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Huang TC, Arshad Q, Kheradmand A. Focused Update on Migraine and Vertigo Comorbidity. Curr Pain Headache Rep 2024:10.1007/s11916-024-01256-0. [PMID: 38635020 DOI: 10.1007/s11916-024-01256-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE OF REVIEW To provide an update on comorbidity of vestibular symptoms and migraine. RECENT FINDINGS Multisensory processing and integration is a key concept for understanding mixed presentation of migraine and vestibular symptoms. Here, we discuss how vestibular migraine should be distinguished from a secondary migraine phenomenon in which migraine symptoms may coincide with or triggered by another vestibular disorder. We also have some updates on the diagnostic criteria of vestibular migraine, its pathophysiology, and common approaches used for its treatment. As a common clinical presentation of migraine and vestibular symptoms, vestibular migraine should be distinguished from a secondary migraine phenomenon, in which migraine symptoms may be triggered by or coincide with another vestibular disorder. Recent experimental evidence suggests vestibular symptoms in vestibular migraine are linked to multisensory mechanisms that control body motion and orientation in space.
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Affiliation(s)
| | - Qadeer Arshad
- Centre for Vestibular Neurosciences, Department of Brain Sciences, Imperial College London, London, UK
- inAmind Laboratory, College of Life Sciences, University of Leicester, Leicester, UK
| | - Amir Kheradmand
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Laboratory of Computational Sensing and Robotics (LCSR), Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Evangelista ASDL, Diniz J, Costa APM, Dourado MET, Mantello EB. Neurological and vestibular findings in three cases of Multiple Sclerosis. Codas 2023; 35:e20210153. [PMID: 37991027 PMCID: PMC10702714 DOI: 10.1590/2317-1782/20232021153en] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/26/2022] [Indexed: 03/29/2024] Open
Abstract
Multiple sclerosis (MS) is a chronic and inflammatory autoimmune disease that affects the central nervous system (CNS). Dysfunction of body balance is also a common symptom and may be related to neurological injuries resulting from this disease. The aim of this study was to characterize the neurological and vestibular findings of three clinical cases diagnosed with MS. Data on the neurological evaluation and the magnetic resonance imaging of the skull were collected from the medical records. The patients responded to an initial interview and underwent clinical assessment of body balance and Video Head Impulse Test (vHIT). Vestibular symptoms and alterations were observed in at least one of the clinical tests of body balance and cerebellar function. In vHIT, changes were obtained in oculomotor tests, such as the presence of semi-spontaneous nystagmus and in parameters of the saccade test, and reduced gain in one or more vertical channels. Lesions were found on MRI of the skull in central areas that process vestibular information, such as the cerebellum and brainstem. The association of these findings suggests the presence of central vestibular dysfunction, compatible with the lesions detected in imaging exams.
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Affiliation(s)
| | - José Diniz
- Departamento de Cirurgia, Universidade Federal do Rio Grande do Norte – UFRN – Natal (RN), Brasil.
| | - Ana Paula Machado Costa
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte – UFRN – Natal (RN), Brasil.
| | | | - Erika Barioni Mantello
- Programa Associado de Pós-graduação em Fonoaudiologia, Universidade Federal do Rio Grande do Norte – UFRN – Natal (RN), Brasil.
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Evangelista ASDL, Diniz Júnior J, Costa APM, Dourado Júnior MET, Mantello EB. Neurological and vestibular findings in three cases of Multiple Sclerosis. Codas 2023; 35:e20210153. [PMID: 37991027 DOI: 10.1590/2317-1782/20232021153pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/26/2022] [Indexed: 11/23/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic and inflammatory autoimmune disease that affects the central nervous system (CNS). Dysfunction of body balance is also a common symptom and may be related to neurological injuries resulting from this disease. The aim of this study was to characterize the neurological and vestibular findings of three clinical cases diagnosed with MS. Data on the neurological evaluation and the magnetic resonance imaging of the skull were collected from the medical records. The patients responded to an initial interview and underwent clinical assessment of body balance and Video Head Impulse Test (vHIT). Vestibular symptoms and alterations were observed in at least one of the clinical tests of body balance and cerebellar function. In vHIT, changes were obtained in oculomotor tests, such as the presence of semi-spontaneous nystagmus and in parameters of the saccade test, and reduced gain in one or more vertical channels. Lesions were found on MRI of the skull in central areas that process vestibular information, such as the cerebellum and brainstem. The association of these findings suggests the presence of central vestibular dysfunction, compatible with the lesions detected in imaging exams.
