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Murphy CE, Roberts RA, Picou EM, Jacobson GP, Green AP. Probabilities of Isolated and Co-Occurring Vestibular Disorder Symptom Clusters Identified Using the Dizziness Symptom Profile. Ear Hear 2024; 45:878-883. [PMID: 38287481 DOI: 10.1097/aud.0000000000001482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
OBJECTIVES Dizziness is among the most common reasons people seek medical care. There are data indicating patients with dizziness, unsteadiness, or vertigo may have multiple underlying vestibular disorders simultaneously contributing to the overall symptoms. Greater awareness of the probability that a patient will present with symptoms of co-occurring vestibular disorders has the potential to improve assessment and management, which could reduce healthcare costs and improve patient quality of life. The purpose of the current investigation was to determine the probabilities that a patient presenting to a clinic for vestibular function testing has symptoms of an isolated vestibular disorder or co-occurring vestibular disorders. DESIGN All patients who are seen for vestibular function testing in our center complete the dizziness symptom profile, a validated self-report measure, before evaluation with the clinician. For this retrospective study, patient scores on the dizziness symptom profile, patient age, and patient gender were extracted from the medical record. The dizziness symptom profile includes symptom clusters specific to six disorders that cause vestibular symptoms, specifically: benign paroxysmal positional vertigo, vestibular migraine, vestibular neuritis, superior canal dehiscence, Meniere disease, and persistent postural perceptual dizziness. For the present study, data were collected from 617 participants (mean age = 56 years, 376 women, and 241 men) presenting with complaints of vertigo, dizziness, or imbalance. Patients were evaluated in a tertiary care dizziness specialty clinic from October 2020 to October 2021. Self-report data were analyzed using a Bayesian framework to determine the probabilities of reporting symptom clusters specific to an isolated disorder and co-occurring vestibular disorders. RESULTS There was a 42% probability of a participant reporting symptoms that were not consistent with any of the six vestibular disorders represented in the dizziness symptom profile. Participants were nearly as likely to report symptom clusters of co-occurring disorders (28%) as they were to report symptom clusters of an isolated disorder (30%). When in isolation, participants were most likely to report symptom clusters consistent with benign paroxysmal positional vertigo and vestibular migraine, with estimated probabilities of 12% and 10%, respectively. The combination of co-occurring disorders with the highest probability was benign paroxysmal positional vertigo + vestibular migraine (~5%). Probabilities decreased as number of symptom clusters on the dizziness symptom profile increased. The probability of endorsing vestibular migraine increased with the number of symptom clusters reported. CONCLUSIONS Many patients reported symptoms of more than one vestibular disorder, suggesting their symptoms were not sufficiently captured by the symptom clusters used to summarize any single vestibular disorder covered by the dizziness symptom profile. Our results indicate that probability of symptom clusters indicated by the dizziness symptom profile is comparable to prior published work on the prevalence of vestibular disorders. These findings support use of this tool by clinicians to assist with identification of symptom clusters consistent with isolated and co-occurring vestibular disorders.
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Affiliation(s)
- Claire E Murphy
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard A Roberts
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Erin M Picou
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Gary P Jacobson
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrea P Green
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Current Position: Sonova USA, Inc., Aurora, Illinois, USA
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Lu L, Ni W, Liu Y, Sun L, Li F. Anti-saccade as a tool to evaluate cognitive impairment in vestibular migraine. Front Neurol 2024; 15:1419372. [PMID: 38948136 PMCID: PMC11211558 DOI: 10.3389/fneur.2024.1419372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/03/2024] [Indexed: 07/02/2024] Open
Abstract
Background Vestibular migraine (VM), an intricate subtype of migraine, amalgamates the dual attributes of migraine and vestibular disorders. In clinical settings, individuals with VM frequently articulate concerns regarding the manifestation of subjective cognitive impairment. This cognitive dysfunction is intricately linked with diminished mobility, heightened susceptibility to falls, and increased absenteeism in afflicted patients. Consequently, comprehending the features of cognitive impairment in VM patients holds potential clinical significance. The pursuit of rapid and objective methods for detection and assessment is foundational and prerequisite for efficacious cognitive management of VM patients. Methods The study encompassed 50 patients diagnosed with vestibular migraine and recruited 50 age-sex matched healthy controls. All participants underwent anti-saccade tasks, and cognitive evaluation was performed using the MMSE and MoCA to assess overall cognitive function. Additionally, RBANS scales were employed to measure specific cognitive domains. Results The VM patients and normal controls demonstrated statistical parity in terms of age, gender, education, weight, and BMI, with no significant differences observed. Analysis of cognitive scores divulged a marked increase in the incidence of Mild Cognitive Impairment (MCI) in VM patients compared to Healthy Controls (HCs). Both MMSE and MoCA scores were notably lower in VM patients compared to their healthy counterparts. The RBANS cognitive test indicated significant impairment in immediate memory, visuospatial construction, language, attention, and delayed memory among VM patients. Notably, the Trail Making Test and Stroop Color-Word Test revealed compromised processing speed and executive function cognitive domains. The anti-saccadic task highlighted significantly elevated anti-saccadic latency and frequency of direction errors in vestibular migraine patients. Symptom severity, illness duration, and episode frequency in VM patients positively correlated with counter-scanning errors and negatively correlated with cognitive performance across diverse cognitive domains. Conclusion VM patients exhibit cognitive decline across multiple cognitive domains during the interictal period. This cognitive impairment may not be fully reversible, underscoring its potential clinical significance for cognitive management in VM patients. The sensitivity of anti-saccade tasks to the cognitive status of VM patients positions them as promising objective indicators for diagnosis, intervention, and evaluation of cognitive impairment effects in VM in future applications.
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Affiliation(s)
- Lingmei Lu
- Department of Neurology, Qidong People’s Hospital/Affiliated Qidong Hospital of Nantong University, Nantong, China
| | - Wenyu Ni
- Department of Endocrinology, Qidong People’s Hospital/Affiliated Qidong Hospital of Nantong University, Nantong, China
| | - Yin Liu
- Dizziness Clinic, Jilin Provincial Academy of Chinese Medicine Sciences, Changchun, China
| | - Li Sun
- Dizziness Clinic, Jilin Provincial Academy of Chinese Medicine Sciences, Changchun, China
| | - Fei Li
- Department of Neurology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
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Nascimento J, Araújo P, Moreira I, Henriques MM, Amorim M, Machado E, Monteiro C. Visual vertigo in children- adaptation and validation of the visual vertigo analogue scale to European Portuguese. J Vestib Res 2024:VES230140. [PMID: 38875066 DOI: 10.3233/ves-230140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
BACKGROUND Visual vertigo occurs after vestibular and non-vestibular pathology and can be present in children and adolescents. It can be assessed by "the Visual Vertigo Analogue Scale" (VVAS), a questionnaire with a Portuguese version for adults. OBJECTIVES To perform the adaptation to pediatric age and validation of VVAS in European Portuguese. METHODS This prospective study involved the pediatric adaptation of the Portuguese VVAS, according to recognized guidelines. It was then completed by 30 healthy controls and 18 children with vestibulopathy. Patient caregivers also completed the Dizziness Handicap Inventory - Patient Caregivers (DHI-PC) to further explore the link between questionnaires. Groups were compared for severity of visual vertigo and VVAS test-retest reliability was tested. RESULTS The VVAS score was significantly higher in vestibular group (p < 0.001). No statistically significant differences were found between VVAS initial and re-test scores (p = 0.33). VVAS severity scores showed a positive correlation with DHI-PC (r = 0.598, p = 0.009). CONCLUSION The present Pediatric adaptation of VVAS in European Portuguese shows good psychometric properties for the assessment of visual vertigo. A positive correlation with the DHI-PC was showed, establishing the potential use of both questionnaires in the evaluation of vertigo children.
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Affiliation(s)
- Joana Nascimento
- Department of ENT, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Pedro Araújo
- Department of ENT, Hospital da Luz, Lisbon, Portugal
| | - Inês Moreira
- Department of ENT, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | | | - Margarida Amorim
- Department of ENT, Centro Hospitalar de Coimbra, Lisbon, Portugal
| | - Eugénia Machado
- Department of ENT, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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Hannigan IP, Rosengren SM, Di Tanna GL, Watson SRD, Welgampola MS. Effects of nonprescription therapies on vestibular migraine: a questionnaire-based observational study. Intern Med J 2024; 54:916-924. [PMID: 38204302 DOI: 10.1111/imj.16314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/30/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Vestibular migraine (VM) is a common cause of recurrent vertigo. Migraine headache preventative therapies are currently prescribed to control vertigo symptoms in VM. Clinical trials of nutraceuticals for migraine headache prevention have shown positive outcomes, but, to date, there have been no studies to assess their effectiveness in the management of VM. AIMS To report the effects of nonprescription therapy management on VM symptoms. METHODS We undertook a prospective, questionnaire-based assessment of patients diagnosed with VM between November 2019 and August 2021 at two Sydney tertiary referral clinics. Patients were advised on optimising sleep, hydration, exercise and nutrition and instructed to use an over-the-counter combination product containing riboflavin 200 mg, magnesium 150 mg, coenzyme Q10 75 mg and feverfew 200 mcg. Symptom severity and frequency were assessed using the Dizziness Handicap Inventory (DHI), the Vertigo Symptom Score short-form (VSS-sf) and two visual analogue scales for severity (VAS-s) and frequency (VAS-f) before and 3 months after commencing treatment. RESULT In 82 participants (78% female; mean age, 44 ± 14 years) we recorded a decrease in DHI (mean, 16.8 [95% confidence interval (CI), 12.8-20.9], VSS-sf (9.3, 7.1-11.5), VAS-s (3.0, 2.2-3.8) and VAS-f (2.8, 2.1-3.4), equating to an improvement of 44.1%, 44.9%, 44.1% and 38.9% for each measure respectively. On the DHI and VSS-sf, 41 (50%) and 44 (53.7%) patients showed improvement in their symptoms; 39 (47.6%) and 36 (43.9%) patients noted no change and two patients reported worsening. The supplement was well-tolerated. CONCLUSIONS The results provide preliminary evidence that VM symptom frequency and severity can be reduced by using nonprescription therapies.
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Affiliation(s)
- Imelda P Hannigan
- Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
- Blacktown Neurology Clinic, Blacktown, New South Wales, Australia
| | - Sally M Rosengren
- Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Gian L Di Tanna
- Biostatistics and Data Science Division, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Shaun R D Watson
- Blacktown Neurology Clinic, Blacktown, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Miriam S Welgampola
- Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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5
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Wang C, Young AS, Raj C, Bradshaw AP, Nham B, Rosengren SM, Calic Z, Burke D, Halmagyi GM, Bharathy GK, Prasad M, Welgampola MS. Machine learning models help differentiate between causes of recurrent spontaneous vertigo. J Neurol 2024; 271:3426-3438. [PMID: 38520520 DOI: 10.1007/s00415-023-11997-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 09/10/2023] [Accepted: 09/13/2023] [Indexed: 03/25/2024]
Abstract
BACKGROUND Vestibular migraine (VM) and Menière's disease (MD) are two common causes of recurrent spontaneous vertigo. Using history, video-nystagmography and audiovestibular tests, we developed machine learning models to separate these two disorders. METHODS We recruited patients with VM or MD from a neurology outpatient facility. One hundred features from six "feature subsets": history, acute video-nystagmography and four laboratory tests (video head impulse test, vestibular-evoked myogenic potentials, caloric testing and audiogram) were used. We applied ten machine learning algorithms to develop classification models. Modelling was performed using three "tiers" of data availability to simulate three clinical settings. "Tier 1" used all available data to simulate the neuro-otology clinic, "Tier 2" used only history, audiogram and caloric test data, representing the general neurology clinic, and "Tier 3" used history alone as occurs in primary care. Model performance was evaluated using tenfold cross-validation. RESULTS Data from 160 patients with VM and 114 with MD were used for model development. All models effectively separated the two disorders for all three tiers, with accuracies of 85.77-97.81%. The best performing algorithms (AdaBoost and Random Forest) yielded accuracies of 97.81% (95% CI 95.24-99.60), 94.53% (91.09-99.52%) and 92.34% (92.28-96.76%) for tiers 1, 2 and 3. The best feature subset combination was history, acute video-nystagmography, video head impulse test and caloric testing, and the best single feature subset was history. CONCLUSIONS Machine learning models can accurately differentiate between VM and MD and are promising tools to assist diagnosis by medical practitioners with diverse levels of expertise and resources.
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Affiliation(s)
- Chao Wang
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, University of Sydney, Sydney, Australia
| | - Allison S Young
- Central Clinical School, University of Sydney, Sydney, Australia
| | - Chahat Raj
- School of Computer Science, Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, Australia
| | - Andrew P Bradshaw
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
| | - Benjamin Nham
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, University of Sydney, Sydney, Australia
| | - Sally M Rosengren
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, University of Sydney, Sydney, Australia
| | - Zeljka Calic
- Department of Neurophysiology, Liverpool Hospital, Sydney, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - David Burke
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, University of Sydney, Sydney, Australia
| | - G Michael Halmagyi
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, University of Sydney, Sydney, Australia
| | - Gnana K Bharathy
- School of Computer Science, Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, Australia
| | - Mukesh Prasad
- School of Computer Science, Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, Australia
| | - Miriam S Welgampola
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia.
- Central Clinical School, University of Sydney, Sydney, Australia.
