Can video head impulse testing aid differential assessment of suspected vestibular migraine attacks?
Abstract
Vestibular migraine is a clinically defined disorder characterized by recurrent vestibular symptoms associated with migraine features, and its acute attacks may be difficult to distinguish from peripheral vestibular disorders such as acute unilateral vestibulopathy/vestibular neuritis, Ménière's disease, and vestibular schwannoma. This review synthesizes current evidence on the clinical interpretation and proposed pathophysiological context of video head impulse test findings during acute vestibular migraine episodes, with particular attention to vestibulo-ocular reflex gain, refixation saccades, and subjective visual vertical abnormalities. Available evidence suggests that vestibulo-ocular reflex gain is often preserved during acute vestibular migraine, although variable or transient reductions have also been reported, limiting its diagnostic specificity when used alone. Refixation saccades, including covert, bilateral small-amplitude, or occasionally unilateral high-amplitude patterns, have also been reported during acute vestibular migraine. However, these findings are non-specific and may also be associated with peripheral vestibular dysfunction, age-related variability, compensatory responses, gaze-fixation instability, or technical artifacts. When recording quality is adequate, their distribution and temporal evolution may provide adjunctive information, but they should not be used independently to infer a specific central mechanism or establish the diagnosis of…
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