Video and Functional Head Impulse Test in Vestibular Migraine

Abstract

Introduction: Vestibular migraine is a disease characterised by spontaneous episodic vertigo and typical migraine symptoms and is estimated to occur in 9% of migraine patients. The video head impulse test (vHIT) assesses vestibulo-ocular reflex (VOR) gain and corrective saccades, while the functional head impulse test (fHIT) evaluates the ability to recognize visual stimuli during head movements. Aim of the study: This study aims to aims to evaluate the VOR functions using the video head impulse test and functional head impulse test in the vestibular migraine. Method: Forty patients in the age range of 18 to 50 years participated in the study. The participants were divided into two groups: Group 1 included twenty participants with vestibular migraine(4 males, 16 females, mean age: 29.5 years) and Group 2 included healthy participants age and gender matched to vestibular migraine participants. All the participants underwent a detailed audiological test battery followed by video head impulse test and functional head impulse test. Results: All healthy individuals demonstrated normal VOR gain values and absence of corrective saccades across all semicircular canals. There was no statistically significant differences found in mean VOR gain or functional head impulse test scores between healthy individuals and those with vestibular migraine. A few vestibular migraine participants had reduced VOR gain or corrective saccades in isolated canals, but none showed abnormalities across all canals. Both groups performed similarly on fHIT, with most individuals correctly identifying ≥8 optotypes. No significant correlation was found between VOR gain and fHIT scores in either Conclusions: Although individuals with vestibular migraine showed mean VOR gain values comparable to healthy controls, subtle abnormalities were noted in a few participants, including reduced gain in specific semicircular canals and presence of corrective saccades. fHIT scores was similar between groups, with no statistically significant difference in the number of correctly identified optotypes. No correlation was found between VOR gain and fHIT scores in either group. These findings suggest that while semicircular canal function may appear normal in vestibular migraine, subtle individual-level differences, particularly in the presence of corrective saccades, may indicate intermittent or localised vestibular dysfunction in a few individuals. fHIT and vHIT together may provide complementary insights into the functional impact of vestibular migraine. The absence of significant differences between groups highlights the challenge of diagnosing vestibular migraine based on objective vestibular tests alone. A multimodal assessment approach, including detailed patient history, symptom characterisation, and both vHIT and fHIT, remains essential.