{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T11:23:58Z","timestamp":1783596238256,"version":"3.55.0"},"reference-count":44,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Caloric\u2013vHIT (CalHiT) dissociation has been considered highly characteristic of M\u00e9ni\u00e8re\u2019s disease (MD), but its occurrence in vestibular migraine (VM) remains incompletely characterized. Objective: The primary aim was to characterize, through detailed longitudinal analysis, the clinical and mechanistic heterogeneity underlying caloric-vHIT dissociation in seven patients with definite VM in a retrospective cohort. Study design: Observational, retrospective case series. Methods: From a standardized vestibular cohort of 100 consecutive patients with definite MD or VM evaluated between 2015 and 2018, seven patients with definite VM who exhibited caloric-vHIT dissociation were identified and followed up for approximately seven years. The frequency of dissociation patterns within the source cohort was recorded to contextualize case selection, and each case was characterized descriptively as follows: Patterns were classified as CalHiT-0 (CP &lt; 22%, vHIT \u2265 0.80), CalHiT-A (CP \u2265 22%, vHIT \u2265 0.80), CalHiT-B (CP &lt; 22%, vHIT &lt; 0.80), and CalHiT-C (CP \u2265 22%, vHIT &lt; 0.80). Results: At the cohort level, A-pattern dissociation occurred in 17.5% of patients with VM (7\/40) and 56.7% of patients with MD (34\/60), while B-pattern dissociation was rare (MD: 2\/60, 3.3%; VM: 1\/40, 2.5%). One patient with CalHiT-A VM was lost to follow-up and excluded from the longitudinal analysis. At the case level, the seven cases (six CalHiT-A and one CalHiT-B) suggested mechanistic heterogeneity, including compensated peripheral hypofunction, familial vulnerability, traumatic injury, and potential central modulation. VM was distinguished by the absence of fluctuating auditory symptoms, absence of progressive hearing loss characteristic of MD, and DHI-measured disability comparable to that of MD despite substantially lower objective vestibular deficits. No VM case with confirmed follow-up evolved toward MD. Conclusions: Caloric-vHIT dissociation occurred in approximately one-sixth of patients with definite VM and should not be regarded as a stand-alone sign of endolymphatic hydrops. The clinical heterogeneity across cases suggests that several mechanisms other than hydrops may produce a comparable pattern. These observations could support future studies exploring whether a distinct VM phenotype defined by this dissociation can be established and favor interpreting the dissociation alongside the auditory and longitudinal profiles rather than in isolation.<\/jats:p>","DOI":"10.3390\/jcm15145369","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T10:16:22Z","timestamp":1783592182000},"page":"5369","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Caloric-vHIT Dissociation in Vestibular Migraine: An Observational, Retrospective Case Series Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Carlos","family":"Palomino-Diaz","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, Cl\u00ednica Universidad de Navarra, Calle Marquesado de Santa Marta, 1, 28027 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9982-7951","authenticated-orcid":false,"given":"Melissa","family":"Blanco-Pareja","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Cl\u00ednica Universidad de Navarra, Calle Marquesado de Santa Marta, 1, 28027 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margarita","family":"S\u00e1nchez-Del-R\u00edo","sequence":"additional","affiliation":[{"name":"Department of Neurology, Cl\u00ednica Universidad de Navarra, Calle Marquesado de Santa Marta, 1, 28027 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raquel","family":"Manrique-Huarte","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Cl\u00ednica Universidad de Navarra, Av. P\u00edo XII 36, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7238-0036","authenticated-orcid":false,"given":"Pablo","family":"Irimia-Sieira","sequence":"additional","affiliation":[{"name":"Department of Neurology, Cl\u00ednica Universidad de Navarra, Av. P\u00edo XII 36, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1192-5901","authenticated-orcid":false,"given":"Nicol\u00e1s","family":"P\u00e9rez-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Cl\u00ednica Universidad de Navarra, Calle Marquesado de Santa Marta, 1, 28027 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Colombo, B., and Teggi, R. (2025). Vestibular Migraine: Epidemiology, Classification, and Clinical Features. Vestibular Migraine and Other Episodic Vertigos: An Update: Clinical and Therapeutical Approach, Springer Nature.","DOI":"10.1007\/978-3-031-78100-1"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"5173","DOI":"10.1007\/s00405-022-07366-y","article-title":"Depression scores and quality of life of vertiginous patients, suffering from different vestibular disorders","volume":"279","author":"Maihoub","year":"2022","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Hain, T.C., and Cherchi, M. (2019). Migraine-Associated Vertigo. Dizziness and Vertigo Across the Lifespan, Elsevier.","DOI":"10.1016\/B978-0-323-55136-6.00011-3"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Strupp, M., Brandt, T., and Dieterich, M. (2023). Vertigo and Dizziness: Frequent Multisensory Symptoms. Vertigo and Dizziness: Common Complaints, Springer International Publishing.","DOI":"10.1007\/978-3-030-78260-3"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3567","DOI":"10.1007\/s00415-023-11677-3","article-title":"Comparison of clinical features in patients with vestibular migraine and migraine","volume":"270","author":"Ak","year":"2023","journal-title":"J. Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1111\/head.12129","article-title":"Comparison of Interictal Vestibular Function in Vestibular Migraine vs Migraine Without Vertigo","volume":"53","author":"Boldingh","year":"2013","journal-title":"Headache"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1212\/WNL.0b013e31826e264f","article-title":"Vestibular migraine Long-term follow-up of clinical symptoms and vestibulo-cochlear findings","volume":"79","author":"Radtke","year":"2012","journal-title":"Neurology"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Celebisoy, N., Kisabay, A., \u00d6zdemir, H., Gokcay, F., Saritas, A., Toydemir, H., Yayla, V., Isikay, I., Erkent, I., and Atac, C. (2025). Vestibular migraine: Course of symptoms during a four-year follow-up. Front. Neurol., 16.","DOI":"10.3389\/fneur.2025.1567233"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Vosbeek, E., Seelen, M., Vingerhoed, A., Schermer, T., Cannegieter, S., Terwindt, G., and Bruintjes, T. (2025). Vestibular function tests are helpful in differentiating between Meni\u00e8re\u2019s disease and vestibular migraine. Front. Neurol., 16.","DOI":"10.3389\/fneur.2025.1569247"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Shi, S., Wang, D., Ren, T., and Wang, W. (2022). Auditory Manifestations of Vestibular Migraine. Front. Neurol., 13.","DOI":"10.3389\/fneur.2022.944001"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1001\/jamaoto.2018.0939","article-title":"Association of Tinnitus and Other Cochlear Disorders With a History of Migraines","volume":"144","author":"Hwang","year":"2018","journal-title":"JAMA Otolaryngol.-Head Neck Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e41127","DOI":"10.1097\/MD.0000000000041127","article-title":"Hypothetical criteria and types for cochlear migraine","volume":"104","author":"Lai","year":"2025","journal-title":"Medicine"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Colombo, B., and Teggi, R. (2025). Vestibular Migraine: Vestibular Testing and Pathophysiology. Vestibular Migraine and Other Episodic Vertigos: An Update: Clinical and Therapeutical Approach, Springer Nature.","DOI":"10.1007\/978-3-031-78100-1"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.1007\/s00415-022-11532-x","article-title":"Vestibular migraine or Meniere\u2019s disease: A diagnostic dilemma","volume":"270","author":"Chen","year":"2023","journal-title":"J. Neurol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.1007\/s00405-020-06272-5","article-title":"Comparison of the results of caloric and video head impulse tests in patients with Meniere\u2019s disease and vestibular migraine","volume":"278","author":"Yilmaz","year":"2021","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_16","first-page":"393","article-title":"Comparison between caloric and video-head impulse tests in M\u00e9ni\u00e8re\u2019s disease and vestibular neuritis","volume":"62","author":"Maihoub","year":"2022","journal-title":"Int. J. Audiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"323","DOI":"10.3233\/VES-2011-0422","article-title":"Dynamic tilt thresholds are reduced in vestibular migraine","volume":"21","author":"Lewis","year":"2011","journal-title":"J. Vestib. Res.