Right Superior Temporal Gyrus Altered Functional Activity in Patients With Definite Vestibular Migraine

The study aimed to investigate resting-state functional brain activity alterations in patients with definite vestibular migraine (dVM). Seventeen patients with dVM, 8 patients with migraine, 17 health controls (HCs) were recruited. The amplitude of low frequency fluctuation (ALFF), fractional ALFF (fALFF) and regional homogeneity (ReHo) were calculated to observe the changes in spontaneous brain activity. Then brain regions with altered fALFF were selected for seed-based functional connectivity analysis. Compared with HCs, VM patients showed significantly increased ALFF values in the right temporal lobe (Cluster size = 91 voxels, P=0.002, FWE corrected), and significantly increased ReHo values in the right superior temporal gyrus (STG), middle temporal gyrus (MTG) and inferior temporal gyrus (ITG) (Cluster size = 136 voxels, P=0.013, FWE corrected). Compared with patients with migraine, patients with VM showed significantly increased fALFF values in the right parietal lobe (Cluster size = 43 voxels, P=0.011, FWE corrected) and right frontal lobe (Cluster size =36 voxels, P=0.026, FWE corrected), significantly increased ReHo values in the right thalamus (Cluster size = 92 voxels, P=0.043, FWE corrected). Our findings documented that patients with VM showed enhanced spontaneous functional activity in the right temporal lobe (STG, MTG, and ITG) compared with HCs, and increased spontaneous activity in the right parietal lobe-frontal lobe-thalamus compared with patients with migraine. Patients with VM and migraine both had altered brain function, but the regions involved are different.

Care Gaps and Recommendations in Vestibular Migraine: An Expert Panel Summit

Vestibular migraine (VM) is an increasingly recognized pathology yet remains as an underdiagnosed cause of vestibular disorders. While current diagnostic criteria are codified in the 2012 Barany Society document and included in the third edition of the international classification of headache disorders, the pathophysiology of this disorder is still elusive. The Association for Migraine Disorders hosted a multidisciplinary, international expert workshop in October 2020 and identified seven current care gaps that the scientific community needs to resolve, including a better understanding of the range of symptoms and phenotypes of VM, the lack of a diagnostic marker, a better understanding of pathophysiologic mechanisms, as well as the lack of clear recommendations for interventions (nonpharmacologic and pharmacologic) and finally, the need for specific outcome measures that will guide clinicians as well as research into the efficacy of interventions. The expert group issued several recommendations to address those areas including establishing a global VM registry, creating an improved diagnostic algorithm using available vestibular tests as well as others that are in development, conducting appropriate trials of high quality to validate current clinically available treatment and fostering collaborative efforts to elucidate the pathophysiologic mechanisms underlying VM, specifically the role of the trigemino-vascular pathways.

Visually Evoked Postural Responses (VEPRs) in Children with Vestibular Migraine

Vestibular migraine (VM) is the most common cause of episodic vertigo in children. Vertigo, nausea, dizziness and unsteadiness are often complained of by children with migraine, which can precede, follow or be present simultaneously with headache. The aim of this study was to use posturography to investigate the visually evoked postural responses (VEPRs) of children with VM and compare them to data obtained from children with primary headache (M) and controls (C). Twenty children diagnosed as affected by VM, nineteen children with M without aura and twenty healthy subjects were recruited in this cross-sectional study. Posturography was performed by a standardized stabilometric force-platform (Svep-Politecnica) in the following conditions: open eyes (OE), closed eyes (CE) and during full-field horizontal optokinetic stimulation (OKN-S). Electronystagmography was performed simultaneously to analyze optokinetic reflex parameters. In the OE condition, no difference was found between groups with respect to body sway area. In contrast, this parameter increased in the two pathological groups with respect to controls in the CE condition. The optokinetic stimulations also induced a similar increase of body sway area in the M group relative to controls, but a further increase was elicited in the VM group. Electronystagmographic recording also revealed different optokinetic reflex parameters in the latter groups. This study disclosed an abnormal sensitivity of children with M and VM to full-field moving scenes and a consequent destabilization of posture, as documented by the abnormal VEPRs. Children with VM were particularly exposed to this risk. Possible clinical implications of these findings are discussed.

Altered Processing of Visual Stimuli in Vestibular Migraine Patients Between Attacks: A Combined VEP and sLORETA Study

Objective: Vestibular migraine (VM) is one of the most common causes of recurrent vertigo, but the neural mechanisms that mediate such symptoms remain unknown. Since visual symptoms and photophobia are common clinical features of VM patients, we hypothesized that VM patients have abnormally sensitive low-level visual processing capabilities. This study aimed to investigate cortex abnormalities in VM patients using visual evoked potential (VEP) and standardized low-resolution brain electromagnetic tomography (sLORETA) analysis.Methods: We employed visual stimuli consisting of reversing displays of circular checkerboard patterns to examine “low-level” visual processes. Thirty-three females with VM and 20 healthy control (HC) females underwent VEP testing. VEP components and sLORETA were analyzed.Results: Patients with VM showed significantly lower amplitude and decreased latency of P1 activation compared with HC subjects. Further topographic mapping analysis revealed a group difference in the occipital area around P1 latency. sLORETA analysis was performed in the time frame of the P1 component and showed significantly less activity (deactivation) in VM patients in the frontal, parietal, temporal, limbic, and occipital lobes, as well as sub-lobar regions. The maximum current density difference was in the postcentral gyrus of the parietal lobe. P1 source density differences between HC subjects and VM patients overlapped with the vestibular cortical fields.Conclusion: The significantly abnormal response to visual stimuli indicates altered processing in VM patients. These findings suggest that abnormalities in vestibular cortical fields might be a pathophysiological mechanism of VM.

