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Journal of Neurology

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Open Access 17-10-2023 | Vestibular Migraine | Original Communication

Subjective and objective responses to caloric stimulation help separate vestibular migraine from other vestibular disorders

Authors: I. P. Hannigan, S. M. Rosengren, G. K. Bharathy, M. Prasad, M. S. Welgampola, S. R. D. Watson

Published in: Journal of Neurology | Issue 2/2024

Abstract

Background

Nystagmus generated during bithermal caloric test assesses the horizontal vestibulo-ocular-reflex. Any induced symptoms are considered unwanted side effects rather than diagnostic information.

Aim

We hypothesized that nystagmus slow-phase-velocity (SPV) and subjective symptoms during caloric testing would be higher in vestibular migraine (VM) patients compared with peripheral disorders such as Meniere’s disease (MD) and non-vestibular dizziness (NVD).

Methods

Consecutive patients (n = 1373, 60% female) referred for caloric testing were recruited. During caloric irrigations, patients scored their subjective sensations. We assessed objective-measures, subjective vertigo (SVS), subjective nausea (SNS), and test completion status.

Results

Nystagmus SPV for VM, MD (unaffected side), and NVD were 29 ± 12.8, 30 ± 15.4, and 28 ± 14.2 for warm irrigation and 24 ± 8.9, 22 ± 10.0, and 25 ± 12.8 for cold-irrigation. The mean SVS were 2.5 ± 1.1, 1.5 ± 1.33, and 1.5 ± 1.42 for warm irrigation and 2.2 ± 1.1, 1.1 ± 1.19, and 1.1 ± 1.16 for cold-irrigation. Age was significantly correlated with SVS and SNS, (p < 0.001) for both. The SVS and SNS were significantly higher in VM compared with non-VM groups (p < 0.001), and there was no difference in nystagmus SPV. VM patients SVS was significantly different to the SVS of migraineurs in the other diagnostic groups (p < 0.001). Testing was incomplete for 34.4% of VM and 3.2% of MD patients. To separate VM from MD, we computed a composite value representing the caloric data, with 83% sensitivity and 71% specificity. Application of machine learning to these metrics plus patient demographics yielded better separation (96% sensitivity and 85% specificity).

Conclusion

Perceptual differences between VM and non-VM patients during caloric stimulation indicate that subjective ratings during caloric testing are meaningful measures. Combining objective and subjective measures could provide optimal separation of VM from MD.

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Title: Subjective and objective responses to caloric stimulation help separate vestibular migraine from other vestibular disorders
Authors: I. P. Hannigan
S. M. Rosengren
G. K. Bharathy
M. Prasad
M. S. Welgampola
S. R. D. Watson
Publication date: 17-10-2023
Publisher: Springer Berlin Heidelberg
Keywords: Vestibular Migraine
Migraine
Nystagmus
Nausea
Published in: Journal of Neurology / Issue 2/2024
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-023-12027-z

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Springer Medicine

Subjective and objective responses to caloric stimulation help separate vestibular migraine from other vestibular disorders

Abstract

Background

Aim

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Aim

Methods

Results

Conclusion

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