Relationship between Chronological Orders of Symptoms and Vestibular Abnormality in Patients with Vestibular Migraine

Abstract

Objectives Pathophysiology of vestibular migraine (VM) is still controversial. Vertigo may act as a trigger for migraine or there might other mechanisms which cause migraine and dizziness. VM patients have headaches and dizziness simultaneously or sequentially. Therefore, we hypothesized that the sequence of symptoms might suggest different mechanisms and compared the results of vestibular function tests (VFTs) according to chronological order of headache and vertigo. Methods Forty-two patients with VM were included. They were divided into three subgroups according to the chronological orders of headache and vertigo, and the results of VFTs and the symptomatic improvement were compared between each group. Results Dizziness appeared first in 15 patients (35.7%), both symptoms appeared simultaneously in 20 patients (47.6%), and headaches appeared first in 7 (16.7%). There were no significant differences in symptom duration among the groups. Fourteen (33.3%) showed abnormal caloric results, 7 (16.7%) in head impulse test, 16 (38.1%, vestibular score) and 19 (45.2%, composite score) in sensory organizing test, and 13 (31.0%) in vestibular evoked myogenic potential test. Abnormal rate of the caloric test in the simultaneous group was significantly lower than those of the other two groups. Nineteen (45.2%) showed complete remission in 3 months after preventive medication with no significant difference between each group. Conclusions VM patients whose vertigo occurred with headache simultaneously showed lower incidence of caloric abnormality, suggesting that they have abnormality in central vestibular system rather than peripheral vestibular organs.