RESUMEN
Vestibular migraine (VM) is the most common cause of spontaneous vertigo but remains poorly understood. We investigated the hypothesis that central vestibular pathways are sensitized in VM by measuring self-motion perceptual thresholds in patients and control subjects and by characterizing the vestibulo-ocular reflex (VOR) and vestibular and headache symptom severity. VM patients were abnormally sensitive to roll tilt, which co-modulates semicircular canal and otolith organ activity, but not to motions that activate the canals or otolith organs in isolation, implying sensitization of canal-otolith integration. When tilt thresholds were considered together with vestibular symptom severity or VOR dynamics, VM patients segregated into two clusters. Thresholds in one cluster correlated positively with symptoms and with the VOR time constant; thresholds in the second cluster were uniformly low and independent of symptoms and the time constant. The VM threshold abnormality showed a frequency-dependence that paralleled the brain stem velocity storage mechanism. These results support a pathogenic model where vestibular symptoms emanate from the vestibular nuclei, which are sensitized by migraine-related brainstem regions and simultaneously suppressed by inhibitory feedback from the cerebellar nodulus and uvula, the site of canal-otolith integration. This conceptual framework elucidates VM pathophysiology and could potentially facilitate its diagnosis and treatment.
Asunto(s)
Trastornos Migrañosos/complicaciones , Percepción de Movimiento/fisiología , Vértigo/fisiopatología , Núcleos Vestibulares/fisiopatología , Adulto , Femenino , Humanos , Masculino , Trastornos Migrañosos/diagnóstico , Trastornos Migrañosos/fisiopatología , Movimiento/fisiología , Membrana Otolítica/fisiología , Canales Semicirculares/fisiología , Vértigo/diagnóstico , Vértigo/etiología , Pruebas de Función VestibularRESUMEN
Humans actively stabilize the head-neck system based on vestibular, proprioceptive and visual information. Galvanic vestibular stimulation (GVS) has been used previously to demonstrate the role of vestibular feedback in standing balance. This study explores the effect of GVS on head-neck kinematics and evaluates the approach to investigate the vestibular contribution to head-neck stabilization. GVS was applied to 11 seated subjects using seven different stimuli (single sinusoids and multisines) at amplitudes of 0.5-2 mA and frequencies of 0.4-5.2 Hz using a bilateral bipolar configuration while 3-D head and torso kinematics were recorded using motion capture. System identification techniques were used evaluating coherence and frequency response functions (FRFs). GVS resulted in significant coherence in roll, yaw and lateral translation, consistent with effects of GVS while standing as reported in the literature. The gain of the FRFs varied with frequency and no modulation was observed across the stimulus amplitudes, indicating a linear system response for the stimulations considered. Compared to single sine stimulation, equivalent FRFs were observed during unpredictable multisine stimulation, suggesting the responses during both stimuli to be of a reflexive nature. These results demonstrate the potential of GVS to investigate the vestibular contribution to head-neck stabilization.