Demographic data, clinical feature, and distribution of %CA for the three evaluated groups is reported in Table 1 (patients with VM), table II (patients with AUV) and table III (control group, normal subjects). The mean age of the AUV group (59,6 years, ranging from 39 to 78, 11 males and 9 females) was slightly higher than VM (53,4 years, ranging from 32 to 67, 15 females and 5 males). The control, group was constituted by 20 healthy subjects (10 males and 10 females, age ranging from 39 to 70, mean 53,8). Regarding the patients suffering from VM, the duration of symptoms was 9.8 ± 6.5 months (range 6–31). All the patients reported episodic attacks of rotational vertigo; 9 subjects suffered from chronic unsteadiness. 16 patients reported head motion intolerance and 20 suffered from motion sickness. Regarding the instrumental examination, we found a caloric hyperreflexia in 8 patients. Five patients showed a positional persistent nystagmus, in 1 case associated to the positivity of Head Shaking Test.
Table 1
Vestibular migraine group (VM): demographic data, clinical features, distribution of percentage of correct answers (%CA) on the left and on the right side, without and with confounding screen (CS), situational vertigo questionnaire (SVQ) score. EV = episodic vertigo; DIZZ = dizziness; MS = motion sickness; HMI = head motion intollerance; Hy = hyperreflexia; PosNy = positional persistent nystagmus.
Sex, Age
|
% CA on the left
|
% CA on the right
|
% CA on the left + CS
|
% CA on the right + CS
|
SVQ
|
Instrumental Signs
|
Symptoms
|
F, 41
|
100
|
85
|
80
|
100
|
28
|
PosNy; Hy
|
EV, Dizz, MS, HMI
|
F, 59
|
80
|
100
|
90
|
90
|
21
|
none
|
EV, MS
|
M, 43
|
95
|
90
|
70
|
94,4
|
32
|
Hy
|
EV, MS
|
F, 61
|
100
|
100
|
90
|
100
|
25
|
none
|
EV
|
F, 44
|
100
|
90
|
100
|
55,6
|
45
|
Hy
|
EV, MS, HMI
|
F, 63
|
100
|
100
|
65
|
76
|
34
|
PosNy
|
EV, Dizz, MS, HMI
|
F, 41
|
90
|
100
|
70
|
100
|
28
|
none
|
EV, Dizz, MS, HMI
|
F, 46
|
100
|
100
|
45
|
77,8
|
45
|
Hy
|
EV,MS, HMI
|
F, 69
|
85
|
80
|
40
|
20
|
56
|
Hy
|
EV, MS, HMI
|
F, 42
|
90
|
100
|
90
|
33,8
|
61
|
none
|
EV, Dizz, MS, HMI
|
M, 32
|
80
|
66,7
|
90
|
40
|
48
|
none
|
EV, MS, HMI
|
F, 44
|
100
|
90
|
75
|
90
|
32
|
PosNy
|
EV, Dizz
|
F, 55
|
90
|
100
|
100
|
81,8
|
29
|
none
|
EV, Dizz, MS, HMI
|
F, 51
|
75
|
100
|
100
|
72,7
|
45
|
none
|
EV, MS, HMI
|
M, 45
|
76,9
|
70
|
72
|
55,6
|
41
|
PosNy; HST+
|
EV, Dizz
|
M, 38
|
100
|
100
|
65
|
100
|
25
|
none
|
EV, MS, HMI
|
F, 62
|
80
|
100
|
65
|
82,4
|
39
|
Hy
|
EV, Dizz, MS, HMI
|
F, 47
|
100
|
90
|
80
|
22,2
|
51
|
none
|
EV, MS, HMI
|
F, 39
|
100
|
100
|
60
|
85
|
34
|
none
|
EV, Dizz
|
F, 38
|
90
|
100
|
80
|
66,7
|
52
|
Hy
|
EV, MS, HMI
|
F, 43
|
95
|
90
|
90
|
70
|
48
|
none
|
EV, MS
|
F, 57
|
70
|
100
|
50
|
80
|
46
|
Hy
|
EV, MS, HMI
|
M, 43
|
90
|
100
|
85
|
90
|
28
|
none
|
EV, MS
|
F, 68
|
90
|
100
|
25
|
70
|
60
|
Pos Ny
|
EV
|
F, 41
|
85
|
90
|
65
|
86,7
|
56
|
none
|
EV, MS, HMI
|
Mean
|
90,47
|
93,66
|
73,68
|
73,62
|
|
|
|
Table 2
Acute unilateral vestibulopathy group (AUV): demographic data, distribution of percentage of correct answers (%CA) on the left (L) and on the right side (R), without and with confounding screen (CS), situational vertigo questionnaire (SVQ) score, asymmetry index (AI) detectable at vHIT.