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Villar-Martinez MD, Goadsby PJ. Vestibular migraine: an update. Curr Opin Neurol 2024; 37:252-263. [PMID: 38619053 PMCID: PMC11064914 DOI: 10.1097/wco.0000000000001257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
PURPOSE OF REVIEW We performed a narrative review of the recent findings in epidemiology, clinical presentation, mechanisms and treatment of vestibular migraine. RECENT FINDINGS Vestibular migraine is an underdiagnosed condition that has a high prevalence among general, headache and neuro-otology clinics. Vestibular migraine has a bimodal presentation probably associated with a hormonal component in women. These patients could have a complex clinical phenotype including concomitant autonomic, inflammatory or connective tissue conditions that have a higher prevalence of psychological symptoms, which may mistakenly lead to a diagnosis of a functional neurological disorder. A high proportion of patients with postural perceptual persistent dizziness have a migraine phenotype. Independently of the clinical presentation and past medical history, patients with the vestibular migraine phenotype can respond to regular migraine preventive treatments, including those targeting the calcitonin gene-related peptide pathways. SUMMARY Vestibular migraine is an underdiagnosed migraine phenotype that shares the pathophysiological mechanisms of migraine, with growing interest in recent years. A thorough anamnesis is essential to increase sensitivity in patients with unknown cause of dizziness and migraine treatment should be considered (see supplemental video-abstract).
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Affiliation(s)
- Maria D. Villar-Martinez
- NIHR King's Clinical Research Facility, SLaM Biomedical Research Centre and Wolfson Sensory Pain and Regeneration, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Peter J. Goadsby
- NIHR King's Clinical Research Facility, SLaM Biomedical Research Centre and Wolfson Sensory Pain and Regeneration, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- Department of Neurology, University of California, Los Angeles, California, USA
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Pajaniappane A. Assessment and management of vestibular migraine within ENT. J Laryngol Otol 2024; 138:S22-S26. [PMID: 38291947 DOI: 10.1017/s0022215123002062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
OBJECTIVE Vestibular migraine is a newly recognised and debilitating condition. This article aims to provide an overview of what is known of vestibular migraine, delineating its diagnostic criteria and presenting some initial management strategies to aid ENT professionals in delivering optimal care when patients first present to the otolaryngology clinic. METHOD Although traditionally underdiagnosed, there are now clearly defined diagnostic criteria to aid accurate diagnosis of vestibular migraine. RESULTS A detailed history and clinical examination are the cornerstone of the diagnostic process, but supportive evidence is required from appropriate audio-vestibular tests and imaging. CONCLUSION This is a unique condition that commonly initially presents to ENT. This article provides a summary of diagnostic and management strategies to facilitate early diagnosis and first-line treatment that can be employed in general ENT settings, which may be particularly useful given the limited availability of specialist audio-vestibular medicine and neuro-otology services.
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Affiliation(s)
- Arun Pajaniappane
- Department of Audiovestibular Medicine, St George's University Hospitals NHS Trust, Tooting, UK
- Harley Street Audiovestibular Clinic, London, UK
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Zou X, He J, Zhou M, Zhao F, Tian X, Xu X, Hong W, Wang F, Chen J, Qin C, Xia J, Xie Y, Xiao Y, Liu K, Guo L. Photophobia and Visual Triggers in Vestibular Migraine. Neurol Ther 2024:10.1007/s40120-024-00631-8. [PMID: 38819614 DOI: 10.1007/s40120-024-00631-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/09/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION Vestibular migraine (VM) is a prevalent vestibular disorder characterized by episodic vertigo. However, the relationship between photophobia and visual triggers in VM remains unexplored. We investigated the correlation of photophobia during the VM attack with interictal photosensitivity and visually triggering dizziness in patients with VM. METHODS We enrolled patients diagnosed with VM, with or without photophobia, across seven specialized vertigo and headache clinics in China. Healthy individuals were also included as a control group. Using a cross-sectional survey design, we collected data related to light intensity and dizziness frequency triggered by flicker, glare, and eyestrain using the Headache Triggers Sensitivity and Avoidance Questionnaire. RESULTS A total of 366 patients were recruited. The photosensitivity and frequency of dizziness induced by flicker, glare, and eyestrain observed in patients with VM and photophobia were significantly elevated compared with those in patients without photophobia and control participants (P < 0.001). A significant positive correlation was observed between photosensitivity levels and dizziness frequency triggered by flicker, glare, and eyestrain in patients with VM and photophobia (P < 0.001). CONCLUSIONS This study unequivocally established a positive association of ictal photophobia with interictal photosensitivity and visually triggering dizziness, strongly advocating the need for further research on exposure-based therapies for managing VM. CLINICAL TRIALS REGISTRATION ClinicalTrial.gov Identifier, NCT04939922, retrospectively registered, 14th June 2021.
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Affiliation(s)
- Xiaodong Zou
- Department of Neurology, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, Zhejiang, China
- Key Laboratory of Cancer Prevention and Therapy Combining Traditional Chinese and Western Medicine of Zhejiang Province, Hangzhou, 310012, Zhejiang, China
| | - Jiahui He
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China
| | - Mengting Zhou
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China
| | - Fangling Zhao
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China
| | - Xiulin Tian
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China
| | - Xiaopei Xu
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China
| | - Wenwu Hong
- Department of Neurology, Tiantai People's Hospital of Zhejiang Province, Tiantai, 317200, Zhejiang, China
| | - Faming Wang
- Department of Neurology, Tiantai People's Hospital of Zhejiang Province, Tiantai, 317200, Zhejiang, China
| | - Juanyan Chen
- Department of Neurology, Dongyang People's Hospital, Dongyang, 322103, Zhejiang, China
| | - Chenghui Qin
- Department of Neurology, Affiliated Hospital of Shaoxing University, Shaoxing, 312099, Zhejiang, China
| | - Jinjin Xia
- Department of Neurology, Changxing People's Hospital of Zhejiang Province, Changxing, 313199, Zhejiang, China
| | - Yuying Xie
- Department of Neurology, Shanghang County Hospital, Shanghang, 364299, Fujian, China
| | - Yujin Xiao
- Department of Neurology, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, 314033, Zhejiang, China
| | - Kaiming Liu
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.
| | - Liang Guo
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China.
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Ceriani CEJ. Beyond Vertigo: Vestibular, Aural, and Perceptual Symptoms in Vestibular Migraine. Curr Pain Headache Rep 2024:10.1007/s11916-024-01245-3. [PMID: 38780828 DOI: 10.1007/s11916-024-01245-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To review the vestibular, aural, and perceptual symptoms of vestibular migraine (VM) that may present alongside vertigo. RECENT FINDINGS Increased research attention to the wide spectrum of symptoms presenting in VM patients has improved understanding of this disorder, with recent identification of five different VM phenotypes. Research into the clinical overlap between VM and other chronic vestibular syndromes such as persistent postural-perceptual dizziness and mal-de-debarquement syndrome reveals a range of vestibular symptoms and hints at pathophysiological connections between migraine and vestibular dysfunction. Studies of migraine treatment for hearing loss suggest patients presenting with aural symptoms may have an underlying diagnosis of migraine and deserve a trial of migraine preventives. Research into the neurologic basis of the perceptual disorder Alice in Wonderland syndrome has revealed brain areas that are likely involved and may help explain its prevalence in VM patients. VM is a sensory processing disorder that presents with more than just vertigo. Understanding the range of potential symptoms improves diagnosis and treatment for migraine patients whose diagnosis may be missed when only the symptoms identified in the diagnostic criteria are considered.
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Affiliation(s)
- Claire E J Ceriani
- Department of Neurology, Jefferson Headache Center, Thomas Jefferson University, 900 Walnut St., Ste 200, Philadelphia, PA, 19107, USA.
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Chen Z, Liu Y, Lin C, Li Z, Shan J, Duan Z, Rong L, Wei X, Xiao L, Liu H. Aberrant cerebral blood flow and functional connectivity in patients with vestibular migraine: a resting-state ASL and fMRI study. J Headache Pain 2024; 25:84. [PMID: 38773396 PMCID: PMC11107056 DOI: 10.1186/s10194-024-01792-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 05/15/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Prior neuroimaging studies on vestibular migraine (VM) have extensively certified the functional and structural alterations in multiple brain regions and networks. However, few studies have assessed the cerebral blood flow (CBF) in VM patients using arterial spin labeling (ASL). The present study aimed to investigate CBF and functional connectivity (FC) alterations in VM patients during interictal periods. METHODS We evaluated 52 VM patients and 46 healthy controls (HC) who received resting-state pseudo-continuous ASL and functional magnetic resonance imaging (fMRI) scanning. Comparisons of voxel-based CBF and seed-based FC were performed between the two groups. Brain regions showed significant group differences in CBF analyses were chosen as seeds in FC analyses. Additionally, the associations between abnormal imaging results and clinical features were explored. RESULTS Compared with HC, VM patients showed higher normalized CBF in the right precentral gyrus (PreCG), left postcentral gyrus (PostCG), left superior frontal gyrus and bilateral insular (p < 0.05, FDR corrected). Furthermore, VM patients exhibited increased FC between the right PreCG and areas of the left PostCG, left cuneus and right lingual gyrus (p < 0.05, FDR corrected). In addition, we observed decreased FC between the left insular and regions of the left thalamus and right anterior cingulate cortex, as well as increased FC between the left insular and right fusiform gyrus in VM patients (p < 0.05, FDR corrected). Moreover, these variations in brain perfusion and FC were significantly correlated with multiple clinical features including frequency of migraine symptoms, frequency of vestibular symptoms and disease duration of VM (all p < 0.05). CONCLUSIONS Patients with VM during interictal period showed hyperperfusion and abnormal resting-state FC in brain regions potentially contributed to disrupted multi-sensory and autonomic processing, as well as impaired ocular motor control, pain modulation and emotional regulation. Our study provided novel insights into the complex neuropathology of VM from a CBF perspective.
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Affiliation(s)
- Zhengwei Chen
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Yueji Liu
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Cunxin Lin
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Zhining Li
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Junjun Shan
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Zuowei Duan
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Liangqun Rong
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Xiue Wei
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Lijie Xiao
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China.
| | - Haiyan Liu
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China.
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Feil K, Rattay TW, Adeyemi AK, Goldschagg N, Strupp ML. [What's behind cerebellar dizziness? - News on diagnosis and therapy]. Laryngorhinootologie 2024; 103:337-343. [PMID: 37989215 DOI: 10.1055/a-2192-7278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
Vertigo and dizziness comprise a multisensory and multidisciplinary syndrome of different etiologies. The term "cerebellar vertigo and dizziness" comprises a heterogenous group of disorders with clinical signs of cerebellar dysfunction and is caused by vestibulo-cerebellar, vestibulo-spinal or cerebellar systems. About 10 % of patients in an outpatient clinic for vertigo and balance disorders suffer from cerebellar vertigo and dizziness. According to the course of the symptoms, one can considers 3 types: permanent complaints, recurrent episodes of vertigo and balance disorders, or an acute onset of complaints. The most common diagnoses in patients with cerebellar vertigo and dizziness were as follows: degenerative disease, hereditary forms and acquired forms. In a subgroup of patients with cerebellar vertigo, central cerebellar oculomotor dysfunction is indeed the only clinical correlate of the described symptoms. 81 % of patients with cerebellar vertigo suffer from permanent, persistent vertigo and dizziness, 31 % from vertigo attacks, and 21 % from both. Typical clinical cerebellar signs, including gait and limb ataxia or dysarthria, were found less frequently. Key to diagnosis is a focused history as well as a thorough clinical examination with particular attention to oculomotor function. Regarding oculomotor examination, the most common findings were saccadic smooth pursuit, gaze-evoked nystagmus, provocation nystagmus, rebound nystagmus, central fixation nystagmus, most commonly downbeat nystagmus, and disturbances of saccades. Thus, oculomotor examination is very sensitive in diagnosing cerebellar vertigo and dizziness, but not specific in distinguishing different etiologies. Laboratory examinations using posturography and a standardized gait analysis can support the diagnosis, but also help to estimate the risk of falls and to quantify the course and possible symptomatic treatment effects. Patients with cerebellar vertigo and dizziness should receive multimodal treatment.
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Affiliation(s)
- Katharina Feil
- Schwerpunkt neurovaskuläre Erkrankungen, Neurologische Universitätsklinik, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Tim W Rattay
- Schwerpunkt neurodegenerative Erkrankungen, Neurologische Universitätsklinik, Universitätsklinikum Tübingen, Tübingen, Germany
- Hertie-Institut für klinische Hirnforschung, Universitätsklinikum Tübingen, Tübingen
| | - Adedolapo Kamaldeen Adeyemi
- Schwerpunkt neurovaskuläre Erkrankungen, Neurologische Universitätsklinik, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Nicolina Goldschagg
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, München, Germany
- Deutsches Schwindel- und Gleichgewichtszentrum, DSGZ, Ludwig-Maximilians-Universität München, München, Germany
| | - Michael Leo Strupp
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, München, Germany
- Deutsches Schwindel- und Gleichgewichtszentrum, DSGZ, Ludwig-Maximilians-Universität München, München, Germany
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12
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Arshad Q, Moreno-Ajona D, Goadsby PJ, Kheradmand A. What visuospatial perception has taught us about the pathophysiology of vestibular migraine. Curr Opin Neurol 2024; 37:32-39. [PMID: 38018799 PMCID: PMC11090135 DOI: 10.1097/wco.0000000000001232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
PURPOSE OF REVIEW A decade has passed since vestibular migraine (VM) was formally established as a clinical entity. During this time, VM has emerged amongst the most common cause of episodic vertigo. Like all forms of migraine, VM symptoms are most prominent during individual attacks, however many patients may also develop persistent symptoms that are less prominent and can still interfere with daily activities. RECENT FINDINGS Vestibular inputs are strongly multimodal, and because of extensive convergence with other sensory information, they do not result in a distinct conscious sensation. Here we review experimental evidence that supports VM symptoms are linked to multisensory mechanisms that control body motion and position in space. SUMMARY Multisensory integration is a key concept for understanding migraine. In this context, VM pathophysiology may involve multisensory processes critical for motion perception, spatial orientation, visuospatial attention, and spatial awareness.
