Background Vestibular symptoms are a frequent and disabling manifestation of migraine, yet their underlying pathophysiology remains incompletely understood. Although subtle vestibular abnormalities have been described, their clinical relevance and relationship with dizziness-related disability in migraine are still unclear. Methods In this cross-sectional study, consecutive participants with episodic migraine (EM) or chronic migraine (CM) and vestibular symptoms, as well as healthy controls (HC), were recruited. All subjects underwent a standardized bedside vestibular examination and video head impulse testing (vHIT). Vestibulo-ocular reflex (VOR) gain was measured bilaterally, and gain asymmetry was calculated as a continuous variable. Vestibular-related disability was assessed using the Dizziness Handicap Inventory (DHI). Between-group comparisons were performed, and correlations between vHIT asymmetry and DHI scores were explored within the migraine group. Results A total of 101 participants were included (30 HC, 30 EM, and 41 CM). Median vHIT gain asymmetry was comparable between groups (HC: 3.75% IQR 2.58–5.70; EM: 3.26% 2.37–5.57; CM: 3.16% 1.35–5.05; p = 0.514), with no significant differences in VOR gain. Within the migraine population, greater vHIT asymmetry was weakly but significantly associated with higher dizziness-related disability (Spearman's ρ = 0.274, p = 0.021), despite asymmetry values remaining within normative ranges. Conclusions Peripheral vestibular function, as assessed by vHIT, appears preserved in migraine. However, subtle vestibular asymmetry which is clinically silent in healthy individuals may contribute to dizziness-related disability in migraine, likely reflecting altered central sensory processing rather than peripheral vestibular dysfunction.
Jaimes et al. (Wed,) studied this question.