Objective test results in Migraine, with an emphasis on dizziness and hearing testing.

Timothy C. Hain, M.D. • Last updated: January 30, 2019

Migraine is a cluster of symptoms, and at least as of 2018, has no definitive "objective" test. Because migraine is not homogeneous, it is probably impossible for this to ever happen either. However, we do have a collection of laboratory tests that have been reported in migraine, and presumably these test results correlate with some of the symptoms of migraine. Our take on this is that we think that individuals with migraine are basically normal people, and thus most of these papers suggesting that this or that test works, are false positives. There is a selection bias in academics -- it is difficult to get a paper published unless it says something novel. This means that the publishing process selects for papers that are invalid. Perhaps this is why so few academic papers are reproducible.

Vestibular testing

One would generally expect that patients with migraine would be normal with respect to their vestibular testing, or perhaps a little better than normal, in as much as many of them are unusually sensitive to motion as well as many other sensory inputs.

ENG and Rotatory chair testing

VEMP testing

Salviz et al (2016) reported that "cVEMP differentiated MD patients from VM and healthy controls with asymmetrically reduced amplitudes on affected ears with low response rates at 500 Hz TBs, and alteration of frequency dependent responses at 500 and 1000 Hz TBs. These findings suggest that cVEMP can be used as a diagnostic test to differentiate MD from VM. " We are very dubious as cVEMP amplitudes are "all over the place" in our practice.

Chang et al reported 50% abnormality in children with benign paroxysmal vertigo. We find this difficult to understand, and we wonder if there was difficulty with getting children to cooperate.

Auditory testing.

One would generally expect that patients with migraine would be normal with respect to their hearing sensitivity, or perhaps a little better than normal, in as much as many of them are unusually sensitive to sound as well as many other sensory inputs. Thus we would expect that all of these papers would be false positives.

Audiometry and OAE testing

Hamed et al (2012) reported "Fifty-eight patients with migraine and 40 healthy subjects were assessed using routine diagnostic audiometry along with transient evoked otoacoustic emissions (TOAEs), distortion product otoacoustic emissions (DPOAEs), and auditory brainstem response (ABR) at high and low repetition rate frequencies. RESULTS: Nearly two thirds of patients with migraine had one or more abnormalities in electrophysiological testing. Compared with control subjects, patients reported significant lowering of TOAEs amplitude at frequencies of 1 kHz (right: P = .0003; left: P = .002), 3 kHz (right: P = .025), and 4 kHz (right: P = .019); prolonged wave III latency (right: P = .009); and I-V interpeak latency (IPL) (left: P = .024) at high repetition rate frequencies." We are doubtful that this has any meaning.

Joffilly et al (2016) reported that "women with migraine and phonophobia exhibited deficits in OAE suppression, which points to a disorder affecting the medial olivocochlear efferent system. " They said that TEOAE suppression was lower in migraine. We are not sure what to make of this.

Bolay et al (2008), provided somewhat similar results concerning absent suppression, suggesting that "In patients with migraine ..., mean amplitudes of TEOAEs were not suppressed by contralateral sound stimulus (P > 0.05).

Battista (2004) reported that "Three patients in the migraine-associated dizziness group had an elevated pure-tone average (>/=26 dB) and/or low-frequency pure-tone average at initial and/or follow-up assessment. CONCLUSION: Audiometric findings of patients with migraine-associated dizziness are most often normal. " We think this is very reasonable.

Dash e tal (2008), suggested that ABRs were often prolonged. We are dubious.

Vollu et al (2017) reported that "No significant difference was observed between migraine and VM patients with respect to audiometric and tympanometric measurements." This seems reasonable to us.

ECOG testing:

Vollu et al (2017) reported that "EcochG data suggests average SP/AP scores of VM patients are significantly higher than migraine patients. " As ECOG testing is technically difficult, we are dubious that this observation will translate into clinically meaningful results.