Research in Vestibular Science

Review

Vestibular Migraine: A Recent Update on Diagnosis and Treatment: Young Seo Kim, Hak Seung Lee; Res Vestib Sci. 2022;21(3):67-74. Published online September 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.3.67

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Abstract PDF: Vestibular migraine (VM) is a variant of migraine resulting in vestibular symptoms in addition to symptoms typical of migraine. However, without a biomarker or a complete understanding of the pathophysiology, VM remains underrecognized and underdiagnosed. Therefore, the diagnosis of VM is still challenging. Meanwhile, VM should be clearly differentiated from other similar diseases. Here, we highlight these challenges, discuss common vestibular symptoms and clinical presentations in VM, and review the current aspects of its clinical diagnosis and evaluation. The concepts related to the treatment of VM are also discussed.

Original Article

Relationship between Chronological Orders of Symptoms and Vestibular Abnormality in Patients with Vestibular Migraine: Sae Eun YI, Jun Woo Park, Jang Wook Kwak, Yeonjoo Choi, Sang Hun Lee, Seung Cheol Ha, Hong Ju Park; Res Vestib Sci. 2021;20(2):51-57. Published online June 14, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.2.51

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Abstract PDF: Objectives
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.
Methods
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.
Results
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.
Conclusions
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.

Case Reports

Nystagmus in Intracranial Vertebral Artery Dissection Caused by Golf Swing: Jin Woo Choi, Yeonsil Moon, Jung Eun Shin, Chang-Hee Kim; Res Vestib Sci. 2021;20(1):28-32. Published online March 11, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.1.28

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Abstract PDF Supplementary Material: Vertebral artery dissection (VAD) during a golf swing is extremely rare. Golfrelated VAD has been reported to occur more commonly at extracranial segments on the right side. In the present study, we report a 57-year-old, right-handed, female amateur golfer with golf-related VAD which developed at the intracranial segment (V4) of the left vertebral artery. The patient complained of sudden vertigo with nausea and vomiting, and aggravation of the left tinnitus. Video oculography showed very weakly left- and upbeating spontaneous nystagmus. The intensity of nystagmus was increased by positioning such as bowing, lying down or right head-rolling. The patient was treated with oral aspirin, and complete recanalization of the left vertebral artery was observed in a follow-up imaging study.

Anti-GQ1b Antibody Syndrome Presenting with Severe Headache: Seo-Young Choi, Kyeung-Hae Kim, Jong Kuk Kim, Nam Jun Kim, Young Hee Kim, Kwang-Dong Choi; Res Vestib Sci. 2020;19(4):141-143. Published online December 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.4.141

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Abstract PDF: Anti-GQ1b antibody syndrome, including Miller Fisher syndrome, Guillain-Barré syndrome with ophthalmoplegia, Bickerstaff’s brainstem encephalitis, and acute ophthalmoplegia without ataxia, has overlapped clinical symptoms and mostly associated with anti-GQ1b immunoglobulin (Ig) G antibody. We report two cases of anti-GQ1b antibody syndrome mainly presenting with a severe headache. The 60-year-old man was admitted for severe headache and gait disturbance. Neurological examination revealed limb and truncal ataxia, areflexia, nystagmus, and ophthalmoplegia. Serum IgG anti-GQ1b antibody was positive. He recovered after intravenous (IV) immunoglobulin and steroid. The 23-year-old man suffered from severe headache (visual analogue scale=10) within the periorbital area. Ophthalmoplegia with gaze-evoked nystagmus were revealed. Serum IgG anti-GQ1b and anti-GT1a antibodies were positive. Headache was improved by IV immunoglobulin and steroid. The pathophysiology of headache in anti-GQ1b antibody syndrome is largely unknown. The affected nerve or structures in the brainstem including the trigeminovascular system may induce intractable severe headache.

Delayed Audio-Vestibular Symptoms in Spontaneous Intracranial Hypotension: Han-Sol Choi, Jae-Myung Kim, Hong Chan Kim, Hyong-Ho Cho, Seung-Han Lee; Res Vestib Sci. 2020;19(1):29-33. Published online March 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.1.29

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Abstract PDF: Intracranial hypotension (IH) is a neurological disorder characterized by orthostatic headache due to cerebrospinal fluid (CSF) volume depletion. IH usually results from CSF leak caused by either spontaneous or traumatic dural injury and may also present nausea, neck stiffness, tinnitus or dizziness. We experienced a 52-year-old woman presenting with acute spontaneous vertigo, tinnitus and hearing impairment on both ears with right side predominancy which mimicked Meniere’s disease. Video-oculography revealed spontaneous left-beating nystagmus which was modulated by position change. There was binaural low-frequency sensorineural hearing loss (SNHL) in pure tone audiometry. Other neuro-otologic evaluations including caloric test, vestibular evoked myogenic potential, video head impulse tests were unremarkable. Of interest, she had been treated of orthostatic headache due to spontaneous IH 10 days before admission. Taken together the clinical and laboratory findings, audio-vestibular symptoms of the patient were thought to be related with insufficient treatment of IH. After massive hydration and bed rest, her symptoms were markedly improved and SNHL was also disappeared in the follow-up pure tone audiometry. IH should be considered as a differential diagnosis in dizzy patient with tinnitus, hearing impairment even the typical orthostatic headache is not accompanied.

Arnold-Chiari Type 1 Malformation Mimicking Benign Paroxysmal Positional Vertigo: Young Chul Kim, Chae Dong Yim, Hyun Jin Lee, Dong Gu Hur, Seong Ki Ahn; Res Vestib Sci. 2019;18(3):87-90. Published online September 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.3.87

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Abstract PDF: Arnold-Chiari malformation type 1 is a congenital disease characterized by herniation of the cerebellar tonsils through the foramen magnum. Most common clinical symptom is pain, including occipital headache and neck pain, upper limb pain exacerbated by physical activity or valsalva maneuvers. Various otoneurological manifestations also occur in patients with the disease, which has usually associated with dizziness, vomiting, dysphagia, poor hand coordination, unsteady gait, numbness. Patients with Arnold-Chiari malformation may develop vertigo after spending some time with their head inclined on their trunk. Positional and down-beating nystagmus are common forms of nystagmus in them. We experienced a 12-year-old female who presented complaining of vertigo related to changes in head position which was initially misdiagnosed as a benign paroxysmal positional vertigo.

Symposium I

History Taking of Headache Patients: Byung Kun Kim; Res Vestib Sci. 2013;12:S11-S15. Published online June 1, 2013

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Abstract PDF: Headache is a most common complaint in neurological outpatient clinic. It has diverse underlying causes and numerous patterns of presentation. All headaches can be divided into primary and secondary headaches. More than ninety percent of headaches seen in clinical practice are due to primary headaches-most of them are tension type headache or migraine-where there are no confirmatory tests. A comprehensive history taking is critical for the correct diagnosis. Headache history taking is an art that needs constant practice. This review aims to discuss the way to go about taking a quick and correct history in headache patients.

Original Article

Clinical Manifestations of Headache in Meniere’s Disease: Jae Ho Ban, Hyun Jin Choi, Seung Suk Lee, Su Mi Kim, No Hee Lee, Hee Jun Kwon, Jong Kyu Lee; J Korean Bal Soc. 2007;6(2):181-185.

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Abstract PDF: Background and Objectives: A possible link between Meniere’s disease (MD) and headache was originally suggested by Prosper Meniere. We aimed to analyze the clinical manifestation of headache in definite MD compared with benign paroxysmal positional vertigo (BPPV) as a control group. Materials and Methods: We examined headache in 67 patients with definite MD according to the criteria of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). Sex- and age-matched 67 patients with BPPV served as a control group. Information was obtained concerning the prevalence, localization, severity, character, sequence of headache and response to therapy. Results: Altogether 60 MD patients (90%) and 47 BPPV patients (70%) was reply the questionnaire. 46 MD patients (69%) and 15 BPPV patients (22%) reported headache. Headache was moderate to severe in 39 MD patients (85%) and as a whole more severe than that of the BPPV patients (P<0.05). Temporal area was the most frequently involved region in MD group, whereas posterior neck area was most frequent in BPPV group. The sequence of headache and vertigo attack was pre-(23%), intra-(33%), after-(44%). The 39 patients (89%) of headache in MD was response to the vestibular suppressants, diuretics, calcium channel blocker. Conclusion: It is concluded that high incidence of headache and migraine in combination with MD seems to common pathophysiology with migraine. Therefore, our results could provide predictive value in the treatment and follow up of MD patients with headache.

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