(319) Motion Sensitivity and Vestibular Rehabilitation Outcomes in Pediatric Vestibular Migraine

Introduction: Motion sensitivity is a hallmark presenting symptom of vestibular migraines (VM) in the pediatric population and is often employed in vestibular rehabilitation outcome measurements via the Motion Sensitivity Quotient (MSQ). We hypothesize that the MSQ may be a useful diagnostic tool for discerning VM versus non-VM patients as well as a prognosticator for vestibular rehabilitation outcomes in the pediatric population.

Methods: A retrospective cohort analysis of 677 pediatric patients from a single pediatric tertiary care center presenting with dizziness who completed vestibular testing from January 2016 to August 2022 was performed. Using International Headache Society diagnostic criteria for VM, patients were divided into definite or probable VM and non-VM groups. Patients underwent a vestibular physical therapy (PT) evaluation to obtain an MSQ score. Exclusion criteria were prior intracranial/otologic surgeries (excluding tympanostomy tubes) or no initial MSQ. The main outcome measures were initial MSQ, number and duration of vestibular PT sessions, PT goals met and post-treatment MSQ, all analyzed using t-tests.

Results: Of the 273 patients that met study criteria, 46% were classified with VM and 54% non-VM. There was no statistically significant difference in initial MSQ between VM (9.08) and non-VM patients (7.87, p = 0.20), and both groups demonstrated improvement in MSQ after completing PT (p = 0.003). VM patients, however, were less likely to meet at least one PT treatment goal (60 % vs. 73% in non-VM, p = 0.045). VM patients also trended towards an increased number of PT sessions (5.0 vs. 4.3, p = 0.11), longer duration of PT follow-up (2.9 vs. 2.5 months, p = 0.18), and higher post-treatment MSQ (4.2 vs. 2.0, p = 0.18).

Conclusions: MSQ does not appear to be a reliable diagnostic tool in discerning VM from non-VM pediatric patients. Additionally, VM patients may display less responsiveness to vestibular rehabilitation of motion sensitivity given worse performance in attaining PT goals and the trend toward longer, more frequent PT visits with higher post-treatment MSQ compared to their non-VM counterparts.