Application of Head Shaking Tilt Suppression Test and Video Head Impulse Test in the Antidiastole of Vestibular Migraine and Meniere's Disease

Background As revealed by previous studies, the head shaking tilt suppression test (HSTST) is associated with the vestibular cerebellum-mediated central storage mechanism and the video head impulse test (vHIT) is crucial for the diagnosis of peripheral vestibular diseases. Objective To explore the clinical application value of HSTST and vHIT in vestibular migraine (VM) and Meniere's disease (MD) . Methods Patients presenting with vertigo or dizziness as the primary complaint and diagnosed with VM and MD were selected from the Neurology Department of the Second People's Hospital of Guiyang from July 2021 to December 2022. After collecting their medical history and performing bedside examinations, pure tone audiometry test was conducted on those with hearing impairment. All patients completed vestibular function tests, including head shaking test (HST), HSTST, caloric test, and vHIT, were performed, followed by calculating the tilt suppression index (TSI). Then the Clinical features and examination results of VM and MD patients with HST positive were compared, and the ROC curve of TSI was plotted to distinguish between the two groups of patients. Results Among the 50 VM patients involved in the study, 22 (44.0%) were HST positive, including 19 (86.4%) exhibiting horizontal nystagmus and 3 (13.6%) showing vertical nystagmus. Among the 45 MD patients, 23 (51.1%) were HST positive, all of whom were horizontal nystagmus. The analysis of the patients with HST positive showed that the female to male ratio in VM and MD patients was 4.5∶1 and 1∶1.3, respectively. The prevalence of family history of headaches was higher in VM patients compared to MD patients (P<0.05). VM patients exhibited lower proportions of vomiting, tinnitus, ear tightness, and hearing loss symptoms (31.8%, 18.2%, 13.6%, 13.6%) compared to MD patients (73.9%, 100.0%, 82.6%, 100.0%), with a higher proportion of accompanying headache symptoms (77.3%) than MD patients (8.7%) (P<0.05). Pure tone audiometry revealed a higher hearing loss rate in MD patients compared to VM patients (P<0.001). Significant differences were observed in vHIT between VM and MD patients (P<0.05). Then the TSI differed significantly between VM and MD patients [ (25.41±12.15) % and (78.71±13.76) %, respectively] (P<0.05). From ROC curves, the area under the curve (AUC) was 0.962 (95%CI=0.91-1.00) with a cut-off point at 0.66 (sensitivity=0.90, specificity=0.95) . Conclusion Vestibular migraine primarily involves a central mechanism, and HSTST combined with vHIT can be used as auxiliary examination tools to differentiate diagnosis between VM and MD.