Differences in clinical features between vestibular migraine, migraine with vestibular symptoms, and migraine without vestibular symptoms: A cross-sectional study

Abstract

Abstract Background: Vestibular migraine (VM) is associated with a higher central sensitization than migraines without vestibular symptoms. VM and migraines with vestibular symptoms (MwVS) may share a similar disorder spectrum, as no differences in clinical features have been found, apart from disability. Patients with VM experience fluctuating mechanical pain thresholds and vestibular symptoms even without migraine attacks, suggesting persistent central sensitization. We hypothesized that interictal allodynia or hyperalgesia, which are indicative of persistent central sensitization, could be used to differentiate between VM, MwVS, and migraine without vestibular symptoms, that is, migraine only (MO). This study aimed to compare the demographic and clinical characteristics of VM, MwVS, and MO during the interictal phase and to determine whether VM exhibits more interictal allodynia/hyperalgesia than MwVS and MO. Methods: In this cross-sectional study, we enrolled consecutive migraineurs aged 18–65 years who were assigned into the VM, MwVS, and MO groups and administered a structured questionnaire comprising diagnostic questions for migraine, VM, and associated variables. Clinical variables were compared among the three groups. After confirming data normality, variables were compared using appropriate tests. A multivariate logistic regression identified significant VM-associated variables, applying backward stepwise selection. Results were considered statistically significant when the two-tailed p-values < 0.05. The presence of interictal widespread pressure hyperalgesia (IWPH) was determined using a manual tender point survey as an alternative to the quantitative sensory testing method, which is the gold standard. Results: Overall, 163 patients, of which 31 (19%), 54 (33.1%), and 78 (47.9%) were assigned to the VM, MwVS, and MO groups, respectively, were included in this study. Post-hoc comparison revealed that aura, tender point count, and IWPH were significantly associated with VM compared to MwVS. Multivariate logistic regression confirmed that aura and IWPH were independent and significant predictors of VM. No significant differences were observed in clinical features between MwVS and MO. Conclusions: Aura and IWPH are independent predictors of VM, potentially playing pivotal roles in its pathogenesis. We have identified clinical features that differentiate between VM and MwVS, which can enhance our understanding of VM.