Sudden Onset of Vestibular Migraine Complicated with BPPV and Mal de Debarquement Syndrome – a Diagnostic Dilemma

Vestibular migraine is combination of migraine and vestibular symptoms. In clinical examination it can be replaced with benign paroxysmal positional vertigo (BPPV) cupulolithiasis, but also BPPV is common comorbidity in migraine patients. There is also high association between vestibular migraine and Mal de Debarquement syndrome. Patient came to hospital with vertigo that was diagnosed as left PC-BPPV canalolithiasis. After first Epley's maneuver symptoms didn't resolved. Week after, at second Epley's maneuver performed patient developed left PC-BPPV cupulolithiasis. Month after, at third Epley's maneuver BPPV resolved but patient developed Mal de Debarquement syndrome. Laboratory testing showed hyperhomocisteinemia and homozygous MTHFR C677T and PAI, with low vitamin D. After reviewing the vestibular symptoms in the first attack which was misdiagnosed as BPPV canalolithiasis, and history of migraine, patient was diagnosed with vestibular migraine. Patient well responded to migraine diet and supplementation with B complex. Vestibular disorders are similar to each other and they can overlap. More attention in taking detailed medical history should be given to patients with vertigo or dizziness.

Endolymphatic Hydrops in Vestibular Migraine Associated with Menière’s Disease: A Report of Two Cases

Vestibular migraine and Menière’s disease have similar clinical features which are recurrent dizziness or auditory symptoms, so it is challengeable to establish the correct diagnosis. Herein, a 31-year-old male and a 56-year-old female showed recurrent dizziness with auditory symptoms and suffered from vestibular migraine. They met the diagnostic criteria for vestibular migraine, but the Menière’s diagnostic criteria were not satisfied as there was no hearing loss. Delayed intravenous gadolinium enhanced magnetic resonance imaging of the inner ear was taken to find out of correlation of the inner ear and revealed endolymphatic hydrops. This case can improve the understanding of the pathophysiology of a vestibular migraine associated Menière’s disease.

Changes of calcitonin gene-related peptide and other serological indicators in vestibular migraine patients

Objective It aims to evaluate the diagnostic ability of CGRP and other blood indicators in vestibular migraine (VM) patients, and to explain the potential pathological effects of these biomarkers. The hypothesis of VM being a variant of migraine was examined. Methods A total of 32 VM patients, 35 migraine patients, and 30 healthy control subjects (HC) were selected for this cross-sectional study. Detailed statistics on demographic data, clinical manifestations, calcitonin gene-related peptide (CGRP) and common clinical laboratory indicators were measured within 24 hours from the onset of the conditions. Receptor operating characteristic (ROC) curve and area under the curve (AUC) were analyzed for biomarkers. The risk factors of VM and migraine were determined through univariate and multivariate analyses. Results Compared with HC, serum CGRP levels (p (VM) = 0.012, p (Migraine) = 0.028) increased and Mg2+ levels (p (VM) < 0.001, p (Migraine) < 0.001) deceased in VM patients and migraine patients. In multiple logistic regression, VM was correlated with CGRP [odds ratio (OR) = 1.07; 95% confidence interval (CI), 1.02–1.12; P = 0.01] and Mg2+ [odds ratio (OR) = 0.03; 95% CI, 0.07–0.15; P < 0.001)]. Migraine was correlated with CGRP [odds ratio (OR) = 1.07; 95% CI, 1.02–1.12; P = 0.01] and Mg2+ [odd ratio (OR = 0.01; 95% CI, 0–0.02; P <0.001)]. Mg2+ discriminated good differentiation between VM and migraine groups, with AUC of 0.649 (95% CI, 0.518 to 0.780). The optimal threshold for Mg2+ to diagnose VM was 0.805. Conclusions This study demonstrated that CGRP and Mg2+ may be promising laboratory indicators to discriminate HC from VM/migraine, while Mg2+ may be uded as a discriminator between VM and migraine.

Differences of Sleep Disorders Between Vestibular Migraine and Benign Paroxysmal Positional Vertigo

Introduction: Sleep disorders can affect the overall health and quality of life of patients. This study was conducted to compare the differences of sleep disorders in vestibular migraine (VM) patients and benign paroxysmal positional vertigo (BPPV) patients.Methods: VM patients, BPPV patients, and healthy controls (HCs) were recruited. Pittsburgh sleep quality index and polysomnography monitoring were used as subjective and objective, respectively, evaluation methods to evaluate the sleep quality of participants in the latest month.Results: Fifty-seven BPPV patients, 48 VM patients, and 42 HCs were included in this study. There were 79.16% VM patients, 54.39% BPPV patients, and 14.28% HCs with sleep disorders. The difference in the incidence rate of sleep disorders was significant between VM patients and BPPV patients (p = 0.008) and significantly higher in both the VM group (p &lt; 0.00001) and BPPV group (p = 0.00004) than in the HC groups (14.28%). Compared with BPPV patients, the VM patients had the significantly lower sleep efficiency (p &lt; 0.001) and N3 (p &lt; 0.001) and the significantly higher time of wake-up after sleep onset (p &lt; 0.001), N1 (p &lt; 0.001), and N2 (p &lt; 0.001). Meanwhile, the VM patients had significantly higher incidence rates of severe obstructive sleep apnea hypoventilation syndrome (p = 0.001) and periodic leg movement in sleep (p = 0.016).Conclusion: The incidence rate of sleep disorders was significantly higher in both VM and BPPV patients than in the HC groups. To improve the curative effects, clinicians should pay more attention to the comorbidity of sleep disorders in treating VM and BPPV.