Vestibular Lab Testing: Interpreting the Results in the Headache Patient with Dizziness

Chan, Timothy M.; Hale, Troy; Steenerson, Kristen

doi:10.1007/s11910-020-01036-4

Cited by 7 publications

(8 citation statements)

References 74 publications

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“…Tests of perceptual threshold, which are still not clinically available, show reduced dynamic tilt thresholds in vestibular migraine patients ( 49 ). The measurement of subjective visual vertical (SVV) and subjective visual horizontal (SVH) can serve as diagnostic indicators of dysfunction in spatial orientation ( 50 ). Abnormal SVV and SVH measurements occur in a significant number of individuals with VM, especially during head tilt where the brain is challenged to maintain spatial orientation ( 51 , 52 ).…”

Section: Care Gap 3: Lack Of a Known Diagnostic Laboratory Testing Or An Objective Marker Available For Cliniciansmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Care Gap 3: Lack Of a Known Diagnostic Laboratory Testing Or An Objective Marker Available For Cliniciansmentioning

confidence: 99%

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

et al. 2022

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“…VHIT calculates vestibulo-ocular reflex gain, determines the presence and amplitude of covert and overt catch-up saccades and records eye and head movements 8-13 . Unlike the caloric test, it is a physiological test, each semicircular canal can be evaluated, gives a more comprehensive assessment and is better tolerated by the patient 2 , 14 , 15 .…”

Section: Discussionmentioning

confidence: 99%

“…The fact that the clinical appearance of VM varies according to age creates difficulties in differential diagnosis. There is no laboratory test or biomarker that gives a definitive diagnosis for VM 2 . Therefore, vestibular tests in patients with VM are investigated to obtain information that will help in differential diagnosis 2 .…”

Section: Discussionmentioning

confidence: 99%

“…Vestibular symptoms are more common in patients with migraine than in the general population. In about half of patients, dizziness has also been reported 1 , 2 . Vestibular migraine (VM) is considered as a separate entity because of case-controlled studies 3 .…”

Section: Introductionmentioning

confidence: 99%

“…The lifetime prevalence is estimated to be 1% 4 . It can be seen at any age and is more common in women 5 with the highest prevalence in middle-aged women 2 . There is no objective diagnostic test or biomarker for vestibular migraine.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of video head impulse test during vertiginous attack in vestibular migraine

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Akkılıc

2022

Acta Otorhinolaryngol Ital

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SUMMARY Objective The aim of this study is to evaluate vestibular functions with video head impulse test (VHIT) and to understand the value of VHIT in differential diagnosis in patients with vestibular migraine (VM) during dizziness attack. Materials and methods Two groups were enrolled in this study. The first consisted of 84 vestibular migraine patients, and second group of 74 healthy subjects. VHIT was applied to patients with VM during vertigo attack and the results were compared with the VHIT values applied to subjects in the control group. Results The mean vestibulo-ocular reflex (VOR) in all semicircular canals in the VM group was lower than healthy individuals, but the results were not statistically significant. Refixation saccades were found in 52.3% of VM patients and in 10.2% of healthy individuals. Conclusions When patients with VM were evaluated with VHIT during vertiginous attack, VOR gain values were not different from healthy individuals, but the number of catch-up saccades were higher in VM patients, which indicates peripheral vestibular involvement. For differential diagnosis in patients with VM, vestibular tests should be performed during the vertigo attack. When evaluating VHIT results, the presence of refixation saccades should also be evaluated.

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