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The integration of multisensory motion stimuli is impaired in vestibular migraine patients

Journal of Neurology volume 267, pages 2842–2850 (2020)Cite this article

Abstract

Background

Vestibular migraine (VM) is a relatively recently acknowledged vestibular syndrome with a very relevant prevalence of about 10% among patients complaining of vertigo. The diagnostic criteria for VM have been recently published by the Bárány Society, and they are now included in the latest version of the International Classification of Headache Disorders, yet there is no instrumental test that supports the diagnosis of VM.

Objective

In the hypothesis that the integration of different vestibular stimuli is functionally impaired in VM, we tested whether the combination of abrupt vestibular stimuli and full-field, moving visual stimuli would challenge vestibular migraine patients more than controls and other non-vestibular migraineurs.

Methods

In three clinical centers, we compared the performance in the functional head impulse test (fHIT) without and with an optokinetic stimulus rotating in the frontal plane in a group of 44 controls (Ctrl), a group of 42 patients with migraine (not vestibular migraine, MnoV), a group of 39 patients with vestibular migraine (VM) and a group of 15 patients with vestibular neuritis (VN).

Results

The optokinetic stimulation reduced the percentage of correct answers (%CA) in all groups, and in about 33% of the patients with migraine, in as many as 87% of VM patients and 60% of VN patients, this reduction was larger than expected from controls’ data.

Conclusions

The comparison of the fHIT results without and with optokinetic stimulation unveils a functional vestibular impairment in VM that is not as large as the one detectable in VN, and that, in contrast with all the other patient groups, mainly impairs the capability to integrate different vestibular stimuli.

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Author information

Affiliations

  1. Neurology Unit, ASST Settelaghi, Insubria University, DMC, Varese, Italy

    Maurizio Versino

  2. Neuro-Otology and Neuro-Ophthalmology Lab, IRCCS Mondino Foundation, Pavia, Italy

    Maurizio Versino & Silvia Colnaghi

  3. Department of Otology and Skull Base Surgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy

    Marco Mandalà

  4. Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy

    Silvia Colnaghi

  5. Department of Surgery and Biomedical Sciences, University of Perugia, Perugia, Italy

    Giampietro Ricci & Mario Faralli

  6. Department of Computer, Electric and Biomedical Engineering, University of Pavia, Via Ferrata, 5, 27100, Pavia, Italy

    Stefano Ramat

Authors
  1. Maurizio Versino
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  2. Marco Mandalà
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  3. Silvia Colnaghi
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  4. Giampietro Ricci
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  5. Mario Faralli
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  6. Stefano Ramat
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Corresponding author

Correspondence to Stefano Ramat.

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Conflicts of interest

Stefano Ramat is a shareholder of Beon Solutions srl (Zero Branco, TV, Italy), a company producing the fHIT system used in this study.

Ethical standards

All the procedures performed were in accordance both with clinical and with the ethical and privacy standards of the institutional ethical committees and with the 1964 Helsinki declaration.

Informed consent

The participants signed an informed consent form.

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Versino, M., Mandalà, M., Colnaghi, S. et al. The integration of multisensory motion stimuli is impaired in vestibular migraine patients. J Neurol 267, 2842–2850 (2020). https://doi.org/10.1007/s00415-020-09905-1

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  • DOI: https://doi.org/10.1007/s00415-020-09905-1

Keywords

  • Vestibular migraine
  • International classification of headache disorders
  • Functional head impulse test
  • Vestibular ocular reflex
  • Optokinetic stimulation