Sensitivity and specificity of the video head impulse test in the diagnosis of vestibular migraine – A systematic review and meta-analysis

OBJECTIVE: To estimate the proportion of patients with VM who have abnormal vHIT results and to determine the sensitivity and specificity of the test to detect VM. METHODS: statistic. The accuracy of vHIT was estimated through sensitivity, specificity, and predictive values. A significance level was 5%. This review was not registered in PROSPERO (International Prospective Register of Systematic Reviews) because it evaluates previously published observational studies of diagnostic performance without patient-level data collection. RESULTS: Nine studies published between 2016 and 2023 were included in the meta-analysis. The prevalence of abnormal results was 43%. vHIT had a sensitivity of 42%, specificity of 89%, positive predictive value of 83%, and negative predictive value of 54% for VM diagnosis. Saccades was observed in 36% of cases. Normal VOR gain was found in 22% of cases, while low VOR gain was observed in 12%. The gains in the lateral, anterior, and posterior semicircular canals ranged from 0.87 to 0.90. Except for normal VOR gain, all other outcomes showed high heterogeneity across studies. CONCLUSION: 43% of VM patients exhibited abnormalities in vHIT. The test demonstrated low sensitivity and high specificity to detect VM.