-Equilib. Orientat."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1007\/s00415-023-12027-z","article-title":"Subjective and objective responses to caloric stimulation help separate vestibular migraine from other vestibular disorders","volume":"271","author":"Hannigan","year":"2024","journal-title":"J. Neurol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1177\/03331024211006042","article-title":"Clinical, oculographic, and vestibular test characteristics of vestibular migraine","volume":"41","author":"Young","year":"2021","journal-title":"Cephalalgia"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1097\/MAO.0000000000004644","article-title":"The Differences in Caloric Test and vHIT Results Between Meni\u00e8re\u2019s Disease and Vestibular Migraine: A Systematic Review and Meta-Analysis","volume":"46","author":"Vosbeek","year":"2025","journal-title":"Otol. Neurotol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"King, S., Wang, J., Priesol, A.J., and Lewis, R.F. (2014). Central Integration of Canal and Otolith Signals is Abnormal in Vestibular Migraine. Front. Neurol., 5.","DOI":"10.3389\/fneur.2014.00233"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"P\u00e9rez-Fern\u00e1ndez, N., and Arbizu, L. (2026). Patient-Level Modeling of M\u00e9ni\u00e8re\u2019s Disease vs. Vestibular Migraine: Performance of Speech Discrimination and Caloric-vHIT Dissociation. J. Clin. Med., 15.","DOI":"10.3390\/jcm15051908"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"167","DOI":"10.3233\/VES-2012-0453","article-title":"Vestibular migraine: Diagnostic criteria","volume":"22","author":"Lempert","year":"2012","journal-title":"J. Vestib. Res.-Equilib. Orientat."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"(2013). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia, 33, 629\u2013808.","DOI":"10.1177\/0333102413485658"},{"key":"ref_25","first-page":"1","article-title":"Diagnostic criteria for Meniere\u2019s disease","volume":"25","author":"Carey","year":"2015","journal-title":"J. Vestib. Res.-Equilib. Orientat."},{"key":"ref_26","first-page":"1","article-title":"Electronystagmography","volume":"189","author":"Jongkees","year":"1964","journal-title":"Acta Otolaryngol. Suppl."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Halmagyi, G.M., Chen, L., Macdougall, H.G., Weber, K.P., Mcgarvie, L.A., and Curthoys, I.S. (2017). The Video Head Impulse Test. Front. Neurol., 8.","DOI":"10.3389\/fneur.2017.00258"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Mavrodiev, V., Strupp, M., Vinck, A., van de Berg, R., and Lehner, L. (2024). The dissociation between pathological caloric testing and a normal video head impulse test helps differentiate between Meni\u00e8re\u2019s disease, vestibular migraine, and other vestibular disorders: A confirmatory study in a large cohort of 2,101 patients. Front. Neurol., 15.","DOI":"10.3389\/fneur.2024.1449261"},{"key":"ref_29","first-page":"NP287","article-title":"Clinical characteristics of patients with dizziness\/vertigo showing a dissociation between caloric and video head impulse test results","volume":"104","author":"Li","year":"2022","journal-title":"ENT-Ear Nose Throat J."},{"key":"ref_30","first-page":"1695","article-title":"Long-term follow-up of patients with vestibular neuritis by caloric testing and directional preponderance calculation","volume":"280","author":"Jassoy","year":"2022","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_31","unstructured":"Jacobson, G.P., Shepard, N.T., Barin, K., Burkard, R.F., Janky, K., and McCaslin, D.L. (2021). Balance Function Assessment and Management, Plural Publishing. [3rd ed.]."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1111\/cge.12150","article-title":"Familial clustering and genetic heterogeneity in Meniere\u2019s disease","volume":"85","author":"Requena","year":"2014","journal-title":"Clin. Genet."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/S1567-4231(10)09032-5","article-title":"Chapter 32\u2014Inherited vestibular and vestibulocerebellar disorders","volume":"Volume 9","author":"Jen","year":"2010","journal-title":"Handbook of Clinical Neurophysiology"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Cantillo-Mart\u00ednez, M., Lorente-Piera, J., Manrique-Huarte, R., S\u00e1nchez-del-R\u00edo, M., P\u00e9rez-Fern\u00e1ndez, N., Chico-Vila, C., Moreno-Ajona, D., and Irimia, P. (2025). Insights into Vestibular Migraine: Diagnostic Challenges, Differential Spectrum and Therapeutic Horizons. J. Clin. Med., 14.","DOI":"10.3390\/jcm14144828"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Oh, S.Y., Dieterich, M., Lee, B.N., Boegle, R., Kang, J.J., Lee, N.R., Gerb, J., Hwang, S.B., and Kirsch, V. (2021). Endolymphatic Hydrops in Patients With Vestibular Migraine and Concurrent Meniere\u2019s Disease. Front. Neurol., 12.","DOI":"10.3389\/fneur.2021.594481"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1017\/S0022215124001099","article-title":"Dissociation between caloric test and the video head impulse test in individuals with auditory neuropathy spectrum disorders","volume":"139","author":"Sinha","year":"2025","journal-title":"J. Laryngol. Otol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2357","DOI":"10.1111\/ene.14889","article-title":"Sensitized rotatory motion perception and increased susceptibility to motion sickness in vestibular migraine: A cross-sectional study","volume":"28","author":"Wurthmann","year":"2021","journal-title":"Eur. J. Neurol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1111\/j.1468-2982.2004.00662.x","article-title":"Vertigo and dizziness related to migraine: A diagnostic challenge","volume":"24","author":"Neuhauser","year":"2004","journal-title":"Cephalalgia"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Curthoys, I.S., Zee, D.S., Dumas, G., Pastras, C.J., and Dlugaiczyk, J. (2025). Skull vibration induced nystagmus, velocity storage and self-stability. Front. Neurol., 16.","DOI":"10.3389\/fneur.2025.1533842"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1080\/21695717.2019.1630984","article-title":"Dissociated vestibular test results (caloric and vHIT) in patients with Meniere\u2019s disease are not due to velocity storage malfunction","volume":"18","year":"2020","journal-title":"Hear. Balance Commun."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"14323","DOI":"10.1038\/s41598-019-50803-y","article-title":"Self-motion perception is sensitized in vestibular migraine: Pathophysiologic and clinical implications","volume":"9","author":"King","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Filippopulos, F.M., Zwergal, A., and Huppert, D. (2022). Is There an \u201cAcquired Idiopathic Head-Shaking Nystagmus\u201d?\u2014A Discussion of Mechanisms and Clinical Implications Based on a Case Report. Front. Neurol., 13.","DOI":"10.3389\/fneur.2022.897012"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1080\/00016480500415605","article-title":"Analysis of the vestibulo-ocular reflex time constant in patients with benign recurrent vertigo associated with head-shaking nystagmus","volume":"126","year":"2006","journal-title":"Acta Oto-Laryngol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1152\/jn.00674.2018","article-title":"The neural basis of motion sickness","volume":"121","author":"Cohen","year":"2019","journal-title":"J. Neurophysiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5369\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T10:37:23Z","timestamp":1783593443000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5369"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,9]]},"references-count":44,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15145369"],"URL":"https:\/\/doi.org\/10.3390\/jcm15145369","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,9]]}}}