Evaluation of semicircular canals in patients with vestibular migraine with suppression head impulse paradigm test and video head impulse test

Abstract

Background & Objective: Vestibular migraine (VM) is a prevalent disorder characterized by recurrent episodes of spontaneous vertigo, which may occur with or without headaches. This study aimed to evaluate the vestibular system in individuals with VM using the video head impulse test (vHIT) and suppression head impulse paradigm (SHIMP).

Methods: In this study, 20 individuals diagnosed with VM according to the Bárány Society criteria were included in the VM group, and 20 individuals without vertigo symptoms were included as controls. All participants underwent both vHIT and SHIMP tests. The Beck Depression Inventory (BDI) and Dizziness Handicap Inventory (DHI) were also administered to assess depression and dizziness.

Results: No significant differences in vestibular- ocular reflex (VOR) gains were observed between the VM and control groups across all semicircular canal (SCC) planes. Overt saccades were noted in 12 VM patients in the right lateral SCC, and in 9 patients in the left lateral SCC. Covert saccades were observed in 1 patient in each of the right and left lateral SCCs. No saccades occurred in the anterior or posterior SCCs. The SHIMP test revealed no significant differences in gain or anti-compensatory saccades between the groups. However, significant differences were observed in the BDI and DHI scores (p = 0.000).

Conclusion: vHIT and SHIMP testing do not effectively identify vestibular dysfunction during the inter-attack period in VM patients. However, overt saccades may serve as potential indicators of dysfunction. Both otoneurological evaluation and psychological assessment are crucial in the comprehensive evaluation of VM patients.