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 Table of Contents  
Year : 2022  |  Volume : 20  |  Issue : 1  |  Page : 154-157

Comparison between video head impulse and videonystagmography in patients with vertiginous migraine

1 Audiovestibular Medicine, ENT Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
2 Audiovestibular Medicine, ENT Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
3 Neuropsychiatry Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt

Date of Submission29-Dec-2021
Date of Decision08-Jan-2022
Date of Acceptance10-Jan-2022
Date of Web Publication4-Mar-2022

Correspondence Address:
MSc Waleed M.N Mohamed
Audiovestibular Medicine, ENT Department, Assiut, Postal Code 71524
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/azmj.azmj_147_21

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Background and aim In addition to the classic migraine symptoms of vertigo, dizziness, and imbalance, vestibular migraine causes vertigo, dizziness, and imbalance. The video head impulse test (VHIT) is a novel approach for determining the function of each semicircular canal. Although videonystagmography (VNG) is an effective tool for identifying peripheral vertigo, not all patients with central vertigo can be easily detected. The goal of this research is to confirm the findings of the functional outcome of VHIT versus VNG in patients with vertiginous migraine.
Patients and methods We selected 40 patients (both sexes) with vestibular migraine and 25 normal individuals as control. Both groups were subjected to complete clinical examination after thorough history taking, laboratory investigations, VHIT, and VNG.
Results VNG had excellent predictive value in the patients’ group (95% confidence interval=0.891–0.998, P=0.0001) with a 96.6% sensitivity and 86.2% specificity, while VHIT had poor predictive value with a sensitivity of 100% and specificity of 48.1% (95% confidence interval=0.523–0.779, P=0.099).
Conclusion VNG has a specificity and sensitivity for the prognosis of vestibular migraine that is virtually identical to VHIT.

Keywords: vestibular migraine, video head impulse test, videonystagmography

How to cite this article:
Mohamed WM, Elzaree GA, Hassan MM, Mohamed AM. Comparison between video head impulse and videonystagmography in patients with vertiginous migraine. Al-Azhar Assiut Med J 2022;20:154-7

How to cite this URL:
Mohamed WM, Elzaree GA, Hassan MM, Mohamed AM. Comparison between video head impulse and videonystagmography in patients with vertiginous migraine. Al-Azhar Assiut Med J [serial online] 2022 [cited 2022 Jun 29];20:154-7. Available from: http://www.azmj.eg.net/text.asp?2022/20/1/154/339068

  Introduction Top

Women are 1.5–5 times more likely than men to suffer from vestibular migraine, and it can strike at any age; the average age of onset for females was 37.7 and 42.4 years for males. Vestibular migraine has also been linked to familial clustering, an autosomal-dominant inheritance pattern, and lower penetrance in men. Before experiencing vestibular attacks, the majority of people with vestibular migraine suffer from migrainous headaches [1].

To diagnose vestibular migraine, researchers looked for at least five cases of moderate or severe vestibular symptoms spending 5 min to 72 h, a present or prior migraine history with or without aura as per the International Classification of Headache Disorders, and a headache with at least two of the accompanying features − visual aura, photophobia, and phonophobia − one-sidedness, moderate or severe pain intensity, pulsating quality, and exacerbation by normal physical action [2].

The most frequent diagnostic methods are videonystagmography (VNG) and electronystagmography, which allow for the identification of vertigo or balance disorders by detecting nystagmus, a key diagnostic sign. They cannot be utilized as the sole examination to determine a diagnosis because they do not provide answers to all queries [3].

Recently, availability of new video-based clinical tools that allow the eye to enroll unpredicted head compulsions and initiates the accomplishment of the scleral search coil in a magnetic field installation has risen [4]. The vestibulo-ocular reflex gain may be evaluated and eventual refixation saccades can be recorded utilizing high-velocity (>150 o/s) and acceleration stimulations (head impulses) with this video head impulse test (VHIT) device (1–16 Hz). This system is good, not only in for initial evaluation but also for follow up, as confirmed in MD patients [5].

