Background

We characterise the history, vestibular tests, ictal and interictal nystagmus in vestibular migraine.

Method

We present our observations on 101 adult-patients presenting to an outpatient facility with recurrent spontaneous and/or positional vertigo whose final diagnosis was vestibular migraine (n = 27) or probable vestibular migraine (n = 74). Ictal and interictal video-oculography, caloric and video head impulse tests, vestibular-evoked myogenic potentials and audiometry were performed.

Results

Common presenting symptoms were headache (81.2%), spinning vertigo (72.3%), Mal de Débarquement (58.4%), and motion sensitivity (30.7%). With fixation denied, ictal and interictal spontaneous nystagmus was observed in 71.3 and 14.9%, and purely positional nystagmus in 25.8 and 55.4%. Spontaneous ictal nystagmus was horizontal in 49.5%, and vertical in 21.8%. Ictal spontaneous and positional nystagmus velocities were 5.3 ± 9.0°/s (range 0.0–57.4), and 10.4 ± 5.8°/s (0.0–99.9). Interictal spontaneous and positional nystagmus velocities were <3°/s in 91.8 and 23.3%. Nystagmus velocities were significantly higher when ictal (p < 0.001/confidence interval: 2.908‒6.733, p < 0.001/confidence interval: 5.308‒10.085). Normal lateral video head impulse test gains were found in 97.8% (mean gain 0.95 ± 0.12) and symmetric caloric results in 84.2% (mean canal paresis 7.0 ± 23.3%). Air- and bone-conducted cervical-vestibular-evoked myogenic potential amplitudes were symmetric in 88.4 and 93.4% (mean corrected amplitude 1.6 ± 0.7, 1.6 ± 0.8) with mean asymmetry ratios of 13.0 and 9.0%. Air- and bone-conducted ocular-vestibular-evoked myogenic potentials were symmetric in 67.7 and 97.2% (mean amplitude 9.2 ± 6.4 and 20.3 ± 12.8 µV) with mean asymmetry ratios of 15.7 and 9.9%. Audiometry was age consistent and symmetric in 85.5%.

Conclusion

Vestibular migraine is characterised by low velocity ictal spontaneous nystagmus, which can be horizontal, vertical, or torsional, and normal audiovestibular test results.

中文翻译：

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前庭性偏头痛的临床、眼科和前庭检查特征

背景

我们描述了前庭偏头痛的病史、前庭试验、发作期和间期眼球震颤的特征。

方法

我们展示了我们对 101 名因复发性自发性和/或位置性眩晕在门诊就诊的成人患者的观察结果，这些患者的最终诊断为前庭性偏头痛（n = 27）或可能的前庭性偏头痛（n = 74）。进行了发作期和发作间期视频眼部描记术、热量和视频头部脉冲测试、前庭诱发的肌源性电位和听力测量。

结果

常见的症状是头痛 (81.2%)、旋转性眩晕 (72.3%)、Mal de Débarquement (58.4%) 和运动敏感 (30.7%)。在拒绝固视的情况下，71.3% 和 14.9% 的患者出现发作期和发作间期自发性眼震，25.8% 和 55.4% 的患者出现单纯位置性眼震。自发性发作性眼球震颤水平为 49.5%，垂直为 21.8%。发作性自发性和位置性眼球震颤速度为 5.3 ± 9.0°/s（范围 0.0-57.4）和 10.4 ± 5.8°/s（0.0-99.9）。91.8% 和 23.3% 的发作间期自发性和位置性眼球震颤速度 <3°/s。发作时眼球震颤速度显着更高 ( p  < 0.001/置信区间: 2.908-6.733, p < 0.001/置信区间：5.308-10.085)。正常横向视频头部脉冲测试增益为 97.8%（平均增益 0.95 ± 0.12），对称热量结果为 84.2%（平均根管麻痹 7.0 ± 23.3%）。气导和骨导颈前庭诱发的肌源性肌源性电位振幅对称性分别为 88.4% 和 93.4%（平均校正振幅为 1.6 ± 0.7、1.6 ± 0.8），平均不对称比率为 13.0% 和 9.0%。空气和骨传导眼前庭诱发的肌源性电位在 67.7% 和 97.2%（平均振幅 9.2 ± 6.4 和 20.3 ± 12.8 µV）中对称，平均不对称比率为 15.7% 和 9.9%。85.5% 的听力测试与年龄一致且对称。

结论

前庭性偏头痛的特点是低速发作性自发性眼球震颤，可以是水平、垂直或扭转，前庭听力检查结果正常。