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Affiliation(s)
- Qadeer Arshad
- InAmind Laboratory, College of Life Sciences, University of Leicester, Leicester, UK
| | - David Moreno-Ajona
- Department of Neurology, Queen Elizabeth Hospital, London UK
- NIHR King’s Clinical Research Facility, King’s College London, UK
| | - Peter J. Goadsby
- NIHR King’s Clinical Research Facility, King’s College London, UK
- Department of Neurology, University of California, Los Angeles, CA USA
| | - Amir Kheradmand
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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13
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Ceriani CEJ. Vestibular Migraine Pathophysiology and Treatment: a Narrative Review. Curr Pain Headache Rep 2024; 28:47-54. [PMID: 37889468 DOI: 10.1007/s11916-023-01182-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE OF REVIEW To review the diagnosis of vestibular migraine (VM) and update the clinician on the most recent developments in our understanding of its pathophysiology and treatment. RECENT FINDINGS Functional imaging studies have identified multiple regions of the brain with abnormal activity and connectivity in VM. There is evidence of abnormal sensory processing and integration in VM patients. Calcitonin gene-related peptide (CGRP) has also been found to play a role in trigeminal and vestibular nucleus pathways. Research into treatment modalities has identified several neuromodulation devices that may be effective in VM. There are a growing number of evidence-based preventive options for VM, including medications that target CGRP. VM is best understood as a sensory processing disorder. CGRP appears to play a role, and further research is needed to fully understand its effects. Treatment options are expanding, but there is still a need for more randomly controlled trials in this area.
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Affiliation(s)
- Claire E J Ceriani
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University, 900 Walnut St., Ste 200, Philadelphia, PA, 19107, USA.
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14
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Kolberg, AuD C, Roberts, PhD RA, Watford, DNP KE, Picou, AuD, PhD EM, Corcoran, AuD K. Long-Term Effects of Intervention on Vestibular Migraine: A Preliminary Study. Ann Otol Rhinol Laryngol 2024; 133:111-114. [PMID: 37464590 PMCID: PMC10759244 DOI: 10.1177/00034894231185400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Vestibular migraine is a common cause of vertigo. Intervention often includes preventive and/or rescue medications. Lifestyle modifications are often used along with medications but can be used as the sole intervention. There is lack of clarity regarding the long-term benefits of these interventions. AIMS The purpose of this study was to determine long-term effects of intervention types on dizziness in patients with vestibular migraine. METHODS Twenty-three participants were grouped based on intervention into preventive medication plus lifestyle modifications, rescue medication plus lifestyle modifications, or lifestyle modifications only. Outcomes were determined at ~372 days post intervention by comparing pre- and post-Dizziness Handicap Inventory scores. A difference of ≥18 points was considered a change and we also evaluated change in severity scale on this measure. RESULTS Using the group mean change score, only the rescue medication plus lifestyle modification group was significantly improved at 372 days of intervention. Considering all individual participants, 30% of the participants had improvement in dizziness at this point, regardless of intervention. Fifty percent of the rescue medication plus lifestyle modification group had significant reduction in dizziness, while the preventive medication plus lifestyle modification and the lifestyle modification only groups performed similarly using this criterion. Considering change in severity category, 43% of all participants improved by at least one category. The rescue medication plus lifestyle modifications and the lifestyle modifications only groups performed similarly with 50% of their respectively groups exhibiting improvement by at least one category. Notably, there was no worsening of dizziness for any participant in the lifestyle modification only group. CONCLUSION Our findings suggest that improvement in dizziness is maintained at ~372days of intervention in patients with vestibular migraine. Intervention using rescue medications plus lifestyle modifications had the best outcomes, followed by lifestyle modifications only. There was no worsening in dizziness for the lifestyle modification only intervention. More work is needed to better understand intervention effects, but it is encouraging that effects are maintained at greater than one year.
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Affiliation(s)
- Courtney Kolberg, AuD
- Department of Otolaryngology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Richard A. Roberts, PhD
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kenneth E. Watford, DNP
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Erin M. Picou, AuD, PhD
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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15
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Halmágyi GM, Akdal G, Welgampola MS, Wang C. Neurological update: neuro-otology 2023. J Neurol 2023; 270:6170-6192. [PMID: 37592138 PMCID: PMC10632253 DOI: 10.1007/s00415-023-11922-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/19/2023]
Abstract
Much has changed since our last review of recent advances in neuro-otology 7 years ago. Unfortunately there are still not many practising neuro-otologists, so that most patients with vestibular problems need, in the first instance, to be evaluated and treated by neurologists whose special expertise is not neuro-otology. The areas we consider here are mostly those that almost any neurologist should be able to start managing: acute spontaneous vertigo in the Emergency Room-is it vestibular neuritis or posterior circulation stroke; recurrent spontaneous vertigo in the office-is it vestibular migraine or Meniere's disease and the most common vestibular problem of all-benign positional vertigo. Finally we consider the future: long-term vestibular monitoring and the impact of machine learning on vestibular diagnosis.
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Affiliation(s)
- Gábor M Halmágyi
- Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia.
- Central Clinical School, University of Sydney, Sydney, Australia.
| | - Gülden Akdal
- Neurology Department, Dokuz Eylül University Hospital, Izmir, Turkey
- Neurosciences Department, Dokuz Eylül University Hospital, Izmir, Turkey
| | - Miriam S Welgampola
- Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, University of Sydney, Sydney, Australia
| | - Chao Wang
- Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, University of Sydney, Sydney, Australia
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16
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Rahman SM, Guo L, Minarovich C, Moon L, Guo A, Luebke AE. Human RAMP1 overexpressing mice are resistant to migraine therapies for motion sensitivity: a mouse model of vestibular migraine. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.24.563838. [PMID: 37961568 PMCID: PMC10634789 DOI: 10.1101/2023.10.24.563838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Both enhanced motion-induced nausea and increased static imbalance are \observed symptoms in migraine and especially vestibular migraine (VM). Motion-induced nausea and static imbalance were investigated in a mouse model, nestin/hRAMP1, expressing elevated levels of human RAMP1 in the CNS, which enhances CGRP signaling in the nervous system. Behavioral surrogates such as the motion-induced thermoregulation and postural sway center of pressure (CoP) assays were used to assess motion sensitivity. Tail vasodilation analysis revealed that this model exhibits an increased sensitivity to CGRP's effects at lower doses compared to control mice. In addition, the nestin/hRAMP1 mice exhibit a higher dynamic range in postural sway than their wildtype counterparts, along with increased sway observed in nestin/hRAMP1 male mice that was not present in male littermate controls. Results from migraine blocker experiments were challenging to interpret, but the data suggests that olcegepant is incapable of reversing CGRP-induced alterations in the nestin/hRAMP1 mice, while rizatriptan was ineffective in both the nestin/hRAMP1 and control mice. The results indicate that overexpression of hRAMP1 leads to heightened endogenous CGRP signaling. Results also suggest that both olcegepant and rizatriptan are ineffective in reducing CGRP-triggered nausea and sway in this hypersensitive CGRP mouse model. This study suggests that hypersensitivity to CGRP may be a mouse model for difficult to treat cases of vestibular migraine.
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Padovan L, Becker-Bense S, Flanagin VL, Strobl R, Limburg K, Lahmann C, Decker J, Dieterich M. Anxiety and physical impairment in patients with central vestibular disorders. J Neurol 2023; 270:5589-5599. [PMID: 37550497 PMCID: PMC10576724 DOI: 10.1007/s00415-023-11871-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/10/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND There is increasing evidence for close interrelations between vestibular and emotional brain networks. A study in patients with bilateral peripheral vestibulopathy (BVP) showed relatively low vertigo-related anxiety (VRA), despite high physical impairment. The current working hypothesis proposes the integrity of the peripheral vestibular system as a prerequisite for development of VRA. Here we contribute by evaluating VRA and vestibular-related handicap in central vestibular disorders. METHODS Of 6396 patients presenting in a tertiary vertigo centre, 306 were identified with four clear central vestibular disorders: pure cerebellar ocular motor disorder (COD; 61), cerebellar ataxia (CA; 63), atypical parkinsonian syndromes (APS; 28), vestibular migraine (VM; 154). Their results of the Vertigo Handicap Questionnaire (VHQ), with its subscales for anxiety and handicapped activity, were compared to those of 65 BVP patients. Postural instability was measured on a force-plate. Multivariate linear regression was used to adjust for patient demographics. RESULTS Patients with chronic central vestibular disorders (COD, CA, APS) had relatively low VRA levels comparable to those in BVP, independent of increased handicapped activity or postural instability. Only VM patients showed significantly higher VRA, although their activity impairment and postural instability were lowest. No significant differences within chronic central vestibular disorders were found for VRA and subjective activity impairment. CONCLUSIONS Subjective and objective vestibular-related impairment are not necessarily correlated with vestibular-related anxiety in central vestibular disorders. Our findings rather support the hypothesis that, in addition to an intact peripheral, an intact central vestibular system could also serve as a prerequisite to develop specific VRA.
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Affiliation(s)
- Lena Padovan
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany.
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Sandra Becker-Bense
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Virginia L Flanagin
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Ralf Strobl
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany
- Institute for Medical Information Processing Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität München, Munich, Germany
| | - Karina Limburg
- Clinic for Conservative Orthopaedics, Manual Medicine and Pain Medicine, Sana Klinik München, Munich, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Julian Decker
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany
- Department of Neurology, Schön Klinik Bad Aibling, Bad Aibling, Germany
| | - Marianne Dieterich
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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18
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Shen Y, Li D, Cao Q, Hu M, Hou Z, Xu L, Li Y, Hong D. Risk factors of vestibular migraine-related brain white matter lesions. Acta Neurol Belg 2023; 123:1833-1839. [PMID: 36071312 DOI: 10.1007/s13760-022-02076-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/22/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE AND PURPOSE Migraine is related to white matter lesions (WMLs), and attack frequency and duration in migraine patients are thought to increase WMLs. However, the relationship between vestibular migraine (VM) and WMLs remains unclear. This study explored the risk factors for WMLs in VM patients and provided a basis for the prevention of WMLs in VM patients. METHODS A large single-center cross-sectional study of patients with VM was conducted. None of the patients had comorbidities, such as hypertension and diabetes, or adverse lifestyle habits (smoking and drinking). All patients were divided into WML + and WML- groups after assessment of WMLs using magnetic resonance imaging (MRI). After collecting the patient's detailed medical history, statistical analysis was performed. RESULTS In univariate analysis, the frequency of vertigo was statistically significant between the WML + and WML- groups. However, there was no significant difference in other clinical features. Multivariate regression analysis found that the frequency of vertigo (OR 2.399; 95% CI 1.014-5.679; p = 0.046) was an independent risk factor for WMLs. High frequency of vertigo episodes showed more pronounced risk factors (OR 9.607; 95% CI 1.061-87.014; p = 0.044). CONCLUSION These results substantiate that vertigo frequency is an independent risk factor for WMLs in VM. A high frequency of vertigo episodes is more likely to be associated with WMLs than a low frequency. These results suggest a possible approach to the prevention of WMLs in VM patients.
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Affiliation(s)
- Yu Shen
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Yong Wai Zheng Street 17, Nanchang, Jiangxi, China
| | - Defu Li
- School of Public Health, Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, Jiangxi, China
| | - Qian Cao
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Mengyao Hu
- The Medical Imaging Center, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhou Hou
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Lijun Xu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yanping Li
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Daojun Hong
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Yong Wai Zheng Street 17, Nanchang, Jiangxi, China.
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19
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Özçelik P, Koçoğlu K, Halmágyi GM, Akdal G. Video head impulse and suppression head impulse test in vestibular migraine. Acta Otolaryngol 2023; 143:856-860. [PMID: 38071651 DOI: 10.1080/00016489.2023.2284877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/08/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Vestibular Migraine (VM) is a frequent cause of recurrent spontaneous vertigo. While some report a normal Video Head Impulse Test (vHIT) in VM, others observed abnormal results on this test. Whether or not methodological discrepancies could be the cause of these differences is not known. There are 2 vHIT methods: subjects fixating an earth-fixed target (HIMP paradigm) or a head-fixed target, the suppression head impulse test (SHIMP paradigm). OBJECTIVES The present study aimed to compare VM patients against healthy controls on both HIMP and SHIMP in order to unravel any differences between them. METHODS Forty-eight VM patients and 27 healthy controls tested with both the HIMP and SHIMP paradigm. Results: Our 48 VM patients showed mean VOR normal range gains in both the HIMP and SHIMP paradigms, although there were some VOR impairments in individual semicircular SCCs. VM patients with motion sickness had lower horizontal VOR gain than those without motion sickness, with the HIMP, but not the SHIMP paradigm. CONCLUSION VM patients have normal VOR gain with either vHIT paradigm. SIGNIFICANCE The clinical significance of this observation is that a definitely abnormal vHIT with either method is unlikely to be due to vestibular migraine and an alternative diagnosis should be sought.
