Res Vestib Sci.  2021 Jun;20(2):51-57. 10.21790/rvs.2021.20.2.51.

Relationship between Chronological Orders of Symptoms and Vestibular Abnormality in Patients with Vestibular Migraine

  • 1Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea


Pathophysiology of vestibular migraine (VM) is still controversial. Vertigo may act as a trigger for migraine or there might other mechanisms which cause migraine and dizziness. VM patients have headaches and dizziness simultaneously or sequentially. Therefore, we hypothesized that the sequence of symptoms might suggest different mechanisms and compared the results of vestibular function tests (VFTs) according to chronological order of headache and vertigo.
Forty-two patients with VM were included. They were divided into three subgroups according to the chronological orders of headache and vertigo, and the results of VFTs and the symptomatic improvement were compared between each group.
Dizziness appeared first in 15 patients (35.7%), both symptoms appeared simultaneously in 20 patients (47.6%), and headaches appeared first in 7 (16.7%). There were no significant differences in symptom duration among the groups. Fourteen (33.3%) showed abnormal caloric results, 7 (16.7%) in head impulse test, 16 (38.1%, vestibular score) and 19 (45.2%, composite score) in sensory organizing test, and 13 (31.0%) in vestibular evoked myogenic potential test. Abnormal rate of the caloric test in the simultaneous group was significantly lower than those of the other two groups. Nineteen (45.2%) showed complete remission in 3 months after preventive medication with no significant difference between each group.
VM patients whose vertigo occurred with headache simultaneously showed lower incidence of caloric abnormality, suggesting that they have abnormality in central vestibular system rather than peripheral vestibular organs.


Migraine disorders; Head impulse test; Vertigo; Headache; Semicircular canals; 편두통; 두부충동검사; 현훈; 두통; 반고리뼈관
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