As a result, the goal of this study was to contrast the functional outcomes of VHIT and VNG in individuals with vertiginous migraine.

  Patients and methods Top

This study was performed in Audio-vestibular Unit, ENT Department in Assiut Hospital, Faculty of Medicine, Al-Azhar University between January 2019 and December 2021 The Al-Azhar University, Faculty of Medicine’s Ethics Committee authorized the study procedures. The study is approved by the ethics committee of Al-Azhar University, informed consent was obtained fro each participant. The study is conducted in accordance with Helsinki’s standards 2013.

This study included 40 patients (both sexes) with vestibular migraine and 25 normal individuals as control. Inclusion criteria: we included 40 Egyptian patients known to have vertiginous migraine and 25 normal Egyptian individuals of the same age group as a control. Exclusion criteria: patients with central pathology other than migraine were excluded.

Both groups were subjected to: all patients were provided a full clinical history before having an otorhinolaryngological and neurological investigation by the same physician. Following that, all patients received caloric testing, pure tone audiometry, and VHIT on the same day.

The ICS impulse system (three-dimensional VHIT system) was used to record the VHIT, and the Chartr 200 VNG/ENG system was used to perform the VNG.

Statistical analysis

In Social Sciences (SPSS, version 24.0) for Windows, Student’s t test, analysis of variance, with the Tukey–Kramer test as a post-hoc test in multiple groups, the two test or Fisher’s exact test, receiver-operating characteristic curves, and Spearman’s rank correlation coefficient (r) were used to analyze data (SPSS IBM, Chicago, Illinois, USA).

  Results Top

This prospective comparative observational case–control study was conducted in the Audio-vestibular Unit, ENT Department in Assiut Hospital, Faculty of Medicine, Al-Azhar University on 40 adult participants with vestibular migraine and 25 controls. [Table 1] indicates that there was no statistical difference regarding age with P value of 0.188 with the mean age in patients being 31.7 years and in control being 33.8 years. There was no statistical difference as per sex with P value of 0.465.
Table 1 Characteristics of patients in both study groups

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[Table 2] shows that there were 24 (60%) patients with spontaneous vertigo, seven (17.5%) with positional vertigo, five (12.5%) with head motion-induced vertigo, and four (10) with unsteadiness.
Table 2 Distribution of the studied cases according to vestibular symptoms

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[Table 3] shows that the headache lasted less than 1 min in one (2.5%) case, 1 min to less than 1 h in 16 (40%) individuals, 1 h to less than 24 h in 20 (50%) individuals, and more than 24 h in three (7.5%) individuals.
Table 3 Distribution of the studied cases according to the duration of episodes of headache

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[Table 4] shows that with a P value of 0.018, the VNG test had a significantly higher anomalous frequency than the VHIT.
Table 4 Abnormality rates in vestibular migraine patients compared with canal tests (video head impulse test and videonystagmography tests)

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[Table 5] shows specificity and sensitivity of VNG and VHIT for the prognosis of vestibular migraine in individuals. To begin, VNG found that the patient’s group had outstanding predictive value [95% confidence interval (CI)=0.891–0.998, P=0.0001], with a sensitivity of 96.6% and a specificity of 86.2%. Finally, VHIT had a poor value for prediction (95% CI=0.523–0.779, P=0.099) with a sensitivity of 100% and specificity of 48.1%, according to VHIT.
Table 5 Receiver-operating characteristic curve analysis for the videonystagmography and video head impulse test

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  Discussion Top

In vestibular migraine, occurrences can last anywhere from seconds to days, though they usually last minutes to hours. The majority of vestibular migraine patients in our study said it usually lasts anywhere from minutes to hours. This is in line with prior findings by Stolte et al. [6].