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Affiliation(s)
- Pınar Özçelik
- Institute of Health Sciences, Department of Neurosciences, Dokuz Eylül University, Izmir, Türkiye
- Faculty of Medicine, Department of Neurology, Bezmialem Vakif University, Istanbul, Türkiye
| | - Koray Koçoğlu
- Institute of Health Sciences, Department of Neurosciences, Dokuz Eylül University, Izmir, Türkiye
| | - Gábor M Halmágyi
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, University of Sydney, Sydney, Australia
| | - Gülden Akdal
- Institute of Health Sciences, Department of Neurosciences, Dokuz Eylül University, Izmir, Türkiye
- Faculty of Medicine, Department of Neurology, Dokuz Eylül University, Izmir, Türkiye
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Zanandrea L, Colombo B, Filippi M. Vestibular Migraine Therapy: Update and Recent Literature Review. Audiol Res 2023; 13:724-729. [PMID: 37887845 PMCID: PMC10604437 DOI: 10.3390/audiolres13050064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/04/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Vestibular migraine (VM) is a neurological condition that causes vertigo and headache. It is considered the most common cause of episodic vertigo. However, specific treatments are missing, and medications currently used in VM are borrowed from migraine therapy. A comprehensive practical review of the literature assessing the evidence for abortive and preventive interventions in adults with VM was published in 2022, providing practical recommendations about VM treatment. The aim of our paper is to provide an updated overview of the current state of the art of VM treatment, illustrating new evidence available in this field. Along with traditional pharmacological preventive therapies, medications targeting the CGRP pathways have recently been investigated in terms of treatment effect in VM patients, with encouraging results. Also, there is new evidence of the efficacy of non-pharmacological interventions. However, the overall evidence base for VM treatment remains sparse.
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Affiliation(s)
- Laura Zanandrea
- Neurology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (B.C.); (M.F.)
- Faculty of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Bruno Colombo
- Neurology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (B.C.); (M.F.)
| | - Massimo Filippi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (B.C.); (M.F.)
- Faculty of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
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Mamikoglu B, Algın O, Mengü G, Erdoğan-Küçükdağlı F, Kessler A. Transverse sinus pathologies, vestibular migraine and intracranial hypertension without papilledema. Am J Otolaryngol 2023; 44:103931. [PMID: 37290372 DOI: 10.1016/j.amjoto.2023.103931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 05/13/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND In the absence of papilledema, the presentation of migraine and idiopathic intracranial hypertension (IIH) is very similar. In this respect, an IIH could be presented as a vestibular migraine. Our main objective in this case report is to demonstrate the similarities between IIH and vestibular migraine. CASES This is a report of 14 patients who have IIH without papilledema presented as vestibular migraine to the clinic and followed from 2020 to 2022. RESULTS The common presentation of patients was ear-facial pain, dizziness, and frequent pulsatile tinnitus. One-fourth of the patients reported episodes of true episodic vertigo. The average age was 37.8, the average BMI was 37.4, and the average lumbar puncture-opening pressure was 25.6 cm H2O. Transverse sinus venous flow alterations caused neuroimaging findings of sigmoid sinus dehiscence, empty sella, or tonsillar ectopia. Most patients improved with carbonic anhydrase inhibitors, and one patient was treated with a dural sinus stent. CONCLUSION A transverse sinus stenosis, even in the non-dominant site, may elevate the CSF pressure in obese individuals. This stenosis causes dural sinus-related pulsatile tinnitus with characteristics different from those of an arterial origin. Dizziness is a common complaint in patients with IIH, just like VM. In our opinion, episodic vertigo in these patients is the direct effect of CSF flow alterations into the inner ear's vestibule. Patients with mild elevations will be presented to the clinic, similar to migraines with or without the presence of pulsatile tinnitus. Treatment requires lowering intracranial pressure and managing migraine symptoms.
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Affiliation(s)
- Bulent Mamikoglu
- Department of Otolaryngology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, United States of America; Department of Neurosurgery, University of Illinois Peoria Medical School, United States of America.
| | - Oktay Algın
- Department of Radiology, Şehir Hastanesi (City Hospital) and Adjunct Professor of Neuroimaging Sciences, Yıldırım Beyazıt University and Bilkent University, Ankara, Turkey.
| | - Güven Mengü
- Ankara Hacı Bayram Veli University, Ankara, Turkey.
| | | | - Alex Kessler
- Imaging Sciences Division of Neuroradiology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, United States of America.
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22
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Cha YH. Spinning Through History: Evolution of the Concept of Vestibular Migraine. OTOLOGY & NEUROTOLOGY OPEN 2023; 3:e040. [PMID: 38515642 PMCID: PMC10950175 DOI: 10.1097/ono.0000000000000040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/19/2023] [Indexed: 03/23/2024]
Abstract
Vestibular migraine represents a growing public health problem, imposing enormous societal burdens in the form of patient suffering, loss of productivity, and direct healthcare costs. This raises the question of how we developed our ideas about vestibular migraine and how these ideas shape how we treat it. This review walks through the history of how our conceptualization of migraine and vestibular symptoms evolved, starting with clinical observations in ancient times, inclusion under the umbrella of Meniere's disease, and then separation from Meniere's disease with its own identity. Tradition, clinical observations, and diagnostic criteria developed by professional societies have played prominent roles in building our current concept of vestibular migraine. A review of the ideas that have shaped our current conception of vestibular migraine may help us to see which ones have stood the test of time and which ones should continue to evolve. As in other disciplines, we study history in medicine to be inspired, warned, and sometimes, to be freed.
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Lovato A, Disco C, Frosolini A, Monzani D, Perini F. Monoclonal Antibodies Targeting CGRP: A Novel Treatment in Vestibular Migraine. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1560. [PMID: 37763679 PMCID: PMC10534399 DOI: 10.3390/medicina59091560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/18/2023] [Accepted: 08/26/2023] [Indexed: 09/29/2023]
Abstract
Background. Monoclonal antibodies (mAbs) directed against the calcitonin gene-related peptide (CGRP) or its receptor represented the first targeted and specialized approach to migraine prophylaxis. Nevertheless, they have been rarely considered in the treatment of vestibular migraine (VM). Our aim was to evaluate the effectiveness of anti-CGRP mAbs in VM patients who did not respond to conventional migraine treatments. Methods. Consecutive VM patients treated with erenumab were considered. As a comparison, we considered the same VM patients during conventional migraine treatments (i.e., propranolol, flunarizine, or valproic acid), which were tried before mAbs therapy. Videonystagmography, the Italian version of the Dizziness Handicap Inventory (DHI) questionnaire, and migraine days over the last 3 months were evaluated in all patients before and after treatments. Results. In the present retrospective study, we included 21 female and 2 male VM patients, mean age 45.2 years. All patients underwent contrast-enhanced magnetic resonance imaging that ruled out other causes of vertigo. The DHI questionnaire significantly improved after mAb therapy (p < 0.0001). Mean migraine days over the last 3 months were significantly reduced after treatment (p = 0.001). Videonystagmography was altered in 11 (48%) patients prior to monoclonal antibodies. We found vertical positional nystagmus in 9 patients and horizontal positional nystagmus in 2 patients. After the treatment, we found vertical positional nystagmus only in 1 patient (p = 0.002). When patients were treated with conventional therapies, there was no significant reduction in DHI, and instrumental vestibular examinations remained altered. Conclusions. VM patients using anti-CGRP mAbs experienced a reduction in the dizziness-derived handicap, as reported in the DHI questionnaire. Furthermore, these treatments were significantly associated with a normalization of vestibular instrumental analysis. These findings were not seen with conventional treatments. Treatment with anti-CGRP mAbs may be effective in VM patients who did not respond to conventional migraine treatments. These findings should be tested in large, randomized clinical trials.
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Affiliation(s)
- Andrea Lovato
- Otorhinolaryngology Unit, Department of Surgical Specialties, Vicenza Civil Hospital, 36100 Vicenza, Italy
- Otorhinolaryngology Unit, Department of Surgical Specialties, San Gaetano Clinic, 36016 Thiene, Italy
| | - Caterina Disco
- Neurology Unit, Department of Neuroscience, Vicenza Civil Hospital, 36100 Vicenza, Italy
| | - Andrea Frosolini
- Maxillofacial Surgery Unit, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Daniele Monzani
- Otorhinolaryngology Unit, Department of Surgical Specialties, University of Verona, 37100 Verona, Italy
| | - Francesco Perini
- Neurology Unit, Department of Neuroscience, Vicenza Civil Hospital, 36100 Vicenza, Italy
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24
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O'Toole R, Watson D. Manual cervical therapy and vestibular migraine: A case series. HEALTH OPEN RESEARCH 2023; 5:12. [PMID: 38708034 PMCID: PMC11065132 DOI: 10.12688/healthopenres.13319.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 05/07/2024]
Abstract
Background Vestibular migraine (VM) is a relatively new diagnostic entity with incomplete knowledge regarding pathophysiological mechanisms and therapeutic guidelines. By reporting the effect of manual cervical therapy (MCT) on people with VM, we suggest a possible role for upper cervical afferents in VM treatment and/or pathogenesis. The objective was to describe the change in clinical presentation and self-reported symptoms of VM corresponding to MCT and followed up to six months. Methods A nonrandomised *ABA design was utilised to consecutively and prospectively evaluate selected patients with diagnosed VM. Symptom characteristics (frequency and intensity) were recorded along with standardised patient-reported outcomes (PROs) to document the response to MCT. Results Three patients were recruited who met the diagnostic criteria for VM. All three patients demonstrated improvement in both migraine attack and interictal symptom frequency. These improvements mirrored changes in PROs and were sustained over a six-month follow-up period. Conclusions The improvement that coincided with the intervention including MCT was rapid, observable and sustained. This suggests that the upper cervical spine could be a therapeutic target in VM and may have implications for future research into the pathogenesis of VM.
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Affiliation(s)
- Roger O'Toole
- Melbourne Headache Centre, Melbourne, Victoria, 3000, Australia
| | - Dean Watson
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
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25
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Waissbluth S, Sepúlveda V, Leung JS, Oyarzún J. Vestibular and Oculomotor Findings in Vestibular Migraine Patients. Audiol Res 2023; 13:615-626. [PMID: 37622929 PMCID: PMC10452030 DOI: 10.3390/audiolres13040053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Vestibular migraine (VM) is the most frequent etiology of recurrent spontaneous episodic vertigo. Vestibular and oculomotor abnormalities have been described in VM; however, the diagnosis is currently based on symptoms. The objective of this study was to determine the most frequent abnormalities in videonystagmography (VNG), caloric testing (Cal) and video head impulse test (vHIT) in patients with VM. METHODS A retrospective cohort study was conducted, including all VM and probable VM patients seen from January 2021 to July 2022. Demographics, auditory symptoms and results via VNG, Cal and vHIT were evaluated. VNG results were compared with a control group. RESULTS Sixty patients, 81.7% with VM and 18.3% with probable vestibular migraine, were included. VNG revealed the following abnormalities: 21.7% spontaneous nystagmus; 33.3% positional nystagmus, mostly central; 26.7% optokinetic nystagmus; 56.7% smooth pursuit abnormalities and 70% saccade test abnormalities, mostly velocity and latency. An abnormal unilateral caloric response was seen in 22.9%, while vHIT revealed a low gain in at least one canal in 21.7%, and saccades were seen in at least one canal with normal gains in 18.3%. Concordant results between Cal and lateral vHIT were seen in 77.1% of cases. CONCLUSIONS Although VM is a clinical diagnosis, vestibular and oculomotor abnormalities are commonly seen. The most frequent oculomotor findings were an abnormal saccade test, abnormal smooth pursuit and central positional nystagmus.
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Affiliation(s)
- Sofia Waissbluth
- Department of Otolaryngology, Pontificia Universidad Católica de Chile, Santiago 8330033, Chile
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26
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Umemoto KK, Tawk K, Mazhari N, Abouzari M, Djalilian HR. Management of Migraine-Associated Vestibulocochlear Disorders. Audiol Res 2023; 13:528-545. [PMID: 37489383 PMCID: PMC10366928 DOI: 10.3390/audiolres13040047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/03/2023] [Accepted: 07/12/2023] [Indexed: 07/26/2023] Open
Abstract
Migraine is a chronic neurological disorder that frequently coexists with different vestibular and cochlear symptoms (sudden hearing loss, tinnitus, otalgia, aural fullness, hyperacusis, dizziness, imbalance, and vertigo) and disorders (recurrent benign positional vertigo, persistent postural perceptual dizziness, mal de debarquement, and Menière's disease). Despite evidence of an epidemiological association and similar pathophysiology between migraine and these vestibulocochlear disorders, patients suffering from migraine-related symptoms are usually underdiagnosed and undertreated. Current migraine treatment options have shown success in treating vestibulocochlear symptoms. Lifestyle and dietary modifications (reducing stress, restful sleep, avoiding migraine dietary triggers, and avoiding starvation and dehydration) and supplements (vitamin B2 and magnesium) offer effective first-line treatments. Treatment with migraine prophylactic medications such as tricyclic antidepressants (e.g., nortriptyline), anticonvulsants (e.g., topiramate), and calcium channel blockers (e.g., verapamil) is implemented when lifestyle and dietary modifications are not sufficient in improving a patient's symptoms. We have included an algorithm that outlines a suggested approach for addressing these symptoms, taking into account our clinical observations. Greater recognition and understanding of migraine and its related vestibular and cochlear symptoms are needed to ensure the appropriate diagnosis and treatment of affected patients.
