Medical Student University of California San Francisco, School of Medicine
Objective: Compare the characteristics of patients with vestibular migraine (VM) who had elevated visually enhanced vestibulo-ocular reflex (VVOR) to those of patients with VM who had normal/low VVOR.
Study Design: Retrospective chart review of 217 consecutive English-speaking adult patients between October 2016 and April 2019.
Setting: Tertiary referral center.
Patients:/ Retrospective cohort of 129 patients who had VVOR testing and a neurotology evaluation
Interventions: We reviewed patients’ symptom questionnaires, notes, and vestibular testing results.
Main Outcome Measures: We stratified VM patients by their VVOR results and compared demographics, triggers, associated symptoms, and vestibular test results.
Results: In a cohort of 217, 129 had VVOR testing. Of the 217, 101 patients (47%) had VM. Among 56 VM patients with VVOR testing, 22 patients (39%) had elevated VVOR. Elevated-VVOR VM patients were younger than those with normal/low VVOR (43 vs. 53, p=0.037). A higher proportion of elevated-VVOR VM patients had symptoms triggered by scrolling through a screen (23% vs. 3%, p=0.019). Elevated-VVOR VM patients experienced associated headache (62% vs. 32%, p=0.029) and showed caloric weakness (14% vs.42%, p=0.027) less frequently than normal/low-VVOR VM patients. There was no difference in dizziness handicap index (DHI) between the two groups (45 elevated-VVOR vs. 48 normal/low-VVOR, p>0.05).
Conclusions: Elevated-VVOR VM patients have an earlier onset of symptoms that are triggered more easily by scrolling on a screen than normal/low-VVOR VM patients. The differential rates of associated headaches and caloric weakness suggest that separate processes may mediate the two types of VM.
*Professional Practice Gap & Educational Need: Although VVOR elevation has been linked with VM, VVOR is not universally elevated in all VM patients. The field has a limited understanding of how elevated-VVOR VM patients may present differently from those with normal/low VVOR.
*Learning Objective: Describe the different presentations of VM depending on VVOR results.
*Desired Result: Clinicians will recognize that VVOR can provide an insight into how a particular patient’s VM may present.
*Level of Evidence: III
*Indicate IRB or IACUC: Approved 2/12/19, UCSF IRB 18-25365