Bilateral Endolymphatic Hydrops More Common in Meniere's Disease Patients with Migraine: Imaging Study Finds

Migraines frequently coexist with MD, often complicating the interpretation of clinical diagnoses and inner ear imaging. While EH has been studied in both conditions independently, comparative imaging data for MD patients specifically with and without migraine remain scarce. To address this gap, Yoshiyuki Sasano of the University of Miami Miller School of Medicine and colleagues aimed to evaluate the EH in MD patients with and without migraine.

For this purpose, the researchers conducted a retrospective analysis on 78 patients with definite MD, comparing 56 isolated cases against 22 with comorbid migraine using 3.0 Tesla Magnetic Resonance Imaging (MRI). Utilizing the HYbriD of the reversed image of the positive endolymph signal and native image of the positive perilymph signal (HYDROPS) technique, investigators graded EH severity in the cochlea and vestibule four hours post-contrast, excluding subjects with bilateral MD, claustrophobia, or contrast allergies.

Key Findings of Analysis Include:

• Bilateral Hydrops Prevalence: The analysis unveiled that bilateral EH was significantly more frequent across all inner ear regions in the MD with migraine group compared to isolated MD cases.
• Symmetrical Fluid Signature: Investigators found that MD patients with comorbid migraine exhibit a unique symmetry in EH distribution, showing no significant interaural differences in the inner ear, vestibule, or cochlea.
• Healthy Cochlear Involvement: A significant EH occurred at a significantly higher frequency in the clinically healthy cochlea of the comorbid migraine group (40.9%) than in the isolated MD group (3.6%).
• Earlier Clinical Presentation: The MD patients with comorbid migraine present at a significantly younger mean age of onset (40.1 years) and age of examination (42.8 years) compared to those without migraine.
• Diagnostic Imaging Indicator: Authors conclude that detecting bilateral hydrops via the HYDROPS technique in suspected MD cases should prompt an immediate evaluation for comorbid migraine.

The results suggest that patients with MD and comorbid migraine exhibit a distinct radiological signature of bilateral and symmetrical EH, often involving the clinically healthy ear.

The author emphasizes that clinicians should consider evaluating for comorbid migraine when detecting bilateral endolymphatic hydrops on imaging in suspected Meniere’s disease cases, rather than attributing the findings solely to bilateral disease or asymptomatic fluid accumulation.

They acknowledged that the study's retrospective nature and limited sample size in the comorbid group may constrain the evaluation of specific vertigo triggers and the identification of subtle intergroup differences, which future larger prospective cohort research could further clarify.

Reference

Sasano, Y., Mochizuki, F., Ito, Y., Williams, E., Koizuka, I., Hoffer, M.E., & Komori, M. (2026). Characterizing Differences in Endolymphatic Hydrops Signatures Among Meniere’s Disease Patients with and Without Migraine. Medical Sciences, 14(1), 29.