Abstract 240, Date 1:00 PM, Sunday February 22, 2004 (24 hours) Session D4:Vestibular: Clinical
Pathophysiology of Migraine-Related Dizziness
Joseph M. Furman, Dawn A. Marcus, Patrick J. Sparto, Mark S. Redfern, J. Richard Jennings
The pathophysiological basis for migraine-related dizziness is unknown but may relate to both central and peripheral vestibular abnormalities. The present study was undertaken to explore several potential abnormalities in migraine-related dizziness by assessing vestibulo-ocular function, vestibulo-spinal function, visual-postural responses, spatial orientation, and attention-balance interference in well-defined patients. Subjects included headache-free controls (C), subjects who met the International Headache Society (IHS) criteria for migraine but who had no symptoms suggestive of a vestibular system abnormality (M-V), and subjects who met both IHS criteria for migraine and the Neuhauser criteria for migraine-related vestibulopathy (M+V). Subjects with recognized neurotologic syndromes such as Meniere's disease were excluded from all groups. For each experimental paradigm, five subjects from each group were tested. Abnormalities in M+V subjects included: decreased VOR gain, increased sway on both Equitest platform posturography and in response to optic flow in an immersive virtual environment, slowed reaction time on dual tasks of interference between attentional processes and the VOR, and excessive visual dependence of subjective visual vertical. Taken together, these results suggest that patients with migraine-related dizziness manifest abnormalities in vestibular function and are more visually dependent than persons with migraine without vertigo or headache-free controls. The basis for these group differences is uncertain but may relate to serotonergic mechanisms in the central vestibular system.       This study was supported by the National Headache Foundation, Merck & Company, the Eye and Ear Foundation, and the Raymond & Elizabeth Bloch Charitable and Educational Foundation.