to provide evidence-based and practice-oriented recommendations for diagnosis and treatment of vertigo and dizziness in primary care. The consensus statement of an interdisciplinary working group following anational survey among Swiss primary care physicians and neurotology specialists (neurologists, otorhinolaryngologists) is presented. The associated literature search in PubMed was conducted up to October 2024. Structured history taking and clinical neurotological examination form the basis for the differential diagnosis of the various acute (AVS), episodic (EVS), and chronic (CVS) vestibular syndromes (AVS: e.g., stroke or acute unilateral vestibulopathy; EVS: e.g., benign paroxysmal positional vertigo [BPPV], Menière's disease, vestibular migraine, vestibular paroxysmia; CVS: e.g., bilateral vestibulopathy, persistent postural perceptual dizziness). The present paper covers the following topics: i)"red flags" for apotentially dangerous cause in patients with acute vertigo/dizziness/gait and balance disorders; ii)essential clinical neurotological examination steps; iii)diagnostic and therapeutic maneuvers for posterior and lateral canal BPPV; iv)the most important therapeutic strategies for the vestibular syndromes named above; and v)the top10 recommendations regarding history taking, diagnosis, and treatment of vertigo and dizziness in clinical practice. This review aims to serve as aclinical companion for physicians of all specialties dealing with the primary diagnosis and treatment of vertigo and dizziness.

Otoneurologist’s impression of vestibular migraine

Headache and dizziness are the two most common complaints in patients who see doctors of different specialties. Moreover, an undoubted association between these two symptoms (simultaneous vs sequential occurrence) is identified during the depth patient enquiry. Variability of clinical symptoms together with the widest diversity and ambiguity of vestibular reactions, as well as the lack of instrumental options for adequate diagnosis complicates diagnosis of vestibular migraine (VM). VM is currently diagnosed only on the basis of clinical criteria accepted by the international medical community. The differential diagnosis between VM and Meniere’s disease is no less urgent. Both diseases are only diagnosed using clinical symptoms (based on accepted clinical criteria) and have multiple overlaps in clinical presentation. In many cases, patients with VM are not only treated according to the Meniere’s disease patient management protocol for many years, but also undergo surgical interventions eventually bringing absolutely no relief. However, even a true diagnosis of VM does not guarantee a fast and high-quality choice of preventive treatment due to a large range of groups of drugs used (beta-blockers, calcium channel blockers, anti-CGRP monoclonal antibodies, serotonin and norepinephrine reuptake inhibitors amongst the so-called pain-relieving antidepressants, antiepileptic drugs, some antipsychotic drugs), and their efficacy does not exceed 75%. But the combination of two diseases with interweaving of similar enough and difficult to diagnose VM and Meniere’s disease aggravating the course of each other in one patient represents the most difficult situation.

Resting-state fMRI reveals brain functional alterations linked to balance disorders in vestibular migraine patients

In subjects with Vestibular Migraine (VM), a high Dizziness Handicap Inventory (DHI) scores is commonly observed, often reflecting severe impairment in balance. This investigation aims to evaluate the abnormalities in DHI scores and to explore the associations between alterations in brain function and balance disorders in individuals suffering from VM. Fifty-four subjects with VM and 49 age-, sex-, and education-matched healthy controls (HCs) underwent Resting-state functional magnetic resonance imaging (rs-fMRI). Differences in whole-brain ReHo and seed-based functional connectivity were assessed. Pearson’s correlation was utilized to examine the associations between regions showing significant group disparities and DHI scores. The subjects with VM had higher scores in DHI (mean 49.78 ± 20.07). Compared to the HCs, subjects with VM exhibited significantly decreased ReHo values in the frontal orbital gyrus (FOG), and increased middle cingulate cortex (MCC), and the ReHo in MCC value was significantly negatively correlated with DHI_F scores in the VM group. Additionally, VM exhibited abnormalities in FC between the MCC and precuneus (PreCu). Our findings indicate that subjects with VM frequently experience balance disturbances, which may be attributed to alterations in brain function. These insights provide valuable evidence for the development of physical therapy interventions for VM.