Regarding migraine signs and symptoms, one or even more migraine features, those vary as one-sided location 33 (82.5%), moderate or severe pain intensity 24 (60%), pulsating quality 20 (50%), aggravation by routine physical action 16 (40%), photophobia 16 (40%), and phonophobia 17 (40%) are associated with at least 50% of vestibular occurrences (17.5%), nausea 23 (57.5%), and vomiting three (7.5%) (42.5%), or visual aura seven, as discovered by Fu et al. [7], who discovered that one or even more migraine signs, one-sided location 32 (78%), moderate or severe intensity of pain 28 (68%), exacerbation by ordinary physical action 17 (42%), pulsing quality, 23 (56%), photophobia 16 (39%t), phonophobia 18 (44%), or visual aura seven are all present in at least 50% of vestibular occurrences (17%).

Regarding headache localization, the most common sites were the back of the head on the right or left side (60%) and the back of the head on both sides (23%) (57.5%) while in the study by Teggi et al. [8], the most common side was both the temporal regions in 68 (24.4%) cases.

In this study, tinnitus and hearing impairment were noted by 20 (50%) and 16 (40%) of the patients, respectively, and this was reported to be linked to the findings of Fu et al. [7], who discovered that tinnitus and hearing loss were revealed by 20 (49%) and 16 (39%) of the individuals, consecutively. The individuals’ number with auditory symptoms is expected to more than double as vestibular migraine progresses, as per findings [9]. Hearing loss, on the other hand, does not advance to the point where it is irreversible [10]. Hazzaa and El Mowafy [11] found that three patients were determined to have hearing loss, with bilateral mild high-frequency sensorineural hearing loss as their audiometric configuration.

In our study, there were 32.5% of the studied cases who had abnormal VHIT, which agree with Fu et al. [7], who found that abnormal results were observed in 13 (32%) cases of VHIT.

In this study, there were 57.5% of the studied cases who had unusual VNG and in the study by Awadie et al. [12], the caloric test was done which was significantly lateralized in 22 (37%) patients according to VNG.

In this study, the unusual rate of caloric evaluation was significantly greater than that of the VHIT, with P value of 0.018, which is consistent with the Fu et al. [7] finding that the caloric irrigation test had a much higher abnormal rate than the VHIT. It suggests that in vestibular migraine patients, low-frequency semicircular canal function is impaired. The findings of our investigation are also consistent with recent reports by Yoo et al. [13].

In this study, the mean spontaneous nystagmus in vestibular migraine patients was substantially greater than in healthy persons (P=0.007), confirming the findings of Lotfi et al. [14]. The results of this study’s spontaneous nystagmus test are similar to those of Neugebauer et al. [15].

In the caloric test, there was no statistically significant difference between the two groups in unilateral inadequacies, directional preponderance, or visual fixation index (P>0.05), which is consistent with the Lotfi et al. [14] findings.

As regards VHIT, VHIT had poor predictive value (95% CI=0.523–0.779, P=0.099) with a sensitivity of 100% and specificity of 48.1%, while in the study by Eza-Nuñez et al. [16], the VHIT had a sensitivity of 59% (95% CI=43.7–71.5%), specificity of 66.1% (95% CI= 53–77%), positive predictive value of 62.1% (95% CI=49.3–73.8%), and a negative predictive value of 62% (95% CI=49.3–75.6%). In another study, Awadie et al. [12] found that the VHIT had a 41% sensitivity and an 81% specificity as a predictor of significant caloric test lateralization.

Using the receiver-operating characteristic curve, the VHIT diagnostic value (VHIT Ulmer; Synapsys; Marseille, France) was compared with that of caloric testing by Bartolomeo et al. [17]. They discovered that canal paresis of more than 62.5% had a sensitivity of 100%, and caloric lateralization of less than 40% had a specificity of 100%. For 30% lateralization, however, the sensitivity was just 69%.