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Affiliation(s)
- Kayla K Umemoto
- College of Medicine, California Northstate University, Elk Grove, CA 95757, USA
| | - Karen Tawk
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA 92697, USA
| | - Najva Mazhari
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA 92697, USA
| | - Mehdi Abouzari
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA 92697, USA
| | - Hamid R Djalilian
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA 92697, USA
- Department of Biomedical Engineering, University of California, Irvine, CA 92617, USA
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27
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Zhang Y, Zhang Y, Wang Y, Zhang X, Qin G, Zhang D, Chen L, Zhou J. Inhibition of glutamatergic trigeminal nucleus caudalis- vestibular nucleus projection neurons attenuates vestibular dysfunction in the chronic-NTG model of migraine. J Headache Pain 2023; 24:77. [PMID: 37386456 DOI: 10.1186/s10194-023-01607-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/07/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Prior clinical studies suggest a shared mechanism between vestibular symptoms and migraine headache. However, the specific neuroanatomical substrate connecting vestibular symptoms with migraine remains to be largely unknown. Thus, the aim of this study was to further investigate the mechanisms that whether and how trigeminovestibular neurons produce effects on neuronal activation in vestibular nucleus (VN). METHODS A chronic-NTG rat model was established by recurrent intermittent administration of nitroglycerin (NTG). Pain- and vestibular-related behaviors were assessed. To selectively inhibit the glutamatergic neurons and trigeminal nucleus caudalis (TNC) to VN projection neurons, the AAVs encoding engineered Gi-coupled hM4D receptor were administered in the TNC or VN area. RESULTS We identify a glutamatergic projection from TNC to VN that mediates vestibular dysfunction in a chronic-NTG rat model. Inhibition of the GlutamateTNC neurons alleviates vestibular dysfunction in the chronic-NTG rat. Calcitonin gene-related peptide (CGRP)-expressing neurons in the VN received glutamatergic projections from TNC neurons. Silencing the glutamatergic TNC-VN projection neurons attenuates vestibular dysfunction in the chronic-NTG rat. CONCLUSIONS Together, we reveal a modulatory role of glutamatergic TNC-VN projection neurons in vestibular dysfunction of migraine.
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Affiliation(s)
- Yun Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, 1st You Yi Road, Yu Zhong District, Chongqing, 400016, China
| | - Yixin Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, 1st You Yi Road, Yu Zhong District, Chongqing, 400016, China.
| | - Yanyun Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, 1st You Yi Road, Yu Zhong District, Chongqing, 400016, China
| | - Xiaoyan Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, 1st You Yi Road, Yu Zhong District, Chongqing, 400016, China
| | - Guangcheng Qin
- Laboratory Research Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dunke Zhang
- Laboratory Research Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lixue Chen
- Laboratory Research Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiying Zhou
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, 1st You Yi Road, Yu Zhong District, Chongqing, 400016, China
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28
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Balayeva F, Kirazlı G, Celebisoy N. Vestibular test results in patients with vestibular migraine and Meniere's Disease. Acta Otolaryngol 2023:1-5. [PMID: 37267063 DOI: 10.1080/00016489.2023.2213723] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Vestibular migraine (VM) and Meniere's Disease (MD) are episodic vestibular disorders, sometimes difficult to differentiate from each other on clinical grounds. OBJECTIVE To evaluate vestibular test results of the two groups that may help in the differential diagnosis. METHODS Twenty-two patients with VM, 21 patients with definite MD and 21 healthy volunteers (HC) were studied. Pure tone hearing thresholds (PTHT), cervical vestibular evoked myogenic potentials (cVEMPs), video head impulse test (vHIT) and functional head impulse test (fHIT) were performed. RESULTS PTHT of the MD-affected ears were significantly higher than VM and HC groups (p < .001 for both) when cVEMP amplitudes were lower (p = .005 for HC), (p = .006 for VM). Lateral canal vHIT gain of the MD-affected ears were lower than VM patients (p = .003) and the HC (p < .001). The percentage of correctly identified optotypes (CA%) on fHIT was low for both patient groups when compared with the HC (p < .001). CONCLUSION In addition to hearing loss, low cVEMP amplitudes on the affected side with decreased gain on vHIT indicate disturbed saccular and lateral semicircular canal functions in MD patients differentiating them from VM. A functional deficit in gaze stabilization detected by fHIT is the only abnormality found in patients with VM.
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Affiliation(s)
- Fidan Balayeva
- Department of Neurology, Ege University Medical School, Bornova, Izmir, Turkey
| | - Gülce Kirazlı
- Department of Audiology, Ege University Faculty of Health Sciences, Izmir, Turkey
| | - Nese Celebisoy
- Department of Neurology, Ege University Medical School, Bornova, Izmir, Turkey
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29
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Male AJ, Holmes SL, Hanna MG, Pitceathly RDS, Ramdharry GM, Kaski D. Development of a diagnostic framework for vestibular causes of dizziness and unsteadiness in patients with multisensory neurological disease: a Delphi consensus. J Neurol 2023; 270:3252-3257. [PMID: 36842099 DOI: 10.1007/s00415-023-11640-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 02/27/2023]
Affiliation(s)
- Amanda J Male
- Department of Clinical and Movement Neurosciences, University College London, Queen Square, London, WC1N 3BG, UK.
| | - Sarah L Holmes
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Queen Square Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Michael G Hanna
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Queen Square Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, London, UK
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Robert D S Pitceathly
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Queen Square Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, London, UK
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Gita M Ramdharry
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
- Queen Square Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Diego Kaski
- Department of Clinical and Movement Neurosciences, University College London, Queen Square, London, WC1N 3BG, UK
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30
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Ritz H. Evaluating patients with vertigo. JAAPA 2023; 36:1-6. [PMID: 37229589 DOI: 10.1097/01.jaa.0000918772.20883.9e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
ABSTRACT Dizziness and vertigo are among the most common complaints in medicine. Patients often provide vague descriptions of symptoms, making clinicians' jobs challenging. However, a patient with vertigo also can be one of the most rewarding encounters of a clinician's day. In most cases, a focused history and bedside vestibular testing provide enough information to make a diagnosis and identify patients for appropriate referral. Canalith repositioning maneuvers often resolve symptoms, leaving patients and clinicians satisfied.
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Affiliation(s)
- Howard Ritz
- Howard Ritz practices in otolaryngology at Glens Falls (N.Y.) Hospital. The author has disclosed no potential conflicts of interest, financial or otherwise
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31
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Webster KE, Dor A, Galbraith K, Haj Kassem L, Harrington-Benton NA, Judd O, Kaski D, Maarsingh OR, MacKeith S, Ray J, Van Vugt VA, Burton MJ. Non-pharmacological interventions for prophylaxis of vestibular migraine. Cochrane Database Syst Rev 2023; 4:CD015321. [PMID: 37042522 PMCID: PMC10091802 DOI: 10.1002/14651858.cd015321.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
BACKGROUND Vestibular migraine is a form of migraine where one of the main features is recurrent attacks of vertigo. These episodes are often associated with other features of migraine, including headache and sensitivity to light or sound. These unpredictable and severe attacks of vertigo can lead to a considerable reduction in quality of life. The condition is estimated to affect just under 1% of the population, although many people remain undiagnosed. A number of interventions have been used, or proposed to be used, as prophylaxis for this condition, to help reduce the frequency of the attacks. Many of these interventions include dietary, lifestyle or behavioural changes, rather than medication. OBJECTIVES: To assess the benefits and harms of non-pharmacological treatments used for prophylaxis of vestibular migraine. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 23 September 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs in adults with definite or probable vestibular migraine comparing dietary modifications, sleep improvement techniques, vitamin and mineral supplements, herbal supplements, talking therapies, mind-body interventions or vestibular rehabilitation with either placebo or no treatment. We excluded studies with a cross-over design, unless data from the first phase of the study could be identified. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were: 1) improvement in vertigo (assessed as a dichotomous outcome - improved or not improved), 2) change in vertigo (assessed as a continuous outcome, with a score on a numerical scale) and 3) serious adverse events. Our secondary outcomes were: 4) disease-specific health-related quality of life, 5) improvement in headache, 6) improvement in other migrainous symptoms and 7) other adverse effects. We considered outcomes reported at three time points: < 3 months, 3 to < 6 months, > 6 to 12 months. We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS: We included three studies in this review with a total of 319 participants. Each study addressed a different comparison and these are outlined below. We did not identify any evidence for the remaining comparisons of interest in this review. Dietary interventions (probiotics) versus placebo We identified one study with 218 participants (85% female). The use of a probiotic supplement was compared to a placebo and participants were followed up for two years. Some data were reported on the change in vertigo frequency and severity over the duration of the study. However, there were no data regarding improvement of vertigo or serious adverse events. Cognitive behavioural therapy (CBT) versus no intervention One study compared CBT to no treatment in 61 participants (72% female). Participants were followed up for eight weeks. Data were reported on the change in vertigo over the course of the study, but no information was reported on the proportion of people whose vertigo improved, or on the occurrence of serious adverse events. Vestibular rehabilitation versus no intervention The third study compared the use of vestibular rehabilitation to no treatment in a group of 40 participants (90% female) and participants were followed up for six months. Again, this study reported some data on change in the frequency of vertigo during the study, but no information on the proportion of participants who experienced an improvement in vertigo or the number who experienced serious adverse events. We are unable to draw meaningful conclusions from the numerical results of these studies, as the data for each comparison of interest come from single, small studies and the certainty of the evidence was low or very low. AUTHORS' CONCLUSIONS: There is a paucity of evidence for non-pharmacological interventions that may be used for prophylaxis of vestibular migraine. Only a limited number of interventions have been assessed by comparing them to no intervention or a placebo treatment, and the evidence from these studies is all of low or very low certainty. We are therefore unsure whether any of these interventions may be effective at reducing the symptoms of vestibular migraine and we are also unsure whether they have the potential to cause harm.
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Affiliation(s)
- Katie E Webster
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Afrose Dor
- Wadham College, University of Oxford, Oxford, UK
| | - Kevin Galbraith
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | | | - Owen Judd
- ENT Department, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Diego Kaski
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Otto R Maarsingh
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Samuel MacKeith
- ENT Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Vincent A Van Vugt
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Martin J Burton
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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32
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Webster K, Dor A, Galbraith K, Kassem LH, Harrington-Benton N, Judd O, Kaski D, Maarsingh O, MacKeith S, Ray J, Van Vugt V, Burton M. Pharmacological interventions for prophylaxis of vestibular migraine. Cochrane Database Syst Rev 2023; 2023:CD015187. [PMID: 37073858 PMCID: PMC10093999 DOI: 10.1002/14651858.cd015187.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND Vestibular migraine is a form of migraine where one of the main features is recurrent attacks of vertigo. These episodes are often associated with other features of migraine, including headache and sensitivity to light or sound. These unpredictable and severe attacks of vertigo can lead to a considerable reduction in quality of life. The condition is estimated to affect just under 1% of the population, although many people remain undiagnosed. A number of pharmacological interventions have been used or proposed to be used as prophylaxis for this condition, to help reduce the frequency of the attacks. These are predominantly based on treatments that are in use for headache migraine, with the belief that the underlying pathophysiology of these conditions is similar. OBJECTIVES To assess the benefits and harms of pharmacological treatments used for prophylaxis of vestibular migraine. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 23 September 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs in adults with definite or probable vestibular migraine comparing beta-blockers, calcium channel blockers, antiepileptics, antidepressants, diuretics, monoclonal antibodies against calcitonin gene-related peptide (or its receptor), botulinum toxin or hormonal modification with either placebo or no treatment. We excluded studies with a cross-over design, unless data from the first phase of the study could be identified. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were: 1) improvement in vertigo (assessed as a dichotomous outcome - improved or not improved), 2) change in vertigo (assessed as a continuous outcome, with a score on a numerical scale) and 3) serious adverse events. Our secondary outcomes were: 4) disease-specific health-related quality of life, 5) improvement in headache, 6) improvement in other migrainous symptoms and 7) other adverse effects. We considered outcomes reported at three time points: < 3 months, 3 to < 6 months, > 6 to 12 months. We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS We included three studies with a total of 209 participants. One evaluated beta-blockers and the other two evaluated calcium channel blockers. We did not identify any evidence for the remaining interventions of interest. Beta-blockers versus placebo One study (including 130 participants, 61% female) evaluated the use of 95 mg metoprolol once daily for six months, compared to placebo. The proportion of people who reported improvement in vertigo was not assessed in this study. Some data were reported on the frequency of vertigo attacks at six months and the occurrence of serious adverse effects. However, this is a single, small study and for all outcomes the certainty of evidence was low or very low. We are unable to draw meaningful conclusions from the numerical results. Calcium channel blockers versus no treatment Two studies, which included a total of 79 participants (72% female), assessed the use of 10 mg flunarizine once daily for three months, compared to no intervention. All of the evidence for this comparison was of very low certainty. Most of our outcomes were only reported by a single study, therefore we were unable to conduct any meta-analysis. Some data were reported on improvement in vertigo and change in vertigo, but no information was available regarding serious adverse events. We are unable to draw meaningful conclusions from the numerical results, as these data come from single, small studies and the certainty of the evidence was very low. AUTHORS CONCLUSIONS There is very limited evidence from placebo-controlled randomised trials regarding the efficacy and potential harms of pharmacological interventions for prophylaxis of vestibular migraine. We only identified evidence for two of our interventions of interest (beta-blockers and calcium channel blockers) and all evidence was of low or very low certainty. Further research is necessary to identify whether these treatments are effective at improving symptoms and whether there are any harms associated with their use.