Poly-symptomatology of chronic multi-canalicular benign paroxysmal positional vertigo: a deductive, inductive, and abductive narrative review.

This narrative review aims to present an overview of the symptomatology of chronic multi-canalicular benign paroxysmal positional vertigo (mc-BPPV) from deductive (what is believed to be known), inductive (what is likely), and abductive (hypothetical) perspectives. The purpose is to recognize these symptoms as expressions of an eventual mc-BPPV when they occur in patients with vestibular migraine, whiplash associated disorders (WAD) and other chronic pain disorders. These symptoms are often considered to be biopsychosocial conditions due to a lack of objective findings, that is, the absence of the findings one is looking for-not the absence of findings generally. The symptomatology of mc-BPPV follows a basic neurophysiologic principle: a disorder in one part of the vestibular system often affects the functions of other parts of the vestibular system. In patients with chronic mc-BPPV, abnormal signals are transmitted as afferents to the vestibular nuclei complex; from there, consistently abnormal efferent reflexes are transmitted. These symptoms can include dizziness, visual disturbances, headache, neck pain, temporomandibular joint region pain, other musculoskeletal pain, involuntary movements, tinnitus, temperature disturbance, and cognitive dysfunction. Therefore, it is necessary to consider the possibility of mc-BPPV in patients with vestibular migraine, WAD and other chronic pain disorders.

Vestibular migraine: course of symptoms during a four-year follow-up.

Data about the prognosis of vestibular migraine (VM) is scarce. VM patients on follow-up for at least 4 years were included in this multicenter study to evaluate the course of symptoms. This is a cross-sectional study. A structured questionnaire was used inquiring demographic features, age of onset of migraine headaches and vertigo attacks, headache and vertigo attack frequency, severity, associated features and the presence of interictal dizziness and positional vertigo. Menopause, history of motion sickness, and family history of migraine were recorded. Answers of the first visit were compared with the answers of the last visit. In addition, variables considered were evaluated regarding their effect on the symptom course. 203 patients were studied. Median vertigo and headache attack frequency and severity had significantly dropped during follow-up (p < 0.01 for all comparisons). Complete resolution was reported by only 5.4%. Dizziness between the attacks was present in 67%, and positional vertigo was reported by 20.2%. Univariate analysis showed that aural symptoms (p = 0.013) and menopause (p = 0.016) were risk factors for ongoing frequent vertigo attacks. A history of motion sickness (p = 0.019) and a family history of migraine (p = 0.004) were associated with the risk of frequent migraine headaches. The presence of allodynia (p = 0.002) was associated with severe headache attacks while an early age of onset of vertigo attacks (p = 0.005) was a risk factor for continuing high-frequency vertigo attacks. Though the frequency and severity of headache and vertigo attacks decrease, complete resolution is reported by a minority.

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...

Coordinates-based meta-analysis for vestibular migraine and the underlying mechanisms behind it.

Vestibular migraine (VM) is a leading cause of recurrent vertigo episodes. Voxel-based morphometry (VBM) is a reliable technique to analyze structural changes, particularly in gray matter (GM) volume, across various neurological conditions. Despite the growing amount of neuroimaging data in recent decades, a comprehensive review of GM alterations in VM remains lacking. We conducted a systematic review of three English-language databases (PubMed, Embase, and Web of Science) and two Chinese-language databases (China National Knowledge Infrastructure and Wanfang) to evaluate existing neuroimaging data on GM volume in VM patients. A coordinate-based meta-analysis (CBMA) was performed using the latest algorithm, seed-based d mapping with permutation of subject images (SDM-PSI), to identify brain alterations across individual studies. Five studies (103 VM patients, 107 HCs) were included. The CBMA demonstrated a significant reduction in GM volume in VM patients compared to HCs, with peak convergence in the left rolandic operculum (SDM-Z = -3.68, p-corrected = 0.004, voxels = 629; Brodmann area 48), extending to the posterior insula. Heterogeneity across studies was low (I2 = 19.35%), and no publication bias was detected (Egger's test: p = 0.826). This meta-analysis confirms reliable GM volume alterations in the posterior insula-operculum region of VM patients. Longitudinal studies with standardized imaging protocols are needed to clarify whether these changes are causes or consequences of VM. https://www.crd.york.ac.uk/prospero/, identifier CRD42021277684.

