Central Mechanism And Clinicalapplication Of Migraine-related Vestibular Symptoms

Objective: To evaluate the clinical features of migraine-related vestibular symptoms and explore the clinical utility value of vestibular symptoms in migraine patients.Methods: Consecutive patients visited the outpatient department of neurology presented with a principal complaint of headache.Patients with primary headache diagnosed according to The International Classification of Headache Disorders,3rd edition,whose were divided into the episodic migraine group,chronic migraine group and tension-type headache group.We divided episodic migraine patients into low-frequency,medium-frequency and high-frequency groups.Information on the clinical symptoms were collected with a semistructured questionnaire,and the vestibular symptoms were recorded according to the standard of vestibular symptoms in vestibular migraine.Results: In total,424 patients were recruited,including 222 episodic migraine patients,174 chronic migraine patients and 28 tension-type headache patients.Vestibular symptoms accounted for 25.3% and 3.6% in migraine group and tension-type headache group,respectively.The frequency of vestibular symptoms in the chronic migraine group(54/174)was higher than that in the episodic migraine group(46/222)(P=0.019).We divided episodic migraine patients into low-frequency,medium-frequency and high-frequency groups.The medium-frequency group(headache frequency of 2-8 days per month)had the highest patients(125/222),those migraine features and accompanying symptoms were the most typical.In the time correlation between vestibular symptoms and headache,68.8% of the patients in the low frequency headache group had separate attacks of headache and vestibular symptoms.In the high frequency headache group and chronic migraine group,the incidence of the simultaneous attack of headache and vestibular symptoms was higher than that in low frequency group(P < 0.05).The time correlation between vestibular symptoms and headache occurrence was subdivided according to the frequency of headache,and it was found that the frequency of headache was 8 days per month as a cut-off point.Conclusion: Vestibular symptoms occur frequently in chronic migraine patients,suggesting that vestibular symptoms may be related to the chronicity of migraine.The time correlation between vestibular symptoms and headache occurrence is significantly related to headache frequency,a headache frequency of 8 days per month is recommended as the diagnostic criteria for chronic migraine.Background and Objective: Migraine-related vestibular symptoms are currently considered to be mainly central vestibular mechanism.Previous studies have found that the head shaking tilt suppression test is associated with the vestibular cerebellum-mediated central storage mechanism.This part of vestibular migraine is used as experimental group and Meniere’s disease as the control group.By analyzing the results of head-shaking tilt suppression test of two groups,studying the central mechanism of migraine-related vestibular symptoms,and exploring the clinical application value of the head shaking tilt suppression test in differential diagnosis of vestibular migraine and Meniere’s disease.Methods: Patients who complained of vertigo or dizziness in the Department of Neurology and inpatient Department of Otolaryngology were included.Include patients who meet the diagnostic criteria of vestibular migraine(the International Classification of Headache Disorders,3rd)and the diagnostic criteria of Meniere’s disease(the latest diagnostic criteria of Barany Association Meniere’s disease in 2015).The patients completed history collection,neurological examination and the bedside neuro-otological examination.Patients completed vestibular function test,caloric test,head shaking test and head shaking tilt suppression test,and completed hearing test and gadolinium radiography for patients with hearing loss.The maximum slow phase angular velocity of head shaking nystagmus and the maximum slow phase angular velocity of head shaking tilt surrpression in patients with vestibular migraine and Meniere’s disease were recorded,and the tilt suppression index was calculated according to the maximum slow phase angular velocity of head tilt.The tilt suppression index of the two groups was compared and analyzed.Results:(1)During the study period,there were 49 patients with vestibular migraine and 43 patients with Meniere’s disease.The positive rates of vestibular migraine and Meniere’s disease were 20(40.8%)and 22(51.2%),respectively.Of all the patients with positive head shaking,36(85.7%)had monophasic nystagmus,only 3(7.1%)had biphasic nystagmus,and 3(7.1%)had vertical nystagmus.(2)Vestibular migraine patients were common in women,and the ratio of male to female in Meniere’s disease patients were balanced.There was no difference in age,age of onset and course of disease between the two groups.Most of the patients with vestibular migraine had a family history of headache.There was no significant difference in the duration,degree and type of vestibular symptoms between the two groups,but there were significant differences in headache,vomiting,tinnitus,ear stuffy feeling and hearing loss between the two groups.(3)The bedside head pulse test of the patients with vestibular migraine was all negative,and there were 4 positive to the affected side in patients with Meniere’s disease(p=0.045).The main symptoms of Meniere’s disease were mild and moderate sensorineural hearing loss,among which 9 patients completed gadolinium angiography examination showed hydronephrosis of vestibule,cochlea and semicircular canal on the affected side.There was no significant difference in maximum slow phase angular velocity of head shaking nystagmus between vestibular migraine and Meniere’s disease(p=0.059).The maximum slow phase angular velocity of head title suppression nystagmus was 7.56 ±3.49 and2.18 ±3.72,respectively(p=0.001).The tilt suppression index(%)was24.93 ±1.05 and 81.76 ±4.90(pause 0.001),respectively.Conclusion: Migraine-related vestibular symptoms are mainly the central mechanism,and head shaking tilt suppression test can be used as an auxiliary differential diagnosis tool for vestibular migraine and Meniere’s disease.