Evaluation of Vestibular-Evoked Myogenic Potentials with Different Stimulus Models in Individuals Diagnosed with Vestibular Migraine

Background: Vestibular migraine (VM) is a common cause of episodic vertigo; however, its electrophysiological evaluation has been limited. Purpose: To compare cervical vestibular evoked myogenic potential (cVEMP) and ocular vestibular evoked myogenic potential (oVEMP) elicited by different stimuli in patients with VM and healthy individuals as controls and assess their diagnostic utility. Research Design: Prospective case-control study. Study Sample: Twenty-six patients diagnosed with VM and 26 age-matched and sex-matched healthy volunteers. Data Collection and Analysis: The vestibular evoked myogenic potential (VEMP) responses were recorded using tone burst (TB), click, and 500-Hz chirp stimuli. P1 and N1 latencies, amplitudes, asymmetry ratios, and thresholds were compared between groups. Statistical analyses were performed using appropriate parametric and nonparametric tests (p 0.05 significance level). Results: In the control group, 500-Hz chirp stimuli yielded significantly lower cVEMP and oVEMP thresholds and higher amplitudes compared with those yielded by other stimuli (p 0.05). In the VM group, click stimuli resulted in significantly shorter P1 and N1 latencies, higher thresholds, and lower amplitudes (p 0.05). Conclusions: Differences in VEMP responses in patients with VM suggest the potential involvement of sacculocollic and vestibuloocular reflex pathways. The 500-Hz chirp stimulus appears to be a sensitive tool for evaluating vestibular function. The VEMP amplitude and threshold parameters may assist in the differential diagnosis of VM. Clinical Relevance Statement: The elevated thresholds observed in the VM group across all stimuli during the cVEMP and oVEMP tests may serve as valuable tools that could help determine the differential diagnosis. The lower cVEMP amplitudes observed in the VM group across all stimuli as well as the prolonged wave latencies during the oVEMP tests with the 500-Hz TB and 500-Hz narrowband chirp stimuli suggest that the vestibulocollic reflex arc and vestibuloocular reflex arc may be affected at different levels in patients with VM.