Vestibular Testing Data in Migraine-Associated Vertigo

Abstract

Objectives:

(1) Describe data on comprehensive vestibular testing in migraine-associated vertigo patients. (2) Delineate specific findings in vestibular testing that can assist in the diagnosis and treatment of migraine-associated vertigo.

Methods:

A retrospective case review of individuals diagnosed with migraine-associated vertigo after evaluation by an otologist, a neurologist, and who had vestibular testing between January 1, 2010, and June 31, 2012, at a tertiary referral center. Videonystagmography (VNG), sinusoidal harmonic acceleration (SHA) testing, and cervical vestibular evoked myogenic potential (cVEMP) testing were analyzed.

Results:

Eighty-three patients met inclusion criteria; 63 had a diagnosis of primary migraine-associated vertigo. An additional 20 patients had a secondary diagnosis including Ménières disease, intracranial hypertension, and a history of cranial surgery (secondary migraine-associated vertigo). The average patient was 49 years old, with 82% being female. There was no statistically significant difference between the 2 groups. Overall, 30% of migraine-associated vertigo patients had abnormal caloric testing with a 60% average unilateral weakness. The unilateral weakness was to the right 77% of the time. When VNG, SHA, and cVEMP testing were combined, 24 patients (29%) had an identifiable vestibular weakness; 75% had a peripheral source and 25% had central vestibular findings. A total of 50% of patients with a peripheral weakness were fully compensated, 33% were partially compensated, and 17% were poorly compensated.

Conclusions:

In patients with primary and secondary migraine-associated vertigo, approximately two-thirds of patients were found to have normal vestibular testing. When there was an identifiable vestibular weakness, 75% were peripheral with only 50% fully compensated.