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Affiliation(s)
| | - José Diniz Júnior
- Departamento de Cirurgia, Universidade Federal do Rio Grande do Norte - UFRN - Natal (RN), Brasil
| | - Ana Paula Machado Costa
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte - UFRN - Natal (RN), Brasil
| | | | - Erika Barioni Mantello
- Programa Associado de Pós-graduação em Fonoaudiologia, Universidade Federal do Rio Grande do Norte - UFRN - Natal (RN), Brasil
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Özçelik P, Koçoğlu K, Halmágyi GM, Akdal G. Video head impulse and suppression head impulse test in vestibular migraine. Acta Otolaryngol 2023; 143:856-860. [PMID: 38071651 DOI: 10.1080/00016489.2023.2284877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/08/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Vestibular Migraine (VM) is a frequent cause of recurrent spontaneous vertigo. While some report a normal Video Head Impulse Test (vHIT) in VM, others observed abnormal results on this test. Whether or not methodological discrepancies could be the cause of these differences is not known. There are 2 vHIT methods: subjects fixating an earth-fixed target (HIMP paradigm) or a head-fixed target, the suppression head impulse test (SHIMP paradigm). OBJECTIVES The present study aimed to compare VM patients against healthy controls on both HIMP and SHIMP in order to unravel any differences between them. METHODS Forty-eight VM patients and 27 healthy controls tested with both the HIMP and SHIMP paradigm. Results: Our 48 VM patients showed mean VOR normal range gains in both the HIMP and SHIMP paradigms, although there were some VOR impairments in individual semicircular SCCs. VM patients with motion sickness had lower horizontal VOR gain than those without motion sickness, with the HIMP, but not the SHIMP paradigm. CONCLUSION VM patients have normal VOR gain with either vHIT paradigm. SIGNIFICANCE The clinical significance of this observation is that a definitely abnormal vHIT with either method is unlikely to be due to vestibular migraine and an alternative diagnosis should be sought.
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Affiliation(s)
- Pınar Özçelik
- Institute of Health Sciences, Department of Neurosciences, Dokuz Eylül University, Izmir, Türkiye
- Faculty of Medicine, Department of Neurology, Bezmialem Vakif University, Istanbul, Türkiye
| | - Koray Koçoğlu
- Institute of Health Sciences, Department of Neurosciences, Dokuz Eylül University, Izmir, Türkiye
| | - Gábor M Halmágyi
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, University of Sydney, Sydney, Australia
| | - Gülden Akdal
- Institute of Health Sciences, Department of Neurosciences, Dokuz Eylül University, Izmir, Türkiye
- Faculty of Medicine, Department of Neurology, Dokuz Eylül University, Izmir, Türkiye
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Zhang Q, Wu Q, Chen J, Wang X, Zhang Y, Liu S, Wang L, Shen J, Shen M, Tang X, Mei L, Chen X, Jin Y, Yang J, Zhang Q. Characteristics of vestibular migraine, probable vestibular migraine, and recurrent vertigo of childhood in caloric and video head impulse tests. Front Neurol 2022; 13:1050282. [DOI: 10.3389/fneur.2022.1050282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
ObjectiveVertigo is very common in children, but the specific diagnosis and characteristics are not clear. The main objective of this study was to analyze the characteristics of caloric test (CT) and video head impulse test (vHIT) in vestibular migraine of childhood (VMC), probable vestibular migraine of childhood (PVMC), and recurrent vertigo of childhood (RVC), which can provide a reference value for their clinical diagnosis.MethodsWe selected VMC, PVMC and RVC patients under 18 years of age from the outpatient Department of Otolaryngology–Head and Neck Surgery between May 2021 and August 2022. All patients underwent vestibular function examinations, including eye movement recording CT and vHIT. CT results depended on whether both canal paresis and directional preponderance were under normal limits, and vHIT results depended on the gain values of vestibulo-ocular reflex. The results of both tests were analyzed according to the disease