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Affiliation(s)
- Katie Webster
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Afrose Dor
- Wadham College, University of Oxford, Oxford, UK
| | - Kevin Galbraith
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | | | - Owen Judd
- ENT Department, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Diego Kaski
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Otto Maarsingh
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Samuel MacKeith
- ENT Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Vincent Van Vugt
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Martin Burton
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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33
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Çelebisoy N, Ak AK, Ataç C, Özdemir HN, Gökçay F, Durmaz GS, Kartı DT, Toydemir HE, Yayla V, Işıkay İÇ, Erkent İ, Sarıtaş AŞ, Özçelik P, Akdal G, Bıçakcı Ş, Göksu EO, Uyaroğlu FG. Comparison of clinical features in patients with vestibular migraine and migraine. J Neurol 2023:10.1007/s00415-023-11677-3. [PMID: 37043031 DOI: 10.1007/s00415-023-11677-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 04/13/2023]
Abstract
Vestibular migraine (VM) is accepted as the most common cause of spontaneous episodic vertigo. In most patients, vestibular symptoms follow migraine headaches that begin earlier in life. The aim of this multicenter retrospective study was to find out the differences between migraine patients without any vestibular symptoms (MwoV) and VM patients and to delineate the specific clinical features associated with VM. MwoV and VM patients were compared regarding demographic features, migraine headache years, headache attack frequency, intensity, symptoms associated with headache and vertigo attacks, presence of menopause, history of motion sickness and family history of migraine. Four-hundred and forty patients with MwoV and 408 patients with VM were included in the study. Migraine with aura was more frequent in patients with MwoV (p = 0.035). Migraine headache years was longer (p < 0.001) and headache intensity was higher in patients with VM (p = 0.020). Aural fullness/tinnitus was more common in patients with VM (p < 0.001) when all other associated symptoms were more frequent in patients with MwoV (p < 0.001) as well as attack triggers (p < 0.05). Presence of menopause and motion sickness history was reported more frequently by VM patients (p < 0.001). Logistic regression analysis indicated that longstanding history of migraine with severe headache attacks, aural fullness/tinnitus accompanying attacks, presence of menopause, previous motion sickness history were the differentiating clinical features of patients with VM.
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Affiliation(s)
- Neşe Çelebisoy
- Department of Neurology, Ege University, 35000, Izmir, Turkey.
| | - Ayşın Kısabay Ak
- Department of Neurology, Celal Bayar University, 45000, Manisa, Turkey
| | - Ceyla Ataç
- Department of Neurology, University of Health Sciences Izmir Bozyaka Education and Research Hospital, 35360, Izmir, Turkey
| | | | - Figen Gökçay
- Department of Neurology, Ege University, 35000, Izmir, Turkey
| | | | - Dilek Top Kartı
- Department of Neurology, Celal Bayar University, 45000, Manisa, Turkey
| | - Hülya Ertaşoğlu Toydemir
- Department of Neurology, University of Health Sciences Istanbul Bakırköy Dr. Sadi Konuk Education and Research Hospital, 34158, Istanbul, Turkey
| | - Vildan Yayla
- Department of Neurology, University of Health Sciences Istanbul Bakırköy Dr. Sadi Konuk Education and Research Hospital, 34158, Istanbul, Turkey
| | | | - İrem Erkent
- Department of Neurology, Hacettepe University, 06100, Ankara, Turkey
| | | | - Pınar Özçelik
- Department of Neurology, Dokuz Eylül University, 35330, Izmir, Turkey
| | - Gülden Akdal
- Department of Neurology, Dokuz Eylül University, 35330, Izmir, Turkey
| | - Şebnem Bıçakcı
- Department Of Neurology, Çukurova University, 01380, Adana, Turkey
| | - Eylem Ozaydın Göksu
- Department of Neurology, University of Health Sciences Antalya Education and Research Hospital, 07050, Antalya, Turkey
| | - Feray Güleç Uyaroğlu
- Department of Neurology, University of Health Sciences Izmir Tepecik Education and Research Hospital, 35110, Izmir, Turkey
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Webster KE, Dor A, Galbraith K, Haj Kassem L, Harrington-Benton NA, Judd O, Kaski D, Maarsingh OR, MacKeith S, Ray J, Van Vugt VA, Burton MJ. Pharmacological interventions for acute attacks of vestibular migraine. Cochrane Database Syst Rev 2023; 4:CD015322. [PMID: 37042545 PMCID: PMC10097606 DOI: 10.1002/14651858.cd015322.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
BACKGROUND Vestibular migraine is a form of migraine where one of the main features is recurrent attacks of vertigo. These episodes are often associated with other features of migraine, including headache and sensitivity to light or sound. The unpredictable and severe attacks of vertigo can lead to a considerable reduction in quality of life. The condition is estimated to affect just under 1% of the population, although many people remain undiagnosed. A number of pharmacological interventions have been used, or proposed to be used, at the time of a vestibular migraine attack to help reduce the severity or resolve the symptoms. These are predominantly based on treatments that are in use for headache migraine, with the belief that the underlying pathophysiology of these conditions is similar. OBJECTIVES: To assess the benefits and harms of pharmacological interventions used to relieve acute attacks of vestibular migraine. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 23 September 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs in adults with definite or probable vestibular migraine comparing triptans, ergot alkaloids, dopamine antagonists, antihistamines, 5-HT3 receptor antagonists, gepants (CGRP receptor antagonists), magnesium, paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) with either placebo or no treatment. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were: 1) improvement in vertigo (assessed as a dichotomous outcome - improved or not improved), 2) change in vertigo (assessed as a continuous outcome, with a score on a numerical scale) and 3) serious adverse events. Our secondary outcomes were: 4) disease-specific health-related quality of life, 5) improvement in headache, 6) improvement in other migrainous symptoms and 7) other adverse effects. We considered outcomes reported at three time points: < 2 hours, 2 to 12 hours, > 12 to 72 hours. We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS: We included two RCTs with a total of 133 participants, both of which compared the use of triptans to placebo for an acute attack of vestibular migraine. One study was a parallel-group RCT (of 114 participants, 75% female). This compared the use of 10 mg rizatriptan to placebo. The second study was a smaller, cross-over RCT (of 19 participants, 70% female). This compared the use of 2.5 mg zolmitriptan to placebo. Triptans may result in little or no difference in the proportion of people whose vertigo improves at up to two hours after taking the medication. However, the evidence was very uncertain (risk ratio 0.84, 95% confidence interval 0.66 to 1.07; 2 studies; based on 262 attacks of vestibular migraine treated in 124 participants; very low-certainty evidence). We did not identify any evidence on the change in vertigo using a continuous scale. Only one of the studies assessed serious adverse events. No events were noted in either group, but as the sample size was small we cannot be sure if there are risks associated with taking triptans for this condition (0/75 receiving triptans, 0/39 receiving placebo; 1 study; 114 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS: The evidence for interventions used to treat acute attacks of vestibular migraine is very sparse. We identified only two studies, both of which assessed the use of triptans. We rated all the evidence as very low-certainty, meaning that we have little confidence in the effect estimates and cannot be sure if triptans have any effect on the symptoms of vestibular migraine. Although we identified sparse information on potential harms of treatment in this review, the use of triptans for other conditions (such as headache migraine) is known to be associated with some adverse effects. We did not identify any placebo-controlled randomised trials for other interventions that may be used for this condition. Further research is needed to identify whether any interventions help to improve the symptoms of vestibular migraine attacks and to determine if there are side effects associated with their use.
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Affiliation(s)
- Katie E Webster
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Afrose Dor
- Wadham College, University of Oxford, Oxford, UK
| | - Kevin Galbraith
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | | | - Owen Judd
- ENT Department, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Diego Kaski
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Otto R Maarsingh
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Samuel MacKeith
- ENT Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Vincent A Van Vugt
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Martin J Burton
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Lu Y, Li J, Xu H, Wang CD. Oral traditional Chinese medicine for vestibular Migraine: A systematic review and meta-analysis. J Clin Neurosci 2023; 110:100-108. [PMID: 36863125 DOI: 10.1016/j.jocn.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/06/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE Vestibular migraine is a common vertigo disease, and studies confirm that Traditional Chinese medical has unique advantages in treating vestibular migraine. However, there is no unified clinical treatment method and lacks objective outcome indicators. This study aims to provide evidence-based medical evidence by systematically evaluating the clinical efficacy of oral TCM in treating vestibular migraine. METHODS Search journals related with clinical randomized controlled trials of oral traditional Chinese medicine for vestibular migraine in databases includes China Academic Journals full-text database (CNKI), China Biology Medicine disc (CBM), China Science and Technology Journal Database(VIP), Wangfang Medicine Online(WANFANG), PubMed, Cochrane library, EMBASE, MEDLINE, and OVID databases from their inceptions until September 2022. The quality of the included RCTs was assessed using the Cochrane risk of bias tool, then conduct the Meta analysis by using RevMan5.3. RESULTS There were 179 papers left after selection. Moreover, according to the literature inclusion and exclusion criteria, 158 studies were filtered and the remaining 21 articles would be considered in this paper, which include 1650 patients in total and 828 of them were in the therapy group and 822 of them were in the control group.Furthermore,the therapy group outperformed the control group in terms of the total efficiency rate and TCM syndrome score, and the difference is statistically significant(P < 0.01). The number of vertigo attacks and the duration of each vertigo decreased compared to the control group, which difference is also statistically significant (P < 0.01). The funnel chart of the total efficiency rate was approximately symmetric and publication bias was low. CONCLUSION The oral traditional Chinese medicine is an effective way for vestibular migraine, which would help with the clinical symptoms, reduce the TCM syndrome score, decrease the number of vertigo attacks and the duration of each vertigo, and improve life quality of patients.
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Affiliation(s)
- Ying Lu
- Shanghai TCM-Integrated Hospital, Shanghai University of TCM, Shanghai 200082, China
| | - Jian Li
- Shanghai TCM-Integrated Hospital, Shanghai University of TCM, Shanghai 200082, China
| | - Hui Xu
- Shanghai TCM-Integrated Hospital, Shanghai University of TCM, Shanghai 200082, China
| | - Chang-de Wang
- Shanghai TCM-Integrated Hospital, Shanghai University of TCM, Shanghai 200082, China.
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Gufoni M, Casani AP. "The Pupillary (Hippus) Nystagmus": A Possible Clinical Hallmark to Support the Diagnosis of Vestibular Migraine. J Clin Med 2023; 12:jcm12051957. [PMID: 36902742 PMCID: PMC10004418 DOI: 10.3390/jcm12051957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
(1) Background: Hippus (which in this paper will be called "Pupillary nystagmus") is a well-known phenomenon which has never been related to any specific pathology, so much so that it can be considered physiological even in the normal subject, and is characterized by cycles of dilation and narrowing of the pupil under constant lighting conditions. The aim of this study is to verify the presence of pupillary nystagmus in a series of patients suffering from vestibular migraine. (2) Methods: 30 patients with dizziness suffering from vestibular migraine (VM), diagnosed according to the international criteria, were evaluated for the presence of pupillary nystagmus and compared with the results obtained in a group of 50 patients complaining of dizziness that was not migraine-related. (3) Results: Among the 30 VM patients, only two cases were found to be negative for pupillary nystagmus. Among the 50 non-migraineurs dizzy patients, three had pupillary nystagmus, while the remaining 47 did not. This resulted in a test sensitivity of 0.93% and a specificity of 0.94%. (4) Conclusion: we propose the consideration of the presence of pupillary nystagmus as an objective sign (present in the inter-critical phase) to be associated with the international diagnostic criteria for the diagnosis of vestibular migraine.
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Chen Z, Rong L, Xiao L, Wang Q, Liu Y, Lin C, Wang J, Liu H, Wei XE. Altered brain function in patients with vestibular migraine: a study on resting state functional connectivity. Neuroradiology 2023; 65:579-590. [PMID: 36447059 DOI: 10.1007/s00234-022-03086-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/08/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE To characterize the altered brain function in patients with vestibular migraine (VM) using resting-state functional magnetic resonance imaging (fMRI). METHODS In this prospective study, fMRI images as well as clinical characteristics and behavioral scales were collected from 40 VM patients and 40 healthy controls (HC). All patients received neurological, neuro-otological, and conventional MRI examinations to exclude peripheral vestibular lesions, focal lesions, and other neurological diseases. Seed-based (bilateral parietal operculum cortex 2, OP2) functional connectivity (FC) and independent component analysis (ICA)-based functional network connectivity (FNC) were performed to investigate the brain functional changes in patients with VM. Additionally, the correlations between the altered FC/FNC and behavioral results were analyzed. RESULTS Compared with HC, patients with VM showed increased FC between the left OP2 and right precuneus and exhibited decreased FC between the left OP2 and left anterior cingulate cortex. We also observed increased FC between the right OP2 and regions of the right middle frontal gyrus and bilateral precuneus, as well as decreased FC between the bilateral OP2. Furthermore, patients with VM showed decreased FNC between visual network (VN) and networks of auditory and default mode, and exhibited increased FNC between VN and executive control network. A correlation analysis found that FC between the left OP2 and right precuneus was positively correlated with scores of dizziness handicap inventory (DHI) in patients with VM. CONCLUSION The present study demonstrated altered brain function in patients with VM.
