This is the first report of vestibular examinations before and after the successful treatment of vestibular migraine (VM), a common cause of recurrent vertigo, with calcitonin gene-related peptide (CGRP) receptor inhibitor. We evaluated a 42-year-old female with VM and concomitant probable Meniere’s disease, whose headache and dizziness have improved promptly with the administration of erenumab, a CGRP receptor inhibitor. The sensorineural hearing loss in pure-tone audiometry, dysfunctions shown in vestibular examinations (cervical and ocular vestibular evoked myogenic potentials), and mild endolymphatic hydrops shown in gadolinium-enhanced inner ear magnetic resonance imaging, all in the right ear, revealed no change compared with those observed before treatment. This case suggests that VM may be treated by blocking CGRP in the trigeminal ganglion, which suppresses the effects on the vestibular nucleus; herein, no effects were observed in the inner ear despite the clear amelioration of dizziness.

Objectives: To elucidate the differences between the cases of Meniere’s disease (MD) with and without coexisting headaches, especially migraine. The clinical characteristics and vestibular functions are compared.Subjects: Fifteen patients with definite unilateral MD without headaches (MD/H−; 10 males and 5 females; mean age of 55.8 years), and 20 patients with definite unilateral MD with headaches (MD/H+; 3 males and 17 females; mean age of 54.4 years; 15 cases of migraine without aura and 5 cases of suspected migraine or tension-type headache) were enrolled.Methods: The medical records, caloric test results, and cervical vestibular evoked myogenic potential (cVEMP) of the patients were reviewed. A monothermal caloric test by injection of cold water was performed, and canal paresis was assessed. cVEMP was recorded using 500 Hz short tone bursts, and the asymmetry ratio using the corrected amplitude of p13–n23 was determined.Results: The patients in the MD/H− group were predominantly male, whereas more female patients were seen in MD/H+ group (p = 0.004). In the MD/H+ group, the frequency of vertigo and the dizziness handicap inventory (DHI) values were significantly higher than those in the MD/H− group (p = 0.045, <0.001, respectively). There was no statistical difference in the ages, duration of illness, or the hearing levels between both groups. The caloric testing results were abnormal for 10 of the 13 MD/H− cases, and 14 of the 16 MD/H+ cases, which revealed no significant difference between both groups. The cVEMP results revealed positive saccular dysfunction based on the asymmetry ratio of 4 of the 15 MD/H− cases, and 14 of the 20 MD/H+ cases; it was significantly more prevalent in the MD/H+ group than in the MD/H− group (p = 0.018). Multivariate analysis of sex, frequency of vertigo, DHI, and cVEMP results showed significant differences only in the cVEMP results (p = 0.049).Conclusion: The present study revealed differences in patients with MD depending on the presence or absence of headaches. MD without headaches showed a significant male preponderance. MD with coexisting headaches was more associated with severe saccular dysfunctions than MD without headaches. Concomitant headache may affect the manifestations of the vestibular function, especially in the sacculus, in MD cases.

Background: Falls along with gait‐balance disturbances are important symptoms of idiopathic normal pressure hydrocephalus (iNPH).Objectives: This study aimed to validate the Functional Gait Assessment (FGA) item‐difficulty hierarchy, determine its optimal fall cutoff value, and identify key items for assessing fall risk in iNPH.Methods: One hundred eighty‐eight iNPH patients underwent pre‐intervention assessments using the FGA, timed up‐and‐go (TUG), 10‐Meter Gait Speed (10MGS) tests, and their falls history in the past 6 months. Rasch analysis confirmed the validity of the FGA item‐difficulty hierarchy and established the relationship between total scores and logit estimates. Logistic regression identified the optimal FGA cutoff value and key fall‐related items.Results: The FGA's item‐difficulty hierarchy was confirmed to range from item 5 (“gait and pivot turn”) at −2.58 logits (easiest) to item 7 (“gait with narrow base of support”) at 5.35 logits (most difficult). Total scores corresponded to logits from −10.39 (score 0) to 11.64 (score 30). The fall rate was 63.3%. The optimal FGA cutoff value was ≤15 points (area under curve [AUC]: 0.901, P < 0.001), outperforming TUG (AUC: 0.712) and 10MGS (AUC: 0.742). Key fall‐related items (R²: 0.545, P < 0.001) were item 2 (“change in gait speed”), item 7 (“gait with narrow base of support”), item 1 (“gait on level surface”), item 10 (“stair steps”), and item 5 (“gait and pivot turn”).Conclusions: Our findings may facilitate early diagnosis and timely interventions, including tailored rehabilitation and fall prevention strategies, by leveraging the item difficulty and characteristics of the FGA for iNPH patients.