Zhang Ai Juan, Yu Li Qun, Zhang Ai Yuan, Cong Xian Zhu, Zhou Li, Liu Yang
Department of Neurology, Weifang People's Hospital, Weifang, Shandong, China.
Cardiovascular Intensive Care Unit and Rehabilitation Department, Weifang People's Hospital, Weifang, Shandong, China.
J Clin Med Res. 2025 Jun 30;17(6):344-355. doi: 10.14740/jocmr6185. eCollection 2025 Jun.
Migraine, vestibular migraine (VM), and tension-type headache (TTH) are commonly associated with dizziness, vertigo, and postural instability, which increases patients' risk of falling and contributes to anxiety and depression. However, the vestibular pathophysiology underlying these primary headache disorders remains unclear. This study aimed to assess the saccular and utricular functions using vestibular evoked myogenic potentials (VEMPs), to investigate the peripheral and central vestibular involvement across these headaches.
A total of 353 patients diagnosed with migraine, VM, or TTH, based on the International Classification of Headache Disorders, third edition (beta version, ICHD-3β), were recruited from the Dizziness and Headache Clinic at People's Hospital of Weifang between December 2019 and September 2022. All participants underwent standardized clinical assessments and demographic data collection. VEMP tests were performed using 95 dB air-conducted sound stimuli to evaluate peripheral and central vestibular functions prior to enrollment.
Sleep disturbances and psychiatric comorbidities (i.e., anxiety and depression) were significantly more prevalent in TTH patients compared to those with VM and migraine. VM patients also demonstrated higher rates of psychiatric comorbidities than migraine patients. The average headache duration in VM patients was 7.14 years, which was notably longer than the average dizziness duration of 4.03 years. Transient vertigo was reported in 22% of VM patients and 17.65% of TTH patients. The prevalence of occipital and/or neck pain was significantly higher in VM patients than in migraine patients. Absent ocular VEMP (oVEMP) responses, both unilateral and bilateral, were found at a significantly higher rate in VM patients compared to migraine patients. Additionally, cervical VEMP (cVEMP) asymmetry ratios (ARs) were significantly higher in VM patients compared to TTH patients, and marginally higher than in migraine patients (P = 0.05). Prolonged cVEMP latencies (right p13, n23, and interpeak intervals) were observed in both VM and migraine compared to TTH. Left-sided latencies were significantly prolonged in migraine than TTH.
Psychiatric comorbidities were most pronounced in TTH, followed by VM and migraine. Both VM and TTH were associated with transient vertigo, exposing patients to drop-attack risk. The significantly higher occipital and/or neck pain reported in VM than in migraine may suggest the cervical neurovascular involvement in its pathophysiology. VEMP results indicate peripheral vestibular dysfunctions in VM patients and lower brainstem involvement in both VM and migraine patients, with the right-sided abnormalities more severe than the left-sided ones.
偏头痛、前庭性偏头痛（VM）和紧张型头痛（TTH）通常与头晕、眩晕及姿势不稳相关，这增加了患者跌倒的风险，并导致焦虑和抑郁。然而，这些原发性头痛疾病背后的前庭病理生理学仍不清楚。本研究旨在使用前庭诱发肌源性电位（VEMP）评估球囊和椭圆囊功能，以调查这些头痛类型中周围和中枢前庭的受累情况。
2019年12月至2022年9月期间，从潍坊市人民医院头晕与头痛门诊招募了353例根据国际头痛疾病分类第三版（β版, ICHD-3β）诊断为偏头痛、VM或TTH的患者。所有参与者均接受了标准化临床评估并收集了人口统计学数据。在入组前，使用95dB气导声刺激进行VEMP测试，以评估周围和中枢前庭功能。
与VM和偏头痛患者相比，TTH患者的睡眠障碍和精神共病（即焦虑和抑郁）更为普遍。VM患者的精神共病发生率也高于偏头痛患者。VM患者的平均头痛持续时间为7.14年，明显长于平均头晕持续时间4.03年。22%的VM患者和17.65%的TTH患者报告有短暂性眩晕。VM患者枕部和/或颈部疼痛的发生率显著高于偏头痛患者。与偏头痛患者相比，VM患者单侧和双侧眼VEMP（oVEMP）反应缺失的发生率显著更高。此外，与TTH患者相比，VM患者的颈VEMP（cVEMP）不对称率（ARs）显著更高，略高于偏头痛患者（P = 0.05）。与TTH相比，VM和偏头痛患者均观察到cVEMP潜伏期延长（右侧p13、n23和峰间期）。偏头痛患者左侧潜伏期比TTH显著延长。
精神共病在TTH中最为明显，其次是VM和偏头痛。VM和TTH均与短暂性眩晕相关，使患者面临猝倒风险。VM患者报告的枕部和/或颈部疼痛明显高于偏头痛患者，这可能表明其病理生理学中存在颈神经血管受累。VEMP结果表明VM患者存在周围前庭功能障碍，VM和偏头痛患者均存在低位脑干受累，右侧异常比左侧更严重。
