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Vestibular migraine is a debilitating combination of migraine headache and dizziness. Patients diagnosed with this condition usually experience common symptoms of migraine, including throbbing headache, light and/or sound sensitivity and nausea, but the most predominant feature is dizziness. Vestibular symptoms are frequently described as rocking, spinning or a feeling of not being on even ground. The duration of attacks can range between a few minutes to a few days.Nearly 1% of the general population suffers from vestibular migraine, yet despite the prevalence, mechanisms for the association between migraine and vestibular symptoms are not fully understood. Several hypotheses have been proposed, including vestibular associations with serotonergic and noradrenergic brainstem nuclei, and/or an association with trigeminal system activation, which is common during migraine.
A recent study by scientists at Seoul National University College of Medicine reported changes in brain regional metabolism in patients with vestibular migraine that could explain the association between migraine and vestibular dysfunction.
Researchers used FDG-PET scans to map regional brain metabolic activity during vestibular migraine (ictal) and between vestibular migraines (interictal) in two female patients. Analyze was used to assess differences in ictal and interictal brain activity. This was done by normalizing the voxel values of the ictal and interictal scans to the mean voxel values of the brain and subtracting.
The interictal scans showed increased metabolism in the bilateral cerebellum, considered in previous studies to be adaptive compensation for vestibular activation during migraine. Diffuse hypometabolism in the bilateral fronto-parieto-occipital areas was thought to be evidence of suppression of structures related to pain perception and vestibular mechanisms.
In contrast to the interictal scans, the ictus was characterized in both patients by increased metabolism in the bilateral cerebellum, thalamus and frontal cortices, with hypometabolism in the posterior parietal and occipitotemporal areas.
Findings in both patients during the migraine episodes suggested activation of the vestibulo-thalamo-vestibulocortical pathway and reciprocal inhibition between visual and vestibular systems. Albeit limited by having studied only two patients, these results lead the way for future elucidation of a mechanism for migraines which include vestibular symptoms.
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