Exacerbation of Preexisting Otologic Conditions After COVID-19 Infection.

Since the height of the COVID-19 pandemic, there have been an increasing number of reports of incidence of otologic conditions after infection. We aim to investigate whether a history of otologic conditions was associated with elevated risk of similar or exacerbated symptoms after COVID-19 infection. Surveys were administered to patients 18 years or older who had tested positive via PCR testing for COVID-19 infection between January 2020 and September 2022. Incidence of otologic symptoms within the 10-day period after COVID-19 infection was compared between participants with a preexisting otologic condition and control participants. Of 1,499 patients who tested positive for COVID-19, 63.2% were female, 87.5% were White, and the mean age was 58 years. Of these, 721 (48%) reported a preexisting otologic condition, with loss of hearing (25.5%) and history of dizziness (18.8%) being most highly represented among this subcohort. Of patients with a preexisting condition, 35.5% subjectively reported that they believed COVID-19 infection had worsened otologic symptoms of their condition. Univariable analysis revealed that individuals were more likely to report dizziness post-COVID-19 infection if they had a preexisting history of dizziness (29.1% versus 17.8%, p < 0.001) or preexisting history of vestibular neuritis (58.8% versus 19.5%, p < 0.001) than those who did not. Similarly, individuals with a history of vestibular migraine were more likely to report migraine symptoms after infection than those who did not (27.9% versus 7.2%, p < 0.001). Multivariable analysis revealed that preexisting history of dizziness, vestibular neuritis, vestibular migraine, and autoimmune conditions increased the odds of several otologic symptoms, although an exception was observed with decreased odds for changes in hearing in patients with preexisting history of dizziness. Younger age and female gender were associated with higher odds for various otologic symptoms after COVID-19 infection. These findings indicate that certain preexisting otologic conditions may be associated with a greater likelihood of exacerbation after COVID-19 infection and may help guide screening protocols for those at greatest risk. III. UCSD IRB #801971.

Relationship Between Vertigo and Consumption of Psychotropic Drugs: A Prospective Case-Control Study.

Background/Objectives: The association between vestibular symptoms and psychological distress has been previously studied, mainly with the use of questionnaires. The purpose of this study is to compare the consumption of psychotropic drugs between a group of patients with vertigo and a control group. Methods: A prospective cross-sectional, observational, case-control study was carried out, including 506 patients (232 with Ménière's disease, 79 with vestibular migraine, 34 with vestibular neuritis, and 161 with benign paroxysmal positional vertigo). In total, 253 participants were included in the control group. Both groups were comparable regarding age, sex, and history of previous psychiatric diseases. Results: The percentage of patients with vertigo who consumed psychotropic drugs (41.3%) was higher than the percentage of the control group who did so (26.9%) (Fisher's exact test, p < 0.0001; OR = 1.914, CI95% (1.377; 2.662)). The mean number of psychotropic drugs consumed was also higher (Mann-Whitney test, p = 0.0003) in cases (0.68 ± 0.959) than in controls (0.47 ± 0.889). This higher consumption in the group of patients with vertigo was found for all pharmacological groups studied, being especially relevant regarding "anxiolytics and hypnotics and sedatives" and "antidepressants". No statistically significant differences in the consumption of psychotropic drugs between types of vestibular disorders were observed. The longer the symptoms were present, the higher the prevalence of psychotropic drug use was observed. Conclusions: A relationship between vertigo and consumption of psychotropic drugs was found. Recording the consumption of these drugs is proposed as an objective method to better understand the psychological distress that patients with vertigo may suffer from.

