Background: Patients with headache often report symptoms of imbalance, vertigo, and visually provoked dizziness. Vestibular migraine (VM) is a common cause of recurrent dizziness symptoms for many of these patients. Variable results are provided in the available literature describing objective and functional measures of vestibular system function, likely because of the inconsistency of diagnostic criteria over time and the range of clinical presentations of patients with headache and dizziness. Purpose: To describe the clinical presentation of patients with headache and dizziness who receive a final diagnosis of definite VM. Research Design: Retrospective case series. Method: We reviewed 304 consecutive patients between 18 and 62years of age. All patients were evaluated between 2012 and 2024 and received a final diagnosis of definite VM. Data Collection and Analysis: The clinical assessment included objective measures of oculomotor and vestibular reflex performance as well as functional assessments of balance, gaze stability, and spatial orientation. All data were collected as part of the clinical diagnostic battery for patients presenting with headache and dizziness. Results: Imbalance (68.75 percent, n 209) and rotational vertigo (62.5 percent, n 190) were commonly reported. Vestibular assessment results were atypical for at least one metric in 92.1 percent ( n 280) of patients. Most irregularities comprised otolith reflex (ocular vestibular evoked myogenic potentials: 68.39 percent, n 155) or functional testing (subjective visual vertical: 67.68 percent, n 198; dynamic visual acuity testing: 71.01 percent, n 98). Semicircular canal function that was not typical was noted for at least one measure in 29.28 percent ( n 89) of patients. Conclusion: The clinical presentation of VM varies; however, a more complete profile can be described using an expanded protocol beyond standard vestibular reflex pathway testing. Because of the assumed involvement of central vestibular system pathways, evaluations of dynamic and integrative reflex function are likely to improve our ability to identify and appropriately manage patients with suspected VM. Clinical Relevance Statement: Atypical objective and functional vestibular reflex pathway performance are associated with VM, which is a common disorder. The heterogeneous presentation of VM poses challenges for both its diagnosis and treatment.
Zaleski-King et al. (Thu,) studied this question.