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Affiliation(s)
- Zhengwei Chen
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, 221006, Jiangsu Province, China
| | - Liangqun Rong
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, 221006, Jiangsu Province, China
| | - Lijie Xiao
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, 221006, Jiangsu Province, China
| | - Quan Wang
- Medical Imaging Department, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, 221006, Jiangsu Province, China
| | - Yueji Liu
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, 221006, Jiangsu Province, China
| | - Cunxin Lin
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, 221006, Jiangsu Province, China
| | - Jianing Wang
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, 221006, Jiangsu Province, China
| | - Haiyan Liu
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, 221006, Jiangsu Province, China.
| | - Xiu-E Wei
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, 221006, Jiangsu Province, China.
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Bogle JM, King AZ, Deep N, Weisskopf P, Starling AJ. Static Subjective Visual Vertical (SVV) in Patients with Vestibular Migraine. J Am Acad Audiol 2023. [PMID: 36070782 DOI: 10.1055/a-1938-1161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Vestibular migraine (VM) is one of the common causes of episodic dizziness, but it is underdiagnosed and poorly understood. Previous research suggests that otolith reflex pathway performance is often impaired in this patient group, leading to altered perception of roll plane stimuli. Clinically, this perception can be measured with subjective visual vertical (SVV) testing. PURPOSE The aim of this study is to compare static SVV performance (absolute mean SVV tilt, variance) in a cohort of patients diagnosed with VM to results obtained from clinically derived normative data. STUDY DESIGN Retrospective case review. STUDY SAMPLE Ninety-four consecutive patients between 18 and 65 years of age diagnosed with VM were included in this comparison to clinically derived normative data. DATA COLLECTION AND ANALYSIS Retrospective chart review was completed. Demographic data, symptom report, and vestibular laboratory results were documented. SVV performance was documented in terms of absolute mean SVV tilt and response variance. RESULTS Abnormal mean SVV tilt was described in 54% (n = 51) of patients with VM. Including abnormal response variance increased those identified with abnormal presentation to 67% (n = 63). Laboratory findings were insignificant for semicircular canal function, but of those with abnormal ocular vestibular myogenic potential results (n = 30), 77% (n = 23) demonstrated both abnormal SVV and utriculo-ocular reflex performance. There were no associations noted for SVV performance and demographic or other self-report variables. CONCLUSION Absolute mean SVV tilt and response variance are often abnormal in patients diagnosed with VM. These findings support theories suggesting atypical intralabyrinthine integration within the vestibular nuclei and cerebellar nodular pathways.
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Affiliation(s)
- Jamie M Bogle
- Department of Otorhinolaryngology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Ashley Zaleski King
- Department of Speech-Language/Audiology, Towson University, Towson, Maryland
| | - Nicholas Deep
- Department of Otorhinolaryngology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Peter Weisskopf
- Department of Otorhinolaryngology, Mayo Clinic Arizona, Scottsdale, Arizona
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Teelucksingh S, Murali Govind R, Dobson R, Nelson-Piercy C, Ovadia C. Treating Vestibular Migraine When Pregnant and Postpartum: Progress, Challenges and Innovations. Int J Womens Health 2023; 15:321-338. [PMID: 36814528 PMCID: PMC9940493 DOI: 10.2147/ijwh.s371491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 01/18/2023] [Indexed: 02/18/2023] Open
Abstract
Vestibular migraine is a leading cause of vertigo in pregnancy and, although not a distinct migraine subtype, is an episodic syndrome associated with migraine. Vestibular migraine is associated with diverse symptoms such as vertigo, aura, allodynia, osmophobia, nausea, vomiting and tinnitus, many of which may be exacerbated by, masked or even dismissed in pregnancy. Vestibular migraine is likely an underdiagnosed and undertreated condition in pregnancy. The aetiology of vestibular migraine remains incompletely understood, although various theories have been proposed, including genetic predisposition, neurochemical dysregulation and pro-inflammatory mechanisms, all of which are derived from the pathophysiology of classical migraine. Physiologic changes to the endocrine, haematologic and vascular systems in pregnancy may affect pathophysiological processes in vestibular migraine, and can alter the course of symptoms experienced in pregnancy. These changes also predispose to secondary headache disorders, which may have similar presentations. There has been considerable progress in therapeutic advances in vestibular migraine prophylaxis and treatment outside of pregnancy. There is currently no significant evidence base for acute treatment or prophylaxis for pregnant patients, with treatment recommendations extrapolated from studies on classical migraine, and offered on a benefit versus risk basis. Challenges commonly encountered include difficulty establishing a diagnosis, in addition to recognising and treating neuropsychiatric and gestational co-morbidities. Anxiety, depression, hypertensive disorders and cardiovascular disease are closely associated with migraine, and important contributors to morbidity and mortality during pregnancy. Identifying and treating vestibular migraine during pregnancy offers a unique opportunity to impact future patient health through screening and early treatment of associated co-morbidities. There have been innovations in classical migraine therapy that may confer benefit in vestibular migraine in pregnancy, with emphasis on lifestyle modification, effective prophylaxis, abortive therapies, cognitive behaviour therapy and management of vestibular migraine-related comorbidities.
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Affiliation(s)
- Siara Teelucksingh
- Department of Obstetric Medicine, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Renuka Murali Govind
- Department of Obstetric Medicine, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Ruth Dobson
- Preventive Neurology Unit, Queen Mary University of London, London, UK
- Department of Neurology, Royal London Hospital, London, UK
| | - Catherine Nelson-Piercy
- Department of Obstetric Medicine, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
- Department of Women and Children’s Health, King’s College London, London, UK
| | - Caroline Ovadia
- Department of Women and Children’s Health, King’s College London, London, UK
- Department of Obstetrics and Gynaecology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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Guo Z, Wang J, Liu D, Tian E, Chen J, Kong W, Zhang S. Early detection and monitoring of hearing loss in vestibular migraine: Extended high-frequency hearing. Front Aging Neurosci 2023; 14:1090322. [PMID: 36704499 PMCID: PMC9871761 DOI: 10.3389/fnagi.2022.1090322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/09/2022] [Indexed: 01/11/2023] Open
Abstract
Background Vestibular migraine (VM) presents mainly with recurrent vestibular symptoms and migraine. A great number of patients with VM have cochlea symptoms such as tinnitus, hearing loss. Methods A cross-sectional study was conducted on patients with definite VM (dVM) and probable VM (pVM) who met the diagnostic criteria. Auditory-vestibular tests and psychological assessments were performed. Logistic regression was used to evaluate the predictive effect of EHF pure tone audiometry (PTA) for standard frequency (SF) hearing loss. Results Fifteen patients with pVM and 22 patients with dVM were recruited. Overall, the two most vertigo types were vestibulo-visual symptoms (83.78%) and internal vertigo (54.05%). A vertigo attack persisted for <5 min in approximately 57% of patients, compared with 5 min to 72 h in 43%, and lasted longer than 72 h in 8%. Approximately 87% of patients had psychological disorders. Most patients with VM (92%) suffered from some degree of EHF hearing impairment, and 68% had SF hearing loss, which is substantially higher than their complaints (43%). Moreover, the mean EHF hearing threshold cutoff value (57 dB HL) worked well in predicting SF hearing loss (area under curve, AUC, 0.827), outperforming distortion product optoacoustic emission (AUC, 0.748). Conclusion VM has a wide range of clinical manifestations. Hearing loss had a considerably higher rate compared to actual complaints. Moreover, patients with VM tended to have bilateral EHF and high-frequency hearing loss. The effectiveness of the mean EHF hearing threshold cutoff value in predicting hearing loss supported its use in the early detection of hearing loss and monitoring disease progression.
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Affiliation(s)
- Zhaoqi Guo
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jun Wang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dan Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - E. Tian
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jingyu Chen
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Weijia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,Union Hospital, Institute of Otorhinolaryngology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sulin Zhang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,Union Hospital, Institute of Otorhinolaryngology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,*Correspondence: Sulin Zhang ✉
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Gonzalez Eslait FJ, Escudero Triviño PA, Giraldo Vergara YV, Morales García MA, Lucero Gutiérrez VF. Implementation outcomes of a sensory integration therapy program with computerized dynamic posturography in patients with balance and sensory dysfunction. J Otol 2023; 18:26-32. [PMID: 36820156 PMCID: PMC9937828 DOI: 10.1016/j.joto.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/09/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Objective We describe the first-year implementation experience of an Instrumented Sensory Integration Therapy Program in Audiological & Balance Center patients. Design This is a retrospective descriptive study. Participants included Seventy-three adults with diagnoses of acute, episodic, or chronic vestibular syndromes. They were classified into the following two groups: group 1 included 46 individuals treated with ISIT plus VRT, and group 2 included 27 individuals treated only with ISIT. Results The Sensory Organization Test (SOT) for both groups showed a statistical significance for all three sensory inputs; visual systems (G1: p = 0.0003; G2: p = 0.0337), vestibular system (G1: p < 0.0001; G2: p = 0.0003), and balance as demonstrated by compound balance score (G1: p < 0.0001; G2: p = 0.0035), and balance percentage deficit (G1: p < 0.0001; G2: p = 0.0078). Conclusions The severity and complexity of functional neurological disorders in the context of vestibular syndromes seem to require between 10 and 20 therapy sessions, and combined ISIT plus VRT appears to be more effective than ISIT as a monotherapy.
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Affiliation(s)
| | - Paola Andrea Escudero Triviño
- Universidad del Valle, Audiological and Otological Balance Center, Imbanaco Clinic - Grupo Quirón Salud, Cali, Colombia
| | - Yaidy Viviana Giraldo Vergara
- Universidad del Valle, Audiological and Otological Balance Center, Imbanaco Clinic - Grupo Quirón Salud, Cali, Colombia
| | | | - Vanessa Fernanda Lucero Gutiérrez
- Universidad del Valle, Audiological and Otological Balance Center, Imbanaco Clinic - Grupo Quirón Salud, Cali, Colombia,Corresponding author. Vestibular Certified Physical Therapist. Audiological and Otological Balance Center, Imbanaco Clinic - Grupo Quirón Salud, Cali, Colombia.
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Rizk J, Al Hariri M, Khalifeh M, Mghames A, Hitti E. Predictors for hospital admission in emergency department patients with benign paroxysmal positional vertigo: A retrospective review. PLoS One 2023; 18:e0280903. [PMID: 36693076 PMCID: PMC9873188 DOI: 10.1371/journal.pone.0280903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/27/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE This study aims to assess the incidence of Emergency Department (ED) visits for benign paroxysmal positional vertigo (BPPV), describe patient characteristics, management practices and predictors of inpatient admission of BPPV patients. METHODS This was a retrospective chart review of patients presenting with BPPV to a single ED between November 2018 and August 2020. Patients' characteristics, ED management, discharge medications, disposition and unscheduled return visits were determined. RESULTS In total, 557 patients were included. Average age was 49 years, 54.2% were females and 12.4% required hospital admission. In the ED, 51.1% received intravenous hydration, 33.8% received anti-emetics, 10.1% received benzodiazepines, 31.8% underwent canalith repositioning maneuvers (CRMs) and 56.7% were discharged on acetyl-leucine. Of discharged patients, 2.5% had unscheduled return visits. A higher likelihood of admission was associated with age above 54 years (aOR = 4.86, p<0.001, 95% CI [2.67, 8.86]), home use of proton pump inhibitors (PPIs) (aOR = 2.44, p = 0.03, 95% CI [1.08, 5.53]), use of anti-emetics and benzodiazepines in the ED (aOR = 2.34, p = 0.003, 95% CI [1.34, 4.07]) and (aOR = 2.18, p = 0.04, 95% CI [1.03, 4.64]), respectively. CONCLUSION While BPPV is a benign diagnosis, a significant number of patients presenting to the ED require admission. Predictors of admission include older age, PPIs use and ED treatment with anti-emetics and benzodiazepines. Although CRMs are the gold standard for management, CRMs usage did not emerge as protective from admission, and our overall usage was low.
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Affiliation(s)
- Jennifer Rizk
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Moustafa Al Hariri
- Vice President for Medical and Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Malak Khalifeh
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdo Mghames
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Eveline Hitti
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- * E-mail:
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Kang BC, Kim T, Kwon JK. Prevalence of vestibular migraine in an otolaryngologic clinic: Preliminary clinical diagnosis versus diagnosis according to the strictly applied Bárány criteria. J Vestib Res 2023; 33:137-142. [PMID: 36847039 DOI: 10.3233/ves-220112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Diagnostic criteria of vestibular migraine (VM) by the Bárány classification consists of complex combinations of characteristics of dizziness: episodes, intensity, duration, migraine according to International Classification of Headache Disorders (ICHD), and migraine features accompanying vertigo. The prevalence according to strictly applied Bárány criteria may be much lower than preliminary clincal diagnosis. OBJECTIVE The purpose of this study is to investigate the prevalence of VM according to strictly applied Bárány criteria among dizzy patients who visited the otolaryngology department. METHODS The medical records of patients with dizziness from December 2018 to November 2020 were retrospectively searched using a clinical big data system. The patients completed a questionnaire designed to identify VM according to Bárány classification. Microsoft Excel function formulas were used to identify cases that met the criteria. RESULTS During the study period, 955 new patients visited the otolaryngology department complaining of dizziness, of which 11.6% were assessed as preliminary clinical diagnosis of VM in outpatient clinic. However, VM according to strictly applied Bárány criteria accounted for only 2.9% of dizzy patients. CONCLUSION The prevalence of VM according to strictly applied Bárány criteria could be significantly lower than that of preliminary clinical diagnosis in outpatient clinic.