A preliminary study on the effects of vestibular migraine, Meniere's disease and comorbidities on emotional status and cognitive function

Objective: This study aims to investigate the differences in emotional status and cognitive function among patients with vestibular migraine (VM), Meniere's disease (MD), and their comorbidity (VMMD), and to analyze key factors influencing cognitive function. Methods: This cross-sectional study included 96 outpatients (32 males, 64 females, aged 21-73 years) from the Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, between December 2022 and December 2023. The study population consisted of 31 VM patients (VM group), 36 MD patients (MD group), and 29 VMMD patients (VMMD group), along with 32 healthy controls (16 males, 16 females, aged 19-74 years). Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), while emotional status and somatization symptoms were evaluated through the Generalized Anxiety Disorder scale, Patient Health Questionnaire Depression scale, Symptom Checklist-90, and the Self-rating Somatization Symptom scale. Multiple linear regression analysis was conducted to explore the influence of different variables on cognitive function. Results: The total MoCA score in the VMMD group (26.0 [24.5, 28.0]) was significantly lower than that in the control group (28.0 [27.0, 29.0]) and the MD group (28.0 [26.0, 30.0]) (P=0.006). VMMD patients exhibited significant impairments in specific cognitive domains, including visuospatial/executive function, delayed recall, and orientation (P<0.05). Patients with VM, MD, and VMMD showed higher rates of anxiety, depression, and somatization symptoms compared to the control group (P<0.05), with the VMMD group experiencing the most severe emotional distress. Multiple linear regression analysis identified education level and vestibular disease type as key factors affecting cognitive function, with a university-level education predicting higher MoCA scores (P<0.001), while VMMD was associated with cognitive decline (P<0.01). Conclusions: Patients with VM and MD, particularly those with comorbid VMMD, exhibit significant emotional distress. Cognitive impairments are present in VM and VMMD patients, affecting different cognitive domains. These factors should be comprehensively considered in clinical assessments to develop more effective treatment strategies.

Exploring the Link Between Traumatic Brain Injury and Benign Paroxysmal Positional Vertigo.

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder, characterized by brief episodes of vertigo triggered by changes in head position. While idiopathic cases are frequent, post-traumatic BPPV has been increasingly recognized, particularly in individuals who have experienced traumatic brain injury (TBI). TBI, ranging from mild concussions to severe head trauma, is a significant cause of neurological morbidity and is often associated with vestibular dysfunction. The pathophysiology of post-traumatic BPPV is thought to involve direct mechanical disruption of the otolithic organs, alterations in endolymph dynamics, or vascular compromise affecting inner ear structures. Compared to idiopathic BPPV, post-traumatic cases tend to have a more prolonged and refractory course, often requiring multiple repositioning maneuvers for symptom resolution. Additionally, concurrent vestibular pathologies, such as vestibular migraine, post-concussive dizziness, or central vestibular dysfunction, may complicate diagnosis and treatment. Early identification and appropriate management of post-traumatic BPPV are crucial in reducing disability and improving the quality of life in affected patients. This review explores the epidemiology, pathophysiology, clinical characteristics, and treatment considerations of post-traumatic BPPV, emphasizing the importance of a multidisciplinary approach. Understanding the relationship between TBI and BPPV can enhance clinical decision-making and optimize rehabilitation strategies for individuals with vestibular dysfunction following head trauma.

Health-related lifestyle behaviors in patients with vestibular migraine and migraine only: A cross-sectional comparative study.

Health-related lifestyle behaviors in patients with vestibular migraine and migraine only: A cross-sectional comparative study.

Effectiveness Of Vestibular Rehabilitation For Vestibular Migraine Among Female Athletes

Background: Vestibular migraine is a form of migraine in which individuals suffer from a combination of vertigo, dizziness or loss of balance along with other symptoms of migraine. Vestibular migraine (VM) is likely to be the second most prevalent reason for dizziness and affects approximately 3% of population. At middle aged females, the prevalence of migrainous vertigo was 5.0%. Unlike traditional migraines, vestibular migraines may not always present with headaches but can significantly impact athletic performance by causing episodes of unsteadiness, nausea, and difficulty concentrating. Objective: The purpose of this study is to find the effectiveness of vestibular rehabilitation for vestibular migraine among female athletes. Methodology: Through convenient sampling 30 participants with vestibular migraine are included for this study. Group A received Vestibular Rehabilitation Therapy and Group B remained as a Control group and undergoes usual therapy. A received design protocol for six weeks with the sessions supervised for five days in a week. Results: Independent Sample T-Test shows significant difference in DHI (Dizziness Handicap Inventory) scale. Conclusion: In this study exercise protocol is effective for treating dizziness in vestibular migraine patients (p&lt;0.05).

