Background Vestibular migraine (VM) is a relatively recently acknowledged vestibular syndrome with a very relevant prevalence of about 10% among patients complaining of vertigo. The diagnostic criteria for VM have been recently published by the Barany Society, and they are now included in the latest version of the International Classification of Headache Disorders, yet there is no instrumental test that supports the diagnosis of VM. Objective In the hypothesis that the integration of different vestibular stimuli is functionally impaired in VM, we tested whether the combination of abrupt vestibular stimuli and full-field, moving visual stimuli would challenge vestibular migraine patients more than controls and other non-vestibular migraineurs. Methods In three clinical centers, we compared the performance in the functional head impulse test (fHIT) without and with an optokinetic stimulus rotating in the frontal plane in a group of 44 controls (Ctrl), a group of 42 patients with migraine (not vestibular migraine, MnoV), a group of 39 patients with vestibular migraine (VM) and a group of 15 patients with vestibular neuritis (VN). Results The optokinetic stimulation reduced the percentage of correct answers (Ê) in all groups, and in about 33% of the patients with migraine, in as many as 87% of VM patients and 60% of VN patients, this reduction was larger than expected from controls' data. Conclusions The comparison of the fHIT results without and with optokinetic stimulation unveils a functional vestibular impairment in VM that is not as large as the one detectable in VN, and that, in contrast with all the other patient groups, mainly impairs the capability to integrate different vestibular stimuli.
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