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Affiliation(s)
- Byung Chul Kang
- Department of Otorhinolaryngology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - TaeKoon Kim
- Department of Otorhinolaryngology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Joong Keun Kwon
- Department of Otorhinolaryngology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
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Li ZY, Si LH, Shen B, Ling X, Yang X. Altered functional activity in the right superior temporal gyrus in patients with definite vestibular migraine. Neurol Sci 2022; 44:1719-1729. [PMID: 36576643 DOI: 10.1007/s10072-022-06570-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/16/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Vestibular migraine (VM) is one of the most common causes of episodic central vestibular disorders; it is worth investigating whether VM belongs to the migraine subtype or is a separate disorder. The study is aimed at investigating resting-state functional brain activity alterations in patients with definite VM (dVM). METHODS Seventeen patients with dVM, 8 patients with migraine, and 17 health controls (HCs) were recruited. The amplitude of low frequency fluctuation (ALFF), fractional ALFF (fALFF), and regional homogeneity (ReHo) were calculated to observe the changes in spontaneous brain activity. RESULTS Compared with HCs, VM patients showed significantly increased ALFF values in the right temporal lobe (P = 0.002) and increased ReHo values in the right superior, middle, and inferior temporal gyrus (STG, MTG, and ITG, P = 0.013); patients with migraine showed significantly increased ALFF values in the right limbic lobe (P = 0.04), left ITG (P = 0.024), and right frontal lobe (P < 0.001), significantly decreased ALFF values in the pons and brainstem (P = 0.013), and significantly decreased ReHo values in the frontal cortex (P < 0.001). Compared with patients with migraine, VM patients showed significantly increased fALFF values in the right parietal lobe (P = 0.011) and right frontal lobe (P = 0.026) and significantly increased ReHo values in the right thalamus (P = 0.043). CONCLUSIONS Patients with VM and migraine both had altered brain function, but the regions involved are different.
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Affiliation(s)
- Zhe-Yuan Li
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, 100049, People's Republic of China
| | - Li-Hong Si
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, 100049, People's Republic of China
| | - Bo Shen
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, 100049, People's Republic of China
| | - Xia Ling
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, 100049, People's Republic of China
| | - Xu Yang
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, 100049, People's Republic of China.
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Kulesh AA, Parfenov VA. Vestibular migraine: epidemiology, pathogenesis, clinical picture, diagnosis and treatment. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2022. [DOI: 10.14412/2074-2711-2022-6-4-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- A. A. Kulesh
- Department of neurology and medical genetics, Acad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia
| | - V. A. Parfenov
- Department of Nervous Diseases and Neurosurgery, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
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Preysner TA, Gardi AZ, Ahmad S, Sharon JD. Vestibular Migraine: Cognitive Dysfunction, Mobility, Falls. Otol Neurotol 2022; 43:1216-1221. [PMID: 36136612 DOI: 10.1097/mao.0000000000003700] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Recent evidence has shown that vestibular migraine is strongly associated with cognitive difficulties. However, limited data exist on real-world effects of that dysfunction. The objective of this study is to understand the epidemiology of cognitive dysfunction with vestibular migraine and associated sequelae using National Health Interview Survey data. STUDY DESIGN Randomized, population-based survey study of US adults. SETTING We generated a case definition approximating probable vestibular migraine based on Bárány Society criteria and validated that definition in a tertiary care vestibular clinic. PATIENTS Adult respondents to the 2016 NHIS, which queries a representative sample of the civilian, noninstitutionalized US population. INTERVENTION Diagnostic. MAIN OUTCOME MEASURES We evaluated incidence of self-reported cognitive dysfunction with vestibular migraine and whether individuals were more likely to have impaired mobility, falls, and work absenteeism than those without either condition. RESULTS Among individuals with vestibular migraine, 40% reported "some" and 12% reported "a lot" of difficulty thinking versus 13% and 2% of those without vestibular migraine, respectively. Vestibular migraine sufferers were more likely to have difficulty thinking or remembering compared with respondents without dizziness (odds ratio, 7.43; 95% confidence interval, 6.06-9.10; p < 0.001) when controlled for age, sex, education, stroke, smoking, heart disease, and diabetes. Individuals with both vestibular migraine and cognitive dysfunction had fivefold increased odds of falls and 10-fold increased odds of mobility issues compared with those without either condition. Furthermore, individuals with both vestibular migraine and cognitive dysfunction missed 12.8 more days of work compared to those without either condition. CONCLUSION Our findings indicate vestibular migraine is not only associated with cognitive dysfunction, but they are together associated with mobility issues, fall risk, and work absenteeism.
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Affiliation(s)
- Thi A Preysner
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco School of Medicine
| | - Adam Z Gardi
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco School of Medicine
| | - Sarah Ahmad
- Division of Headache Medicine, Department of Neurology, University of California-San Francisco School of Medicine, San Francisco, California
| | - Jeffrey D Sharon
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco School of Medicine
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Choudhary N, Tewari D, Nabavi SF, Kashani HRK, Lorigooini Z, Filosa R, Khan FB, Masoudian N, Nabavi SM. Plant based food bioactives: A boon or bane for neurological disorders. Crit Rev Food Sci Nutr 2022; 64:3279-3325. [PMID: 36369694 DOI: 10.1080/10408398.2022.2131729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Neurological disorders are the foremost occurring diseases across the globe resulting in progressive dysfunction, loss of neuronal structure ultimately cell death. Therefore, attention has been drawn toward the natural resources for the search of neuroprotective agents. Plant-based food bioactives have emerged as potential neuroprotective agents for the treatment of neurodegenerative disorders. This comprehensive review primarily focuses on various plant food bioactive, mechanisms, therapeutic targets, in vitro and in vivo studies in the treatment of neurological disorders to explore whether they are boon or bane for neurological disorders. In addition, the clinical perspective of plant food bioactives in neurological disorders are also highlighted. Scientific evidences point toward the enormous therapeutic efficacy of plant food bioactives in the prevention or treatment of neurological disorders. Nevertheless, identification of food bioactive components accountable for the neuroprotective effects, mechanism, clinical trials, and consolidation of information flow are warranted. Plant food bioactives primarily act by mediating through various pathways including oxidative stress, neuroinflammation, apoptosis, excitotoxicity, specific proteins, mitochondrial dysfunction, and reversing neurodegeneration and can be used for the prevention and therapy of neurodegenerative disorders. In conclusion, the plant based food bioactives are boon for neurological disorders.
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Affiliation(s)
- Neeraj Choudhary
- Department of Pharmacognosy, Adesh Institute of Pharmacy and Biomedical Sciences, Adesh University, Bathinda, Punjab, India
| | - Devesh Tewari
- Department of Pharmacognosy and Phytochemistry, School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| | - Seyed Fazel Nabavi
- Advanced Medical Pharma (AMP-Biotec), Biopharmaceutical Innovation Centre Via Cortenocera, 82030, San Salvatore Telesino, (BN), Italy
- Nutringredientes Research Center, Federal Institute of Education, Science and Technology (IFCE), Baturite, Ceara, Brazil
| | - Hamid Reza Khayat Kashani
- Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Lorigooini
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Rosanna Filosa
- Advanced Medical Pharma (AMP-Biotec), Biopharmaceutical Innovation Centre Via Cortenocera, 82030, San Salvatore Telesino, (BN), Italy
- Department of Science and Technology, University of Sannio, 82100, Benevento, Italy
| | - Farheen Badrealam Khan
- Department of Biology, College of Science, The United Arab Emirates University, Al Ain, 15551 United Arab Emirates
| | - Nooshin Masoudian
- Advanced Medical Pharma (AMP-Biotec), Biopharmaceutical Innovation Centre Via Cortenocera, 82030, San Salvatore Telesino, (BN), Italy
| | - Seyed Mohammad Nabavi
- Advanced Medical Pharma (AMP-Biotec), Biopharmaceutical Innovation Centre Via Cortenocera, 82030, San Salvatore Telesino, (BN), Italy
- Nutringredientes Research Center, Federal Institute of Education, Science and Technology (IFCE), Baturite, Ceara, Brazil
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Denche-Zamorano Á, Paredes-Mateos V, Pastor-Cisneros R, Carlos-Vivas J, Contreras-Barraza N, Iturra-Gonzalez JA, Mendoza-Muñoz M. Physical Activity Level, Depression, Anxiety, and Self-Perceived Health in Spanish Adults with Migraine: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13882. [PMID: 36360762 PMCID: PMC9655698 DOI: 10.3390/ijerph192113882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/10/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Of all neurological disorders, migraine is the second most prevalent in the world and the most disabling, affecting approximately 15% of the general population. It is characterized by recurrent headaches, along with other symptoms and comorbidities such as depression and anxiety, compromising the sufferer's perception of health. Physical activity is a preventive treatment for migraine and its comorbidities. The aim is to analyze the relationship between migraine and physical activity levels (PAL) in the adult Spanish population, as well as PAL and depression, anxiety, and self-perceived health (SPH) in people with migraine. METHODS A cross-sectional study was conducted including 17,137 participants, 1972 with migraine, using data from the Spanish National Health Survey. Non-parametric statistical tests were performed: z-test for independent proportions (to analyze intergroup differences) and chi-square test (to analyze dependence between categorical variables). RESULTS Migraine was related to PAL (p < 0.001). Inactive people had a higher prevalence of migraine than active and very active people (p < 0.05). PAL was related to depression, anxiety, SPH, and analgesic use in people with migraine (p < 0.001). Inactive people had a higher prevalence of depression, anxiety, analgesic use, and negative SPH than active and very active people (p < 0.05). CONCLUSIONS Increasing PA in the population could reduce the prevalence of migraine. In people with migraine, inactivity could worsen SPH and increase depressive and anxious symptoms.
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Affiliation(s)
- Ángel Denche-Zamorano
- Promoting a Healthy Society Research Group (PHeSO), Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
| | - Víctor Paredes-Mateos
- Promoting a Healthy Society Research Group (PHeSO), Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
| | - Raquel Pastor-Cisneros
- Promoting a Healthy Society Research Group (PHeSO), Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
| | - Jorge Carlos-Vivas
- Promoting a Healthy Society Research Group (PHeSO), Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
| | | | - José A. Iturra-Gonzalez
- Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Santiago 9170022, Chile
| | - María Mendoza-Muñoz
- Research Group on Physical and Health Literacy and Health-Related Quality of Life (PHYQOL), Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7004-516 Évora, Portugal
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Villar-Martinez MD, Goadsby PJ. Pathophysiology and Therapy of Associated Features of Migraine. Cells 2022; 11:cells11172767. [PMID: 36078174 PMCID: PMC9455236 DOI: 10.3390/cells11172767] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Migraine is a complex and debilitating disorder that is broadly recognised by its characteristic headache. However, given the wide array of clinical presentations in migraineurs, the headache might not represent the main troublesome symptom and it can even go unnoticed. Understanding migraines exclusively as a pain process is simplistic and certainly hinders management. We describe the mechanisms behind some of the most disabling associated symptoms of migraine, including the relationship between the central and peripheral processes that take part in nausea, osmophobia, phonophobia, vertigo and allodynia. The rationale for the efficacy of the current therapeutic arsenal is also depicted in this article. The associated symptoms to migraine, apart from the painful component, are frequent, under-recognised and can be more deleterious than the headache itself. The clinical anamnesis of a headache patient should enquire about the associated symptoms, and treatment should be considered and individualised. Acknowledging the associated symptoms as a fundamental part of migraine has permitted a deeper and more coherent comprehension of the pathophysiology of migraine.
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Affiliation(s)
- Maria Dolores Villar-Martinez
- Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London WC2R 2LS, UK
- NIHR King’s Clinical Research Facility, SLaM Biomedical Research Centre, King’s College Hospital, London SE5 9RS, UK
| | - Peter J. Goadsby
- Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London WC2R 2LS, UK
- NIHR King’s Clinical Research Facility, SLaM Biomedical Research Centre, King’s College Hospital, London SE5 9RS, UK
- Department of Neurology, University of California, Los Angeles, CA 90095, USA
- Correspondence:
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Corrado M, Demartini C, Greco R, Zanaboni A, Bighiani F, Vaghi G, Grillo V, Sances G, Allena M, Tassorelli C, De Icco R. Oculo-vestibular signs in experimentally induced migraine attacks: an exploratory analysis. Neurol Sci 2022; 43:6561-6564. [PMID: 35953579 PMCID: PMC9616776 DOI: 10.1007/s10072-022-06312-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/30/2022] [Indexed: 11/29/2022]
Abstract
Vestibular symptoms accompanying headache are quite common in migraine patients. Based on the association of vertigo with migraine, vestibular migraine was included in the appendix of the 3rd edition of the International Classification of Headache Disorders as a possible migraine subtype worthy of further investigation. In this post hoc, exploratory analysis, we investigated the occurrence of oculo-vestibular signs (OVSs) during experimentally induced migraine attacks in 24 episodic migraine patients and 19 healthy controls exposed to sublingual nitroglycerin (NTG - 0.9 mg). A comprehensive clinical examination was performed at baseline, at the onset of the migraine-like attack, and immediately before hospital discharge (180 minutes after NTG administration). Three of the 13 migraine patients who developed a spontaneous-like migraine attack during the hospital observation period (23.1%) also developed OVSs during the induction test. Noteworthy, none of the patients with a negative induction test developed OVSs and no OVSs were reported in healthy subjects at any time point. The exploratory nature of our study does not allow to draw definite conclusions on the possible implications of a vestibular dysfunction in migraine pathophysiology. Our results however suggest that NTG administration may lend itself to investigate vestibular dysfunction in migraine, at least in a subset of patients. The present findings represent a starting point for designing future ad hoc and well-powered studies.
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