Clinical Features, Video Head Impulse Test, and Subjective Visual Vertical of Acute and Symptom-Free Phases in Patients with Definite Vestibular Migraine.

Background/Objectives: The most frequent neurologic cause of recurrent vertigo is vestibular migraine (VM). However, its diagnosis relies primarily on patients' histories, as specific diagnostic tests for VM are currently lacking. We aimed to examine and compare clinical features, vestibulo-ocular reflexes (VORs), and subjective visual vertical (SVV) between the ictal (IC) and inter-ictal (II) phases in VM patients. Methods: A repeated-measures study involved 31 patients with definite VM. Vestibular function was assessed using a video head impulse test (vHIT) to evaluate VOR results, and SVV testing to determine verticality perception. Otoneurological examination, including migraine-related disability, was noted. Analyses of repeated measures for numerical traits (SVV deviations, VOR, and clinical outcomes) were conducted using a linear mixed model (LMM), with phase, age, and sex as fixed effects and individual-specific random intercepts. Differences between the IC and II phases for dichotomous variables were analyzed using the χ2 or Fisher's exact test. Results: The LMM analysis revealed that SVV deviations were significantly higher ictally (IC-ly) (β = 0.678, p = 1.51 × 10-6) than interictally (II-ly). VOR results remained normal across phases (p > 0.05), and refixation saccades did not differ significantly based on vHIT results (p > 0.05). Nausea (100% vs. 38.71%, p = 6.591 × 10-8), photophobia (100% vs. 35.48%, p = 1.839 × 10-8), and phonophobia (90.32% vs. 6.45%, p = 9.336 × 10-12) were significantly more frequent IC-ly than II-ly. Conclusions: Our findings highlight phase-dependent alterations in spatial orientation, with increased SVV deviations IC-ly despite stable VOR. The significant differences in migraine-associated symptoms reinforce the dynamic nature of VM. These results emphasize the importance of timing in vestibular assessments and suggest that SVV testing during IC VM episodes may enhance diagnostic accuracy.

Functional network hubs in vestibular migraine: a neuroimaging perspective.

This study utilizes resting-state functional magnetic resonance imaging (rs-fMRI) and graph theory analysis to identify key brain regions in vestibular migraine (VM), explore their associations with clinical symptoms, and examine the role of these functional network hubs in the pathophysiology of VM, offering novel insights and a theoretical basis for understanding its neural mechanisms and improving its clinical diagnosis and treatment. We enrolled patients diagnosed with VM, individuals with Migraine without Aura (MwoA), and healthy control subjects, collecting both clinical and sociodemographic data alongside MRI data. Employing graph theory analysis, we focused on identifying critical hub nodes and networks within VM patients, using metrics like degree, betweenness centrality, and eigenvector centrality for our analysis. The study included 30 VM patients, 28 MwoA subjects, and 31 healthy controls. Analysis of rich-club coefficients across different levels of network sparsity indicated significantly lower normalized rich-club coefficients for VM and MwoA groups compared to healthy controls at a 65% sparsity threshold, particularly within a node degree range of 91 to 94. Notably, the temporal lobes, limbic system, and frontal lobes were predominant regions for rich-club nodes in the VM group, with significant increases in centrality metrics observed in the right posterior parahippocampal gyrus. These metrics in the hippocampus and parahippocampal gyrus showed a positive correlation with the intensity, duration, and progression of headache episodes in VM patients. In vestibular migraine patients, critical hub nodes such as the hippocampus and parahippocampal gyrus are identified, potentially associated with emotional regulation, pain perception, and the memory of pain.