Impact of caloric test asymmetry on response to treatment in vestibular migraine

Abstract

Objective This study aimed to examine the association between caloric asymmetry and response to treatment in patients with vestibular migraine. Method Dizziness Handicap Inventory scores were compared between patients with less than and more than 25 per cent asymmetry (using Cohen effect size) in a cohort of definite vestibular migraine patients who underwent caloric testing between August 2016 and March 2019. Results A total of 31 patients (mean age: 48.7 ± 20.0 years; mean follow up: 9.1 ± 8.1 months) were included. Mean caloric asymmetry was 15.1 ± 15.6 per cent, with 6 (19.4 per cent) patients having asymmetry more than 25 per cent. Overall, patients experienced significant improvement in Dizziness Handicap Inventory total (d = 0.623 (95 per cent confidence interval, 0.007, 1.216)), emotional domain (d = 0.635 (95 per cent confidence interval, 0.019, 1.229)) and functional domain (d = 0.769 (95 per cent confidence interval, 0.143, 1.367)) but not physical domain (d = 0.227 (95 per cent confidence interval, −0.370, 0.815)) scores. Patients with more than 25 per cent asymmetry had no significant improvement in Dizziness Handicap Inventory scores, whereas those with less than 25 per cent asymmetry had significant improvement in Dizziness Handicap Inventory functional domain scores only (d = 0.636 (95 per cent confidence interval, 0.004, 1.244)). Conclusion Vestibular migraine patients with peripheral vestibular weakness on caloric testing may be less likely to improve after treatment compared with those without.

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

“…In addition, while vestibular testing cannot identify the presence of VM, it can put in evidence a concurrent dysfunction such as uncompensated vestibular hypofunction (due to peripheral or central mechanisms), comorbid BPPV as well as utricular/saccular dysfunction ( 35 ). Additionally, certain patterns can emerge on testing as well and help guide the diagnosis and/or the treatment plan ( 36 ). For instance, motion sensitive individuals tend to have longer time decay constants on step velocity rotary chair testing ( 37 , 38 ).…”

Vestibular and Oculomotor Findings in Vestibular Migraine Patients

“…For instance, Yilmaz et al observed caloric weakness in 34% and abnormal vHITs in 18% of vestibular migraine patients during interictal assessment [ 19 ], while Li et al described caloric weakness in 19.4% for acute episodes [ 24 ]. Caloric weakness is variable and has been described in up to 56% of patients with vestibular migraine [ 17 , 20 , 22 , 25 , 26 , 27 , 28 , 29 , 30 ].…”