Patient story, three-dimensional video head impulse test and videostagmography in migraine, vestibular migraine and meniere's disease

It has not been clarified yet whether the pathophysiology of the disease and vestibular migraine is the central or peripheral vestibular disorder. Patients with vestibular migraine are generally referred to the clinic with widespread symptoms in other medical diagnoses, such as partial (vestibular) Meniere's disease. Despite that ear fullness and fluctuating hearing loss symptoms are more common in Meniere's disease, some researchers have found similar complaints in patients with vestibular migraine, suggesting that there is a link between these two diseases. In our study, audiologic and vestibular complaints, migraine headache and motion (especially car) sickness story datas of patients with vestibular migraine and Meniere's disease were collected. Patients will be evaluated for videotagmographic (VNG) findings including bitermal caloric test, three-dimensional video head-impulse test (vHIT) and we will trying to show whether there is any relationship between the patient's story and the test findings. The study was approved by the Local Ethics Committee of Başkent University Medical Faculty (KA16/41). Patients who applied to the Ear, Nose and Throat clinic with a dizziness complaint between January 2015 and September 2016 were evaluated retrospectively. Patients who diagnosed with benign paroxysmal positional vertigo, vestibular neurinitis, cerebellopontin angle pathology, perilymph fistula, labyrinthitis, middle ear or inner ear anomaly and central cause (bleeding, infarct, cerebellar pathology) of dizziness were excluded by clinical history, audiologic evaluation, neurotological tests and radiologic imaging where necessary. Patients were divided into 3 groups. There were 34 patients with definite or probable vestibular migraine in group 1; 30 patients who did not meet the criteria for vestibular migraine and diagnosed with definite, probable or probable Meniere's disease in group 2; 22 patients with Meniere's disease accompanying migraine headaches in group 3. Demographic, audiologic and neurotological test findings of all three groups were compared. While vestibular migraine is more common in women and younger ages, Menere's disease patients with or without migraine headaches are not significantly different in terms of gender. The presence of low frequency hearing loss in audiologic evaluation and accompanied by ear complaints during the attack was found to be significantly lower in the first group compared to the other two groups. Motion sickness was found to be significantly higher in the two groups with migraine story than in group 1. There was a positive correlation between vestibulo-ocular-reflex gain (VOR gain) in vHIT and motion sickness and there was no correlation between canal paresis in caloric test and motion sickness. Post head shaking horizontal only and horizonto-vertical nystagmuses in VNG were more frequent in group 2 especially but vertical nystagmus in other parts of VNG were similar in three groups. The presence of canal paresis alone was not differ among the three groups. The presence of posthead shaking nystagmus and canal paresis together was lower in group 1, compared to the other two groups. Lateral VOR gain loss with catch-up saccades in vHIT were significantly higher in group 2 especially. It could be suggested that auditory complaints and audiologic evaluation are important in the differential diagnosis of vestibular migraine from other peripheral and central vestibular diseases, and motion sickness is closely related to the migraine headache story. Also it may be suggested that VNG gives more signs in the differential diagnosis of Meniere's disease than caloric testing alone, lateral vHIT is important to distinguishing between Meniere's disease and vestibular migraine, and the presence of catch-up saccades without loss of VOR gain in vHIT may be a pathologic condition. Keywords: Migraine, Meniere's, vestibular migraine, vHIT, motion sickness.