Sex, age
|
% correct answers on the left
|
% correct answers on the right
|
% correct answers on the left + CS
|
% correct answers on the right + CS
|
SVQ
|
VHIT (AI)
|
M, 52
|
60
|
100
|
40
|
80
|
28
|
66% L
|
M, 53
|
47,1
|
71,4
|
44,3
|
65,2
|
42
|
70% L
|
F, 42
|
50
|
90
|
45
|
83,4
|
39
|
28% L
|
M, 52
|
63,6
|
83,3
|
61,2
|
82,3
|
41
|
55% L
|
F, 53
|
70
|
90
|
20
|
41,7
|
43
|
30% L
|
F, 57
|
50
|
80
|
30
|
60
|
52
|
41% L
|
M, 42
|
60
|
90
|
40
|
70
|
28
|
66% L
|
F, 62
|
66,7
|
80
|
61,3
|
75,6
|
32
|
56% L
|
M, 47
|
30
|
90
|
20
|
75
|
37
|
28% L
|
F, 54
|
70
|
100
|
61,5
|
95
|
29
|
38% L
|
F, 38
|
22,2
|
63,6
|
19,5
|
55,9
|
53
|
22% L
|
Mean
|
53,6
|
85,3
|
40,3
|
71,3
|
|
|
F, 70
|
87,5
|
71,4
|
80,3
|
62
|
35
|
41% R
|
M, 51
|
88,9
|
40
|
88,9
|
39
|
32
|
31% R
|
M, 69
|
90
|
70
|
80
|
50
|
31
|
42% R
|
M, 59
|
40
|
12,5
|
35
|
10
|
51
|
47% R
|
F, 46
|
90
|
40
|
88
|
32,6
|
28
|
71% R
|
M, 78
|
80
|
50
|
75
|
41,9
|
32
|
45% R
|
M, 42
|
66,7
|
20
|
57,9
|
15,3
|
39
|
28% R
|
F, 39
|
100
|
44,4
|
95
|
36,9
|
44
|
62% R
|
M, 61
|
60
|
10
|
50
|
9
|
51
|
55% R
|
Mean
|
78,12
|
39,81
|
72,2
|
33,0
|
|
|
Table 3
Control group (CTRL): demographic data, distribution of percentage of correct answers (%CA) on the left and on the right side, without and with confounding screen (CS), situational vertigo questionnaire (SVQ) score
Sex, Age
|
% correct answer on the left
|
% correct answer on the right
|
% correct answer on the left + CS
|
% correct answer on the right + CS
|
SVQ
|
F, 45
|
100
|
100
|
100
|
100
|
0
|
M, 66
|
100
|
100
|
95
|
100
|
2
|
M, 48
|
100
|
100
|
95
|
95
|
3
|
F, 49
|
85
|
100
|
90
|
90
|
2
|
M, 70
|
90
|
100
|
100
|
90
|
5
|
M, 44
|
90
|
100
|
100
|
100
|
4
|
M, 68
|
100
|
100
|
90
|
100
|
7
|
M, 42
|
100
|
100
|
95
|
100
|
2
|
F, 50
|
100
|
90
|
90
|
100
|
4
|
M, 58
|
100
|
100
|
81,8
|
88,9
|
8
|
M, 63
|
100
|
100
|
90
|
90
|
7
|
F, 39
|
100
|
100
|
100
|
100
|
3
|
F, 66
|
100
|
90
|
95
|
90
|
10
|
F, 64
|
100
|
100
|
95
|
100
|
4
|
F, 54
|
100
|
100
|
100
|
95
|
7
|
F, 54
|
100
|
100
|
92,9
|
100
|
8
|
M, 65
|
100
|
100
|
94,5
|
95
|
7
|
F, 45
|
90
|
70
|
90
|
100
|
12
|
F, 39
|
100
|
100
|
100
|
90
|
6
|
M, 47
|
100
|
100
|
100
|
100
|
4
|
Mean
|
97,75
|
97,5
|
94,71
|
96,20
|
|
All the patients suffering from AUV, according with the initial diagnosis, showed a unilateral caloric weakness and a pathological Asymmetry Index on vHIT (11 case of left AUV and 9 cases of right AUV, in the text referred to as AUV-L and AUV-R respectively). Only two patients in the AUV group reported the presence of motion sickness.
