Hostname: page-component-848d4c4894-4rdrl Total loading time: 0 Render date: 2024-06-16T15:58:28.106Z Has data issue: false hasContentIssue false

Impact of caloric test asymmetry on response to treatment in vestibular migraine

Published online by Cambridge University Press:  17 March 2021

Y F Liu*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, USA
J R Dornhoffer
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, USA
L Donaldson
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, USA
H G Rizk
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, USA
*
Author for correspondence: Dr Yuan F Liu, Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, 171 Ashley Ave, Charleston29425, USA Email: liuyua@musc.edu

Abstract

Objective

This study aimed to examine the association between caloric asymmetry and response to treatment in patients with vestibular migraine.

Method

Dizziness Handicap Inventory scores were compared between patients with less than and more than 25 per cent asymmetry (using Cohen effect size) in a cohort of definite vestibular migraine patients who underwent caloric testing between August 2016 and March 2019.

Results

A total of 31 patients (mean age: 48.7 ± 20.0 years; mean follow up: 9.1 ± 8.1 months) were included. Mean caloric asymmetry was 15.1 ± 15.6 per cent, with 6 (19.4 per cent) patients having asymmetry more than 25 per cent. Overall, patients experienced significant improvement in Dizziness Handicap Inventory total (d = 0.623 (95 per cent confidence interval, 0.007, 1.216)), emotional domain (d = 0.635 (95 per cent confidence interval, 0.019, 1.229)) and functional domain (d = 0.769 (95 per cent confidence interval, 0.143, 1.367)) but not physical domain (d = 0.227 (95 per cent confidence interval, −0.370, 0.815)) scores. Patients with more than 25 per cent asymmetry had no significant improvement in Dizziness Handicap Inventory scores, whereas those with less than 25 per cent asymmetry had significant improvement in Dizziness Handicap Inventory functional domain scores only (d = 0.636 (95 per cent confidence interval, 0.004, 1.244)).

Conclusion

Vestibular migraine patients with peripheral vestibular weakness on caloric testing may be less likely to improve after treatment compared with those without.

Type
Main Articles
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr Y Liu takes responsibility for the integrity of the content of the paper

