الفهرس 
Introduction and RationaleOnly 14 pages are availabe for public view
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Abstract
Migraine is one of the most common, prevalent, and socioeconomically impactful primary headache disorders and also is one of the top ten disability diseases, ranking second in the world in terms of years of disability (128). Patients with VM symptoms often report sensitivity to head movement and the visual environment or false perceptions, such as sudden sensations of imbalance or tilting (11). For the majority of VM patients, the period between the attacks is characterized by free symptoms and physical examination, changes are detected during the attacks with marked central and vestibular abnormalities (123).
Subjects included in the current study were divided into two groups; Control group: consisted of 60 normal subjects not complaining of any vestibular symptoms in the age range 20-40 years. Study group (VM cases group): Consisted of 30 patients recruited from audio-vestibular clinic in Menoufia university hospital in the age range of 20-40 years diagnosed as vestibular migraine (VM) according to International Headache Society guidelines (58). The study group was subdivided into 2 subgroups: subgroup1 was examined in between attacks (9 patients) at least after one week from the last migraine or vertiginous episode and subgroup2 was examined during the attack (21patients)., with the exclusion of the patients that suffering from other neurological diseases, systemic disorders, congenital nystagmus, poor vision, cervical problems in addition to a history of the oto-vestibular disease. Vestibular assessment was done to the both groups in the current study using vHIT and VNG.
All the patients in the study group (VM group) were subjected to the following: Full history taking [1-migraine criteria: duration of migraine attack, frequency of attack, the character of headache, association, and the received treatment.2- auditory symptoms: Hearing loss, tinnitus, or aural fullness.3-vestibular symptoms: vertigo and imbalance.4- concurrent illness], vestibular office tests (posture and gait tests), otoscopic examination, basic audiological assessment including Pure tone audiometry (model Madsen; Orbiter 922) and Immittancemetry (Interacoustic AT235), and vestibular assessment using videonystagmography (VNG) (NysStarTM VNG, Difra system, EUPEN, Belgium) and video head impulse test (vHIT) (HeadStarTM vHIT, Difra system, EUPEN, Belgium).
Oculomotor abnormalities were reported in 20∕30 patients (67%): In the subgroup (1):4 patients had abnormalities which were gaze test abnormality, prolonged latency of saccade test, and saccadic pursuit. But in the subgroup (2):16 patients had abnormalities which were spontaneous nystagmus, gaze test abnormality, prolonged latency of saccade test, and saccadic pursuit.
This study showed that vHIT abnormalities were reported in 20∕30 patients (67%) of the VM group: in subgroup (1): 3 patients showed a low gain, and in subgroup (2):17 patients showed abnormal gain either low gain in (3 patients) or high gain in (14 patients) and 3 cases showed overt saccades.
In the study group 14 patients (47%) showed abnormality in both vHIT and oculomotor tests [2 in subgroup1 and 12 in subgroup2],6patients (20%) showed vHIT abnormalities with normal oculomotor tests [1 in subgroup1 and 5 in subgroup 2], 6 patients (20%) showed normal vHIT results with abnormal oculomotor tests [2 in subgroup1 and 4 in subgroup 2] and 4 patients (13%) showed no abnormalities in both tests [all 4 patients were in subgroup1].
Summary
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There was a statistically significant difference regarding the duration of headache, frequency of attacks, and duration of vertigo between results of group of patients at initial visits and their results after re-evaluation (3months after their initial visits).
There was a difference in vHIT gain before and after treatment with a statistically significant difference between canals before and after treatment.
The number of abnormalities decreased after treatment: 12 ∕ 18 cases showed improvement and reported normal gain (10 cases changed from high gain to normal gain and 2cases changed from low gain to normal gain) in different canals.
In summary, Abnormalities either in oculomotor function tests or vHIT are common in VM, which were more pronounced during the attacks than in-between the attacks.
vHIT can be used as a monitoring tool during management of VM patients.