Background: Signs of distinct brain dysfunction in patients where migraine intersects with vertigo (i.e. vestibular migraine (VM)), remains elusive. As migraine and vertigo can both independently modulate attentional processes, here we seek the utility of the attentional network to functionally differentiate patients.

Methods: We used the Attentional Network Task (ANT) to elucidate 3 separate functional networks: alerting, orienting and resolving conflict. 120 participants had to attend to the direction of a target visual stimulus, whilst other parameters were simultaneously manipulated. Reaction times across the networks were assessed in, (i) 30 healthy-controls, (ii) 30 VM patients, (iii) 30 patients with migraine without vertigo, and, (iv) 30 patients with benign paroxysmal positional vertigo (BPPV) but no migraine.

Results: Patients with VM (mean= 737.1ms, SEM= 28), migraine (mean= 735.3ms, SEM= 36.4), and BPPV (mean= 720.3ms SEM= 24.3) all exhibited significantly delayed ANT reaction times compared to healthy-controls (mean= 661.3ms, SEM= 23.4). Specific attentional network deficits were observed for resolving conflict in VM, alerting in migraine and orienting in BPPV.

Conclusion: VM patients displayed deficits in executive function characterised by an inability to focus attentional resources and suppress peripheral distractors, whereas migraineurs without vertigo exhibited changes in the alerting network that reflects hypervigilance.