title: Prognostic significance of vestibulospinal abnormalities in patients with vestibular migraine.
abstract: OBJECTIVE
  We evaluated vestibular function test results in vestibular migraine (VM) patients, including caloric, vestibular evoked myogenic potential (VEMP), and dynamic posturography measurements and assessed their relationship with treatment responses.
  
  
  METHODS
  Retrospective case series review.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  We investigated a cohort of 80 VM patients who had suffered recurrent vertigo attacks for more than 6 months. A combination of lifestyle modifications and prophylactic medications were used to treat these subjects. The patients were asked to score the treatment success by ranking symptom score from 0% to 100% for the improvement in overall severity of headache and vertigo. Patients were then classified as complete remission, symptomatic improvement 50% or more, or less than 50% improvement after 6 months of treatment. The periods needed for symptomatic improvement in the 50% or more patient group were recorded, and the responsiveness to medications and the vestibular test result metrics were analyzed to identify clinical outcome predictors.
  
  
  RESULTS
  A symptomatic improvement of 50% or more in vertigo and headache was observed in 71% and 75% of the study subjects across mean periods of 2.3 and 2.2 months, respectively. Improvements in vertigo and headache did not coincide in all. Abnormal caloric, VEMP, and vestibular ratio measurements were found in 25%, 29%, and 58%, respectively. Abnormal vestibular ratios on posturography showed a significant correlation with a poor treatment response of vertigo, and a normal VEMP was significantly related to complete remission from headache, although abnormal caloric results showed no significant correlation with treatment responses. A poor response of vertigo symptoms was observed in 6% of patients with a normal vestibular ratio and 48% of patients with abnormal vestibular ratio. Complete remission from headache was observed in 61% of patients with a normal VEMP and 30% in patients with an abnormal VEMP.
  
  
  CONCLUSIONS
  More than 70% of the patients with VM experienced improvements in both headache and vertigo through a combination of lifestyle changes and prophylactic medications. Abnormal vestibular ratios on posturography and abnormal VEMP responses were frequent findings in VM patients with recurrent attacks for more than 6 months and were indicators of a poor prognosis. The pathophysiology of VM appears to be closely related to vestibular abnormalities, especially in vestibulospinal pathways. Further study with a large population is needed to establish the relationship exactly.
  
  
  METHODS
  2b Individual retrospective cohort study.
authors.affiliation: *Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul; and †Department of Otolaryngology, Jeju National University, Jeju, Republic of Korea.
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Jung
authors.forename: Myung Hoon
authors.initials: MH
authors.lastname: Yoo
authors.forename: Chan Il
authors.initials: CI
authors.lastname: Song
authors.forename: Jae Ryung
authors.initials: JR
authors.lastname: Lee
authors.forename: Hong Ju
authors.initials: HJ
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis* / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies; D014717:Vertigo / Q000175:diagnosis* / Q000503:physiopathology; D015837:Vestibular Diseases / Q000175:diagnosis* / Q000503:physiopathology; D058585:Vestibular Evoked Myogenic Potentials / Q000502:physiology; D014724:Vestibular Function Tests / Q000379:methods*; D014722:Vestibule, Labyrinth / Q000503:physiopathology*; D055815:Young Adult