AUTHOR=Sharif Mishaal , Rea Oliver , Burling Rose , Ellul Miraval Mel , Patel Rakesh , Saman Yougan , Rea Peter , Yoon Ha-Jun , Kheradmand Amir , Arshad Qadeer 

TITLE=Migrainous vertigo impairs adaptive learning as a function of uncertainty

JOURNAL=Frontiers in Neurology

VOLUME=Volume 15 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1436127

DOI=10.3389/fneur.2024.1436127

ISSN=1664-2295

ABSTRACT=Objective: Here we examined whether vestibular migraine, as a source of increased perceptual uncertainty due to the associated dizziness, can interfere with adaptive learning.We implemented the IOWA gambling task (IGT) to assess adaptive learning in both heathy controls and patients with migraine related dizziness. Participants were presented with four decks of cards (A, B, C and D), and requested to select a card over 100 trials. Participants received a monetary reward or a penalty with an equal probability when they selected a card. Card decks A and B (high risk decks) involved high rewards (win £100) and high penalties (lose £250) whereas C and D (low risk decks; favourable reward-to-punishment ratio) involved lower rewards (win £50) and penalties (lose £50) Task success required participants to decide (i.e. adaptively learn) through the feedback they received that C and D were the advantageous decks.Results: Analysis revealed that patients with vestibular migraine selected more high-risk cards compared to the control group. Chronic vestibular migraine patients compared to those with acute presentation showed delayed improvement in task performance. Only in acute vestibular migraine patients, we observed that impaired learning positively correlated with measures of dizzy symptoms.Our findings have clinical implications for how vestibular migraine can affect behavioural adaption in patients, either directly through altered perception, or indirectly by impacting cognitive processes that can result in maladaptive behaviour.