Sensitized rotatory motion perception and increased susceptibility to motion sickness in vestibular migraine: A cross‐sectional study

Abstract

Background and purpose Vestibular migraine (VM) patients are ictally and interictally hypersensitive for self‐motion and visual perception. Increased cortical excitability of the vestibular system represented by lowered motion perception thresholds might play an important role in the pathophysiology of VM. We aimed to compare motion perception thresholds and the vegetative response to rotatory motion, as well as the vestibulo‐ocular reflex (VOR) during rotation in VM patients compared to healthy controls (HC). Methods In this cross‐sectional study, 28 female VM patients in the interictal state and 33 age‐ and gender‐matched HC were investigated sitting in a motorized rotary chair shielded regarding visual and acoustic stimuli for 20 min with slowly increasing velocity (maximum = 72°/s). The motion perception threshold was indicated by the participants by pushing a button. During and after rotation, participants rated the presence and extent of motion sickness using a sickness rating scale. Results We detected lower motion perception thresholds (7.54°/s vs. 23.49°/s; p < 0.001) in VM patients compared to HC but no difference at the basic VOR thresholds. Furthermore, the patients showed enhanced susceptibility to motion sickness during and after the rotation. Conclusions We provide evidence for decreased motion perception thresholds and pronounced susceptibility to motion sickness in VM patients in the interictal state, which could indicate alterations in higher levels of vestibular processing. Future studies should determine whether this could be the pathophysiological hallmark of VM either as a unique disease entity or in differentiation from other forms of migraine.

Reduced vestibular perception thresholds in persistent postural-perceptual dizziness- a cross-sectional study

“…However, investigating participants once has the advantage of avoiding erroneous measurements due to within-session response dynamics induced by repetitive stimuli. Moreover, the protocol used here is also suitable to evaluate the perceptual detection threshold and additionally the development of vegetative symptoms accurately [21]. Furthermore, this simplified and well-tolerated protocol may be used to measure therapy effects in the sense of a longitudinal study.…”

“…Maximum and mean velocity of the slow phase (degrees/second) was calculated by a software (VN415, Interacoustics, Denmark). The same protocol was previously used and able to detect conclusive results in vestibular migraine [21].…”

Calcitonin Gene-Related Peptide (CGRP) Receptor Antagonism Reduces Motion Sickness Indicators in Mouse Migraine Models

“…Migraine and vestibular migraine (VM) are associated with enhanced motion sickness, and VM is the most common cause of spontaneous vertigo but remains poorly understood (1-3). VM patients exhibit lower motion perception thresholds compared to healthy controls but no difference in vestibulo-ocular (VOR) thresholds; VM patients also showed enhanced susceptibility to motion sickness both during and after rotation (3).…”

Response to the Letter to the Editor by Arshad and Bronstein “Motion perception in vestibular migraine”

“…We appreciate the opportunity presented to respond to the esteemed comments from Professors Arshad and Bronstein [1] regarding our manuscript entitled "Sensitized rotatory motion perception and increased susceptibility to motion sickness in vestibular migraine: A cross-sectional study" [2], whereby they clarify that the different study paradigms used may lead to different results with regard to vestibular perceptual thresholds. With reference to the aforementioned study, the comments address vestibular migraine (VM), but may also be relevant for the investigation of other vestibular disorders.…”

“…The datasets analyzed during the study are available from the corresponding author on reasonable request. Sebastian Wurthmann 1,2 Steffen Naegel 1,3 Michael Nsaka…”