Characterizing Differences in Endolymphatic Hydrops Signatures Among Meniere’s Disease Patients with and Without Migraine

<b>Background/Objectives</b>: Migraine is frequently comorbid with Meniere's disease, which may complicate interpretation of inner ear imaging and clinical diagnosis. While endolymphatic hydrops has been studied in Meniere's disease and vestibular migraine separately, comparative imaging data for Meniere's disease patients with and without migraine remain limited. <b>Methods</b>: We retrospectively analyzed 78 patients with definite Meniere's disease who underwent endolymphatic contrast-enhanced MRI (HYbriD of Reversed image of Positive endolymph signal and native image of positive perilymph signal; or "HYDROPS"). Patients were classified as Meniere's disease only group <i>(n</i> = 56), or Meniere's disease with migraine (<i>n</i> = 22). The degree of endolymphatic hydrops (negative, mild, or significant) was assessed separately in the inner ear, the cochlea, and the vestibule. <b>Results</b>: In Meniere's disease group, the affected ear consistently showed higher rates of significant endolymphatic hydrops compared to the healthy ear across the inner ear, cochlea, and vestibule (<i>p</i> < 0.01). In contrast, Meniere's disease with migraine group showed no significant interaural differences. Meniere's disease with migraine group showed a significantly higher frequency of significant endolymphatic hydrops in the healthy cochlea (<i>p</i> < 0.01). Similar patterns were observed in the inner ear (<i>p</i> < 0.025) and vestibule (<i>p</i> = 0.05), although these differences did not reach statistical significance. Bilateral hydrops was significantly more frequent in Meniere's disease with migraine group than in Meniere's disease group among all regions investigated (<i>p</i> < 0.05). <b>Conclusions</b>: Meniere's disease patients with migraine exhibit a distinct endolymphatic hydrops pattern, characterized by bilateral or symmetrical hydrops and involvement of the healthy ear. These findings suggest migraine-related mechanisms may contribute to endolymphatic hydrops, and bilateral endolymphatic hydrops on endolymphatic contrast-enhanced MRI in suspected Meniere's disease cases should prompt consideration of comorbid migraine, in addition to bilateral Meniere's disease or asymptomatic hydrops.