ArticleJournal of clinical neurology (Seoul, Korea)2026
Clinical Heterogeneity in Vestibular Migraine Diagnosed Using Bárány Society Criteria: Differences According to Caloric-Test-Based Evidence of Peripheral Vestibular Dysfunction.
Article in Journal of clinical neurology (Seoul, Korea), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
background and purposeVestibular migraine (VM) is a common cause of episodic vertigo with heterogeneous presentations. Some VM patients show caloric abnormalities suggestive of peripheral vestibular dysfunction (PVD). This study compared clinical symptoms and vestibulo-ocular function between VM patients with caloric canal paresis (CP) >25% (VM-CP+), which was used as an operational definition of evidence of PVD, and those without caloric CP >25% (VM-CP-).
methodsWe enrolled 181 patients diagnosed with VM according to the Bárány Society criteria: 47 in the VM-CP+ group and 134 in the VM-CP- group. All patients underwent videonystagmography and caloric testing, while the video head impulse test (vHIT), vestibular-evoked myogenic potential (VEMP) measurements, and subjective visual horizontal (SVH) and subjective visual vertical (SVV) assessments were performed in available subsets.
resultsCompared with VM-CP- patients, those with VM-CP+ showed higher frequencies of external vertigo, rotational vertigo, spontaneous nystagmus, unidirectional horizontal positional nystagmus, horizontal head-shaking nystagmus, abnormal cervical VEMPs, and abnormal upright SVH/SVV. The vHIT findings were abnormal only in VM-CP+ patients with available data. Conversely, a history of motion sickness and a family history of migraine were more common in VM-CP-. Multivariable regression showed that rotational vertigo, external vertigo, and unidirectional horizontal positional nystagmus were independently associated with VM-CP+, whereas a history of motion sickness and a family history of migraine were negatively associated with VM-CP+.
conclusionsVM-CP+ and VM-CP- patients showed different clinical and vestibulo-ocular patterns, suggesting the presence of clinical heterogeneity within VM. VM-CP+ patients may show a phenotype related to peripheral vestibular asymmetry. Whether this reflects a comorbid or additive effect of migraine and PVD or a migraine-related functional state should be investigated in future prospective studies.
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