  Conclusion Top

In controlled vestibular migraine patients, abnormal vestibular and oculomotor function is common, which means that collecting a thorough history and analyzing aural symptoms aid in the differential diagnosis and is linked to the severity of sickness. In comparison to VHIT, VNG has a nearly identical specificity and sensitivity for vestibular migraine diagnosis. So, we recommend that further research is needed to study the otolith function by VMIP with long-term follow- up of the cases.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Sohn JH. Recent advances in the understanding of vestibular migraine. Behav Neurol 2016; 2016:1801845.  Back to cited text no. 1
Lempert T, Olesen J, Furman J, Waterston J, Seemungal B, Carey J et al. Vestibular migraine: diagnostic criteria. J Vestib Res 2012; 22:167–172.  Back to cited text no. 2
Renata P, Agata PD, Małgorzata Ś, Wiesław K. Application of the video head impulse test in the diagnostics of the balance system in children. Pol Otorhinol Rev 2015; 4:6–11.  Back to cited text no. 3
Blödow A, Pannasch S, Walther LE. Detection of isolated covert saccades with the video head impulse test in peripheral vestibular disorders. Auris Nasus Larynx 2013; 40:348–351.  Back to cited text no. 4
Manzari L, Burgess AM, MacDougall HG, Bradshaw AP, Curthoys IS. Rapid fluctuations in dynamic semicircular canal function in early Méniere’s disease. Eur Arch Otorhinolaryngol 2011; 268:637–639.  Back to cited text no. 5
Stolte B, Holle D, Naegel S, Diener HC, Obermann M. Vestibular migraine. Cephalalgia 2015; 35:262–270.  Back to cited text no. 6
Fu W, Han J, He F, Bai Y, Wei D, Chang N et al. Assessment of vestibular and oculomotor function in patients with vestibular migraine: a preliminary study. Research Square; 2020. DOI: 10.21203/rs.3.rs-31023/v1  Back to cited text no. 7
Teggi R, Colombo B, Albera R, Asprella Libonati G, Balzanelli C, Batuecas Caletrio A et al. Clinical features of headache in patients with diagnosis of definite vestibular migraine: the VM-phenotypes projects. Front Neurol 2018; 9:395.  Back to cited text no. 8
Radtke A, von Brevern M, Neuhauser H, Hottenrott T, Lempert T. Vestibular migraine: long-term follow-up of clinical symptoms and vestibulo-cochlear findings. Neurology 2012; 79:1607–1614.  Back to cited text no. 9
Radtke A, Neuhauser H, von Brevern M, Hottenrott T, Lempert T. Vestibular migraine − validity of clinical diagnostic criteria. Cephalalgia 2011; 31:906–913.  Back to cited text no. 10
Hazzaa N, El Mowafy SSJEJoE. Nose, Throat, Sciences A. Clinical features of vestibular migraine in Egypt. 2016; 17:17–21.  Back to cited text no. 11
Awadie A, Holdstein Y, Kaminer M, Shupak A. The head impulse test as a predictor of videonystagmography caloric test lateralization according to the level of examiner experience: a prospective open-label study. Ear Nose Throat J 2018; 97:16–23.  Back to cited text no. 12
Yoo MH, Kim SH, Lee JY, Yang CJ, Lee HS, Park HJ. Results of video head impulse and caloric tests in 36 patients with vestibular migraine and 23 patients with vestibular neuritis: a preliminary report. Clin Otolaryngol 2016; 41:813–817.  Back to cited text no. 13
Lotfi Y, Mardani N, Rezazade N, Saedi Khamene KE, Bakhshi E. Vestibular function in patients with vestibular migraine. Aud Vest Res 2016; 25:166–174.  Back to cited text no. 14
Neugebauer H, Adrion C, Glaser M, Strupp M. Long-term changes of central ocular motor signs in patients with vestibular migraine. Eur Neurol 2013; 69:102–107.  Back to cited text no. 15
Eza-Nuñez P, Fariñas-Alvarez C, Perez-Fernandez N. The caloric test and the video head-impulse test in patients with vertigo. J Int Adv Otol 2014; 10:144–149.  Back to cited text no. 16
Bartolomeo M, Biboulet R, Pierre G, Mondain M, Uziel A, Venail F. Value of the video head impulse test in assessing vestibular deficits following vestibular neuritis. Eur Arch Otorhinolaryngol 2014; 271:681–688.  Back to cited text no. 17


  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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