Abnormal visuo-vestibular interactions in vestibular migraine: a cross sectional study

• Published in: Brain (London, England : 1878) Vol. 142; no. 3; pp. 606 - 616
• Main Authors: Bednarczuk, Nadja F, Bonsu, Angela, Ortega, Marta Casanovas, Fluri, Anne-Sophie, Chan, John, Rust, Heiko, de Melo, Fabiano, Sharif, Mishaal, Seemungal, Barry M, Golding, John F, Kaski, Diego, Bronstein, Adolfo M, Arshad, Qadeer
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.03.2019
• Subjects: Adult; Cross-Sectional Studies; Dizziness - physiopathology; Female; Humans; Male; Middle Aged; Migraine Disorders - physiopathology; Motion; Original; Reflex, Vestibulo-Ocular - physiology; Vertigo; Vestibular Diseases - physiopathology; Vestibular Function Tests; Vestibular Neuronitis - physiopathology; Vestibule, Labyrinth; Visual Perception - physiology; visuo-vestibular interaction; vestibular migraine; vestibular thresholds; visual motion adaptation
• ISSN: 0006-8950; 1460-2156
• DOI: 10.1093/brain/awy355

Vestibular migraine is amongst the commonest causes of vertigo, but the regions underlying the development of symptoms including enhanced self-motion sensitivity and visually induced dizziness remain unknown. Bednarczuk et al. provide evidence for an abnormal interaction between visual and vestibular cortical regions in vestibular migraine. Abstract Vestibular migraine is among the commonest causes of episodic vertigo. Chronically, patients with vestibular migraine develop abnormal responsiveness to both vestibular and visual stimuli characterized by heightened self-motion sensitivity and visually-induced dizziness. Yet, the neural mechanisms mediating such symptoms remain unknown. We postulate that such symptoms are attributable to impaired visuo-vestibular cortical interactions, which in turn disrupts normal vestibular function. To assess this, we investigated whether prolonged, full-field visual motion exposure, which has been previously shown to modulate visual cortical excitability in both healthy individuals and avestibular patients, could disrupt vestibular ocular reflex and vestibular-perceptual thresholds of self-motion during rotations. Our findings reveal that vestibular migraine patients exhibited abnormally elevated reflexive and perceptual vestibular thresholds at baseline. Following visual motion exposure, both reflex and perceptual thresholds were significantly further increased in vestibular migraine patients relative to healthy controls, migraineurs without vestibular symptoms and patients with episodic vertigo due to a peripheral inner-ear disorder. Our results provide support for the notion of altered visuo-vestibular cortical interactions in vestibular migraine, as evidenced by vestibular threshold elevation following visual motion exposure.