Migraine-related vertigo: Diagnosis and treatment

Motion sensitivity and caloric responsiveness in vestibular migraine and Meniere's disease

OBJECTIVES/HYPOTHESIS

We examined whether scores on a motion sensitivity questionnaire (MSQ) could distinguish between vestibular migraine (VM) and Meniere's disease (MD). As a secondary goal, we examined whether scores on the MSQ correlated with results from caloric testing.

STUDY DESIGN

This study administered a telephone questionnaire to subjects who met clinical criteria for vestibular migraine, Meniere's disease, and controls.

METHODS

A MSQ was administered to 20 subjects meeting American Academy of Otolaryngology (AAO) criteria for MD, 30 subjects meeting Neuhauser criteria for both probable vestