Abstract text (incl. figure legends and references)

Question

Vestibular migraine (VM) is one of the most prevalent causes of episodic vertigo. Neuroimaging offers the possibility to investigate and localize the responsive brain areas in patients with VM. Voxel-based morphometry (VBM) has been generally considered as a reliable technique to analyze structural alterations, especially the gray matter volume (GMV) across neurological diseases. Despite all imaging data accumulated on GMV across the past decades, an overview of the imaging evidence of GMV differences in VM is still missing.

Methods

The coordinate based meta-analysis (CBMA) is a novel method to identify consistent and reliable brain alterations among individual neuroimaging studies. This study was performed under the latest algorithm of CBMA, seed-based d mapping with a permutation of subject images (SDM-PSI).

Results

5 studies were included after systemic review (103 patients and 107 healthy controls). Main CBMA showed significantly decreased GMV in the left rolandic operculum (SDM-Z value=-3.68, p=0.004, Voxels=629) with a peak MNI coordinate (-44, -12, 16) located in Brodmann area (BA) 48 and the two largest voxels belonging to the insula and rolandic operculum were consistently reported in VM patients compared to healthy controls. When removing a study with most patients (14/20) had predominantly left-sided headaches in sensitivity analysis, decreased GMV in the right Heschel gyrus (SDM-Z value=-3.83, p=0.003, Voxels=504) with a peak MNI coordinate (48, -12, 8) located in BA 48 was detected, which is symmetrical to the results reported in the main CBMA.

Conclusions

Our CBMA demonstrated the involvement of the posterior insula–operculum region in VM. The lateralization of the headache attack may determine the lateralization of the GMV alteration. Further longitudinal neuroimaging studies are necessary to draw more precise conclusions and the headache side may need to be taken into account when designing migraine-related neuroimaging studies.