Does VM cause vestibular damage?

Hi gang,

Some recent correspondence I’ve had with Prof Rauch triggered by a recent thread on the forum. Very interesting stuff. Again my thanks to him for always assisting us in his own time.

Scott 8)

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Question: Vestibular damage appears to have been reported in the literature as a possible outcome of migraine disease. I was wondering if this is something you’ve actually come across in your practice in migraine patients?

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Prof Steve Rauch: This is actually very common. Remember that approx 20-30% of patients with migraine headache exhibit VM. About 20% of VM patients develop hearing loss on one side – evidence of “endorgan damage” in the cochlea. Those patients with VM who mimic Meniere’s syndrome — episodic vertigo lasting 20 min-24 hrs plus hearing loss — nearly all gradually develop evidence of endorgan damage (a.k.a. “vestibular hypofunction”) in the form of reduced caloric response and/or reduced VOR gain and increased phase lead on rotation testing.

Some patients with VM who do not look like Meniere’s disease can also develop peripheral hypofunction, too. The challenge in studying and/or assessing this issue is that VM patients tend to have very labile vestibular function test results. In other vestibulopathies, we see test abnormalities on a vestibular test battery that “cluster” — peripheral disorders, such as Meniere’s, labyrinthitis, and vestibular neuritis, show peripheral hypofunction (reduced caloric response, direction changing paroxysmal positional nystagmus, reduced VOR gain and increased phase leads on rotation testing) and central nervous system disorders, such as stroke, cerebellar degeneration, and TBI, show central dysfunction (direction-fixed position-insensitive spnotaneous nystagmus, vertical nystagmus, poor optokinetic nystagmus, impaired fixation suppression, etc…).

The hallmark of VM is that the test abnormalities do not cluster well (i.e. there is a mix of peripheral and central findings) and there is poor test-retest stability (i.e. every time you repeat the test battery, you get different results). Since vestibular function testing makes migraineurs very ill, it is nearly impossible to test them at all, let alone repeatedly. However, in those with a lot of vertigo, repeat testing often shows a more and more persistent and worsening unilateral peripheral hypofunction in the symptomatic ear (same as we see in Meniere’s disease).

Thanks for posting this, Scott. Glad to see an expert’s answer to that question.

This was a good post. We have discussed at length in the past my vestibular damage and hypofunction. It seemed that my damage and VN came first before any type of VM or migraine symptoms. The question I have is, when I had my vestibular testing done all three times, I never had any bad experiences. In fact, I think it proved that my vestibular system and vestibular nerve were in fact completely dead on my right side (the damaged one) when I had the tests done, because I didn’t react at all during any of the tests (I didn’t show any dizziness at all, including when they did ice cold water). It seemed like once the damage was done that most of the migraine symptoms (mostly visual) seemed to creep up and I’ve been living with them 24/7 for over 3 years now with no let up along with remaining vestibular/dizziness/balance issues…

So what was the result again for response. Was it zero? I thought you had some function recorded.

I think it was 73% loss in the right ear. One test suggested 90%.

My testing showed about 75% loss in the right ear and 30% in the left. My ear fullness is always worse on the right, and I often have some right cheek tingling and numbness with ear ringing. Also, nystagmus is much worse on the right. Few episodes before having kids, really bad month after having first kid, and totally disabled after second kid (got husband fixed :). Anyway, the ENT (neurotologist) I saw diagnosed the vestibular loss but doesn’t want to believe it’s migraine. He says the cause of 50% of those with bilateral vestibular loss is idiopathic. The vestibular physical therapist had me try some balance exercises once my migraine was well controlled and confirmed that yeah, my balance still sucks - don’t need to bother retesting. My neurologist treats me for vestibular migraine, and my life is great.
What I mean to say is I think the migraine caused my vestibular damage. There’s no other reasonable explanation.

Many thanks, Scott, for this sticky and for all the other pieces you post; what a gold mine this site is!

One type of possible migraine damage I am curious about, and wonder if Dr. Rauch has any opinion/info on it, is brainstem evoked potentials. I know this is not normally tested in migraine or even in dizzy patients, but I wonder if he knows of any relationship between migraine and abnormal results on this test (called variously BAER, BAEP, ABR, etc.).