Development and Validation of the Predictive Model for the Differentiation between Vestibular Migraine and Meniere’s Disease

Abstract

(1) Background: Vestibular migraine (VM) and Meniere’s disease (MD) share multiple features in terms of clinical presentations and auditory-vestibular dysfunctions, e.g., vertigo, hearing loss, and headache. Therefore, differentiation between VM and MD is of great significance. (2) Methods: We retrospectively analyzed the medical records of 110 patients with VM and 110 patients with MD. We at first established a regression equation by using logistic regression analysis. Furthermore, sensitivity, specificity, accuracy, positive predicted value (PV), and negative PV of screened parameters were assessed and intuitively displayed by receiver operating characteristic curve (ROC curve). Then, two visualization tools, i.e., nomograph and applet, were established for convenience of clinicians. Furthermore, other patients with VM or MD were recruited to validate the power of the equation by ROC curve and the Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva (GiViTI) calibration belt. (3) Results: The clinical manifestations and auditory-vestibular functions could help differentiate VM from MD, including attack frequency (X5), phonophobia (X13), electrocochleogram (ECochG) (X18), head-shaking test (HST) (X23), ocular vestibular evoked myogenic potential (o-VEMP) (X27), and horizontal gain of vestibular autorotation test (VAT) (X30). On the basis of statistically significant parameters screened by Chi-square test and multivariable double logistic regression analysis, we established a regression equation: P = 1/[1 + e−(−2.269× X5 − 2.395× X13 + 2.141× X18 + 3.949 × X23 + 2.798× X27 − 4.275× X30(1) − 5.811× X30(2) + 0.873)] (P, predictive value; e, natural logarithm). Nomographs and applets were used to visualize our result. After validation, the prediction model showed good discriminative power and calibrating power. (4) Conclusions: Our study suggested that a diagnostic algorithm based on available clinical features and an auditory-vestibular function regression equation is clinically effective and feasible as a differentiating tool and could improve the differential diagnosis between VM and MD.

Diagnostic Value of the Vestibular Autorotation Test in Menière’s Disease, Vestibular Migraine and Menière’s Disease with Migraine

“…MD and VM are episodic vestibular syndromes defined by a set of associated symptoms such as tinnitus, hearing loss or migraine features during the attacks. They are both symptomatically diagnosed and share some features in terms of etiology, eliciting factors and clinical manifestations [ 6 , 24 , 25 , 26 ]. With the progression of the disease, they share increasingly more features, which renders it difficult to distinguish between them.…”

Mendelian randomization analysis does not reveal a causal association between migraine and Meniere’s disease

“…In addition, genes associated with neuronal, vascular, ion channel/homeostasis, glutamatergic transmission, and nitic oxide or oxidative stress play an important role in migraine ( 5 ). EH is a common pathology shared by both MD and vestibular migraine, VM, which remains a clinical diagnosis with no highly accurate tests for the disorder ( 6 , 7 ). VM may experience symptoms of MD, and most VM patients experience episodes of vertigo, which occur separately from headaches.…”