前庭性偏头痛中前庭功能检查揭示了什么？

文献信息

中文摘要

引言： 前庭性偏头痛（VM）是复发性眩晕的常见原因，但目前尚无单一前庭功能检查对其具有特异性。本研究旨在评估VM患者的视频眼震图（VNG）、冷热试验和视频头脉冲试验（vHIT）结果，并探讨这些检查之间的关系。
方法： 这项回顾性研究纳入了193例根据Bárány学会/国际头痛学会标准诊断的确定性VM患者（2016年1月至2026年5月）。所有患者均在同一天接受VNG、冷热试验和vHIT检查，且所有病例均处于非急性发作期。将眼动、位置性和冷热试验结果与vHIT结果进行比较。同时记录人口学特征、听力学检查结果和血管合并症。
结果： vHIT正常者占66.3%，异常者占33.7%。总体平均VOR增益为0.97 ± 0.19，vHIT异常患者的平均VOR增益为0.86 ± 0.14。眼动异常检出率为38.3%，位置性试验阳性率为20.7%，冷热试验异常率为40.9%（受累患者平均半规管麻痹为42.9 ± 16.7%）。vHIT与眼动（p=0.262）、位置性（p=0.255）或冷热试验结果（p=0.974）之间均未发现显著关联。冷热-vHIT分离，即冷热反应异常而vHIT正常，见于53例患者（27.5%）。
结论： 前庭功能检查在VM中揭示了一种异质性的功能障碍模式，各检查之间无显著的分类学关联。冷热-vHIT分离可能反映了前庭功能对频率依赖性的差异，但其发生率远低于梅尼埃病中所报道的水平，因此它支持而非替代临床鉴别。这些发现提示每种检查捕捉了前庭功能的不同方面，应作为多模式评估前庭性偏头痛的互补工具。

英文摘要

INTRODUCTION: Vestibular migraine (VM) is a common cause of recurrent vertigo, yet no single vestibular test is specific to it. This study aimed to evaluate videonystagmography (VNG), caloric test, and video head impulse test (vHIT) findings in VM patients and to examine the relationships between these tests.
METHODS: This retrospective study included 193 patients with definite VM diagnosed per Bárány Society/International Headache Society criteria (January 2016-May 2026). All patients underwent VNG, caloric testing, and vHIT on the same day, in all cases outside an acute attack. Oculomotor, positional, and caloric findings were compared with vHIT results. Demographic characteristics, audiometric findings and vascular comorbidities were also recorded.
RESULTS: vHIT was normal in 66.3% of patients and abnormal in 33.7%. Mean VOR gain was 0.97 ± 0.19 overall and 0.86 ± 0.14 in patients with an abnormal vHIT. Oculomotor abnormalities were detected in 38.3%, positional test positivity in 20.7%, and caloric test abnormalities in 40.9% (mean canal paresis 42.9 ± 16.7% in affected patients). No significant associations were found between vHIT and oculomotor (p=0.262), positional (p=0.255), or caloric test results (p=0.974). A caloric-vHIT dissociation, defined as an abnormal caloric response with a normal vHIT, was present in 53 patients (27.5%).
CONCLUSION: Vestibular tests reveal a heterogeneous pattern of dysfunction in VM with no significant categorical inter-test associations. The caloric-vHIT dissociation may reflect frequency-dependent differences in vestibular function, although at a rate well below that reported for Ménière's disease, so that it supports rather than replaces clinical differentiation. These findings suggest that each test captures distinct aspects of vestibular function and should be used as complementary tools in the multimodal evaluation of vestibular migraine.