Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.