type.ResultsAmong the 81 pediatric vertigo patients aged 5–17 years, 44 were females and 37 were males. According to the type of vertigo, 29 patients (25.80%) were diagnosed with VMC, 11 (13.58%) with PVMC, and 41 (50.62%) with RVC. The abnormal rates of the CT in VMC, PVMC, and RVC patients were 24.14%, 36.36%, and 17.07%, respectively. There was no significant difference in the abnormal rates among the three groups (P > 0.05). None of the patients showed abnormal vHIT results (all abnormal rates 0.00%). The abnormal CT rates were significantly higher than those of abnormal vHIT rates (P < 0.05).ConclusionsVMC, PVMC, and RVC are more likely to be diagnosed by symptoms, as neither CT nor vHIT are specific to any conditions. Due to different clinical presentations of vertigo in pediatric patients, it is critical to further clarify the diagnosis with medical history and clinical characteristics.
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What does the video head impulse test tell us about post-caloric vestibular recruitment? Braz J Otorhinolaryngol 2022; 89:300-304. [PMID: 36473769 PMCID: PMC10071539 DOI: 10.1016/j.bjorl.2022.10.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/28/2022] [Accepted: 10/22/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The vestibular recruitment observed in caloric testing is a new tool in the study of the vestibulo-ocular reflex. This study aimed to determine the sensitivity and specificity of the video head impulse test to detect post-caloric vestibular recruitment. METHOD In this cross-sectional study, all participants underwent the standard otoneurological assessment of the service, caloric test, and video head impulse test. A non-linear mixed model was used to test for associations. RESULTS The study group consisted of 250 (89 male and 161 female) patients, with a mean age of 54.84 years. The control group comprised 35 participants, 18 men and 17 women, with a mean age of 40.42 years. Sex and age had no effect on group responses. There was no difference between the study and control groups regarding the interaction between recruitment and gain (p = 0.7487); recruitment and overt (p = 0.7002) and covert saccades (p = 1.0000); and recruitment and anti-compensatory saccades in the contralateral ear (p = 0.3050). The video head impulse test had a sensitivity of 51% and a specificity of 50% as a predictor of post-caloric recruitment. CONCLUSION The video head impulse test results showed no relevance in predicting post-caloric vestibular recruitment.
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Koç A, Akkılıç EC. Evaluation of video head impulse test during vertiginous attack in vestibular migraine. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:281-286. [PMID: 35880368 PMCID: PMC9330756 DOI: 10.14639/0392-100x-n1951] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/20/2022] [Indexed: 11/24/2022]
Abstract
Objective The aim of this study is to evaluate vestibular functions with video head impulse test (VHIT) and to understand the value of VHIT in differential diagnosis in patients with vestibular migraine (VM) during dizziness attack. Materials and methods Two groups were enrolled in this study. The first consisted of 84 vestibular migraine patients, and second group of 74 healthy subjects. VHIT was applied to patients with VM during vertigo attack and the results were compared with the VHIT values applied to subjects in the control group. Results The mean vestibulo-ocular reflex (VOR) in all semicircular canals in the VM group was lower than healthy individuals, but the results were not statistically significant. Refixation saccades were found in 52.3% of VM patients and in 10.2% of healthy individuals. Conclusions When patients with VM were evaluated with VHIT during vertiginous attack, VOR gain values were not different from healthy individuals, but the number of catch-up saccades were higher in VM patients, which indicates peripheral vestibular involvement. For differential diagnosis in patients with VM, vestibular tests should be performed during the vertigo attack. When evaluating VHIT results, the presence of refixation saccades should also be evaluated.
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