References

Neuhauser, H, Lempert, T. Vertigo and dizziness related to migraine: a diagnostic challenge. Cephalalgia 2004;24:8391CrossRefGoogle ScholarPubMed
Liu, YF, Locklear, TD, Sharon, JD, Lacroix, E, Nguyen, SA, Rizk, HG. Quantification of cognitive dysfunction in dizzy patients using the neuropsychological vertigo inventory. Otol Neurotol 2019;40:e723–e31CrossRefGoogle ScholarPubMed
Formeister, EJ, Rizk, HG, Kohn, MA, Sharon, JD. The epidemiology of vestibular migraine: a population-based survey study. Otol Neurotol 2018;39:1037–44CrossRefGoogle ScholarPubMed
Liu, YF, Xu, H. The intimate relationship between vestibular migraine and Meniere disease: a review of pathogenesis and presentation. Behav Neurol 2016;2016:3182735CrossRefGoogle ScholarPubMed
Lempert, T, Olesen, J, Furman, J, Waterston, J, Seemungal, B, Carey, J et al. Vestibular migraine: diagnostic criteria. J Vestib Res 2012;22:167–72CrossRefGoogle ScholarPubMed
Hsu, LC, Wang, SJ, Fuh, JL. Prevalence and impact of migrainous vertigo in mid-life women: a community-based study. Cephalalgia 2011;31:7783CrossRefGoogle ScholarPubMed
Cherchi, M, Hain, TC. Migraine-associated vertigo. Otolaryngol Clin North Am 2011;44:367–75, viii-ixCrossRefGoogle ScholarPubMed
Espinosa-Sanchez, JM, Lopez-Escamez, JA. New insights into pathophysiology of vestibular migraine. Front Neurol 2015;6:12CrossRefGoogle ScholarPubMed
Furman, JM, Marcus, DA, Balaban, CD. Vestibular migraine: clinical aspects and pathophysiology. Lancet Neurol 2013;12:706–15CrossRefGoogle ScholarPubMed
King, S, Wang, J, Priesol, AJ, Lewis, RF. Central integration of canal and otolith signals is abnormal in vestibular migraine. Front Neurol 2014;5:233CrossRefGoogle ScholarPubMed
Seemungal, B, Rudge, P, Davies, R, Gresty, M, Bronstein, A. Three patients with migraine following caloric-induced vestibular stimulation. J Neurol 2006;253:1000–1CrossRefGoogle ScholarPubMed
Wilkinson, D, Ade, KK, Rogers, LL, Attix, DK, Kuchibhatla, M, Slade, MD et al. Preventing episodic migraine with caloric vestibular stimulation: a randomized controlled trial. Headache 2017;57:1065–87CrossRefGoogle ScholarPubMed
Akerman, S, Holland, PR, Goadsby, PJ. Diencephalic and brainstem mechanisms in migraine. Nat Rev Neurosci 2011;12:570–84CrossRefGoogle ScholarPubMed
Marano, E, Marcelli, V, Di Stasio, E, Bonuso, S, Vacca, G, Manganelli, F et al. Trigeminal stimulation elicits a peripheral vestibular imbalance in migraine patients. Headache 2005;45:325–31CrossRefGoogle ScholarPubMed
Vass, Z, Shore, SE, Nuttall, AL, Miller, JM. Direct evidence of trigeminal innervation of the cochlear blood vessels. Neuroscience 1998;84:559–67CrossRefGoogle ScholarPubMed
Frejo, L, Martin-Sanz, E, Teggi, R, Trinidad, G, Soto-Varela, A, Santos-Perez, S et al. Extended phenotype and clinical subgroups in unilateral Meniere disease: a cross-sectional study with cluster analysis. Clin Otolaryngol 2017;42:1172–80CrossRefGoogle ScholarPubMed
Kang, WS, Lee, SH, Yang, CJ, Ahn, JH, Chung, JW, Park, HJ. Vestibular function tests for vestibular migraine: clinical implication of video head impulse and caloric tests. Front Neurol 2016;7:166CrossRefGoogle ScholarPubMed
Celebisoy, N, Gokcay, F, Sirin, H, Bicak, N. Migrainous vertigo: clinical, oculographic and posturographic findings. Cephalalgia 2008;28:72–7CrossRefGoogle ScholarPubMed
von Brevern, M, Zeise, D, Neuhauser, H, Clarke, AH, Lempert, T. Acute migrainous vertigo: clinical and oculographic findings. Brain 2005;128:365–74CrossRefGoogle ScholarPubMed
Shin, JE, Kim, CH, Park, HJ. Vestibular abnormality in patients with Meniere's disease and migrainous vertigo. Acta Otolaryngol 2013;133:154–8CrossRefGoogle ScholarPubMed
Neff, BA, Staab, JP, Eggers, SD, Carlson, ML, Schmitt, WR, Van Abel, KM et al. Auditory and vestibular symptoms and chronic subjective dizziness in patients with Meniere's disease, vestibular migraine, and Meniere's disease with concomitant vestibular migraine. Otol Neurotol 2012;33:1235–44CrossRefGoogle ScholarPubMed
Lopez-Escamez, JA, Carey, J, Chung, W-H, Goebel, JA, Magnusson, M, Mandala, M et al. Diagnostic criteria for Menière's disease. J Vestib Res 2015;25:17CrossRefGoogle ScholarPubMed
Jacobson, GP, Newman, CW. The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg 1990;116:424–7CrossRefGoogle ScholarPubMed
Mutlu, B, Serbetcioglu, B. Discussion of the dizziness handicap inventory. J Vestib Res 2013;23:271–7CrossRefGoogle ScholarPubMed
Jacobson, GP, Newman, CW, Hunter, L, Balzer, G. Balance function test correlates of the Dizziness Handicap Inventory. J Am Acad Audiol 1991;2:253–60Google ScholarPubMed
Decker, J, Limburg, K, Henningsen, P, Lahmann, C, Brandt, T, Dieterich, M. Intact vestibular function is relevant for anxiety related to vertigo. J Neurol 2019;266(suppl 1):14CrossRefGoogle ScholarPubMed
Balaban, CD, Thayer, JF. Neurological bases for balance–anxiety links. J Anxiety Disord 2001;15:5379CrossRefGoogle ScholarPubMed
Balaban, CD, Jacob, RG, Furman, JM. Neurologic bases for comorbidity of balance disorders, anxiety disorders and migraine: neurotherapeutic implications. Expert Rev Neurother 2011;11:379–94CrossRefGoogle ScholarPubMed
Liu, YF, Renk, E, Rauch, SD, Xu, HX. Efficacy of intratympanic gentamicin in Meniere's disease with and without migraine. Otol Neurotol 2017;38:1005–9CrossRefGoogle ScholarPubMed
Holroyd, K, Drew, J, Cottrell, C, Romanek, K, Heh, V. Impaired functioning and quality of life in severe migraine: the role of catastrophizing and associated symptoms. Cephalalgia 2007;27:1156–65CrossRefGoogle ScholarPubMed
Shaia, WT, Zappia, JJ, Bojrab, DI, LaRouere, ML, Sargent, EW, Diaz, RC. Success of posterior semicircular canal occlusion and application of the dizziness handicap inventory. Otolaryngol Head Neck Surg 2006;134:424–30CrossRefGoogle ScholarPubMed
Humphriss, RL, Baguley, DM, Moffat, DA. Change in dizziness handicap after vestibular schwannoma excision. Otol Neurotol 2003;24:661–5CrossRefGoogle ScholarPubMed
Badke, MB, Pyle, GM, Shea, T, Miedaner, J. Outcomes in vestibular ablative procedures. Otol Neurotol 2002;23:504–9CrossRefGoogle Scholar
Puledda, F, Messina, R, Goadsby, PJ. An update on migraine: current understanding and future directions. J Neurol 2017;264:2031–9CrossRefGoogle ScholarPubMed