Characterizing Vestibular Migraine

A recent study sought to determine clinical, oculographic, and vestibular test characteristics of vestibular migraine.

A total of 101 adults who presented to an outpatient facility with recurrent spontaneous and/or positional vertigo were assessed. Patients received a final diagnosis of either vestibular migraine (n = 27) or probable vestibular migraine (n = 74). Evaluation included ictal and interictal video-oculography, caloric and video head impulse tests, vestibular-evoked myogenic potentials, and audiometry.

Patients presented with headache (81.2%), spinning vertigo (72.3%), Mal de Débarquement (58.4%), and motion sensitivity (30.7%). According to the researchers, ictal and interictal spontaneous nystagmus was observed in 71.3 and 14.9%, and purely positional nystagmus in 25.8 and 55.4%. Spontaneous ictal nystagmus was more likely to be horizontal (49.5%) than vertical (21.8%). The ictal spontaneous nystagmus velocity was 5.3 ± 9.0°/s (range, 0.0–57.4), and positional was 10.4 ± 5.8°/s (range, 0.0–99.9).

Interictal spontaneous velocity was <3°/s in 91.8, while for positional, it was 23.3%. Nystagmus velocities were much higher when ictal. Most patients had normal lateral video head impulse test gains (97.8%) and symmetric caloric results (84.2%). Most air- and bone-conducted cervical-vestibular-evoked myogenic potential amplitudes were symmetric (88.4% and 93.4%, respectively); the respective mean asymmetry ratios were 13% and 9%. Most air- and bone-conducted ocular-vestibular-evoked myogenic potentials were symmetric as well (67.7% and 97.2%, respectively); the respective mean asymmetry ratios were 15.7% and 9.9%. In most cases (85.5%), audiometry was age-consistent and symmetric.

“Vestibular migraine is characterised by low velocity ictal spontaneous nystagmus, which can be horizontal, vertical, or torsional, and normal audiovestibular test results,” the researchers wrote in their conclusion.

The study was published in Cephalalgia.