In VM group the %CA at fHIT was 90,48% on the left side and 93,67% on the right side; with the confounding screen (optokinetic stimulation), the %CA fall at 73,69% on the left side and 73,63% on the right side (Fig. 1). Considering %CA on the left and on the right simultaneously, in VM groups the %CA at fHIT was 92,07% without CS and 73,66% with CS. A statistically significant difference has been found between %CA of VM group with and without CS (p < .001), between % CA of VM group without CS and CTRL group without CS (p < .01) and, mostly, between %CA of VM group with CS and CTRL with CS (p < .001). Meanwhile, no significant difference has been found between %CA of CTRL group with and without CS (Fig. 1).
The %CA in the AUV-R group was 78,12% on the left and 39,81% on the right without CS; with CS the %CA was 72,23% on the left and 32,97% on the right. In the AUV-L group the %CA without CS was 53,60% on the left and 85,30% on the right without CS; with CS the %CA was 40,25% on the left and 71,28% on the right. In the control group the %CA was 97,75% on the left and 97,5% on the right without CS and 94,71% on the left and 96,19% on the right with CS. No significant difference has been found between left and right %CA without and with CS, in between the VM and CTRL groups (Fig. 2). Furthermore, a significant difference has been found between %CA on the deficit side and the normal side in AUV-L and AUV-R groups, both without CS (p < .001 and p < .001, respectively) and with CS (p < .001 and p < .001, respectively). A significant difference has been found also in %CA in AUV-R and AUV-L on the normal and on the deficit side and %CA in CTRL group without CS (p < .05, p < .05 and p < .001, p < .001, respectively), and with CS (p < .01, p < .01 and p < .001, p < .001, respectively) (Fig. 2). The data relating to the tests between groups confirm the result of the analysis of variance which allows us to reject the null hypothesis that the subjects of the study are from the same population, but also allow us to say that the population of migraineurs and that of vestibular deficits are among them distinct (p < .001). Since the data are normally distributed, it is possible to establish limits of normality of the response (average plus twice the standard deviation): it therefore appears that if the absolute value of the difference of the errors with and without confounding screen (∆CS) exceeds 10,09, the answer is to be considered pathological.In the control group, only in three cases (out of 40) the absolute value of ∆CS is higher than 10,09 (7,5%). On the other hand, among patients with VM, 29 out of 50 are pathological (58%).Among patients with unilateral vestibular deficit, 10 out of 40 tests are pathological (25%).
The mean ∆CS value in VM group is 18,36. Then, ∆CS in CTRL group is 2,15. Finally, ∆CS in AUV group is 10,4 (Fig. 3). A statistically significant difference has been found between ∆CS in VM and CTRL groups (p < 0.001), and ∆CS in AUV and CTRL groups (p < 0.001). Further, a lower significant difference has been found between ∆CS in VM and AUV groups (p < 0.05) (Fig. 3).
Regarding the report of SVQ, the mean score of VM group is 40.36 (from 21.0 to 61.0); in the AUV the mean score is 38.35 (from 28.0 to 53.0); in the control group, instead, the mean score is 5.25 (from 0.0 to 12.0). The difference between groups is statistical significative (p < .001). A significant difference has been found between SVQ of VM and the AUV patients with the control group (p < .001 and p < .001, respectively). On the other hand, no significant differences have been found between VM and AUV at SVQ scores (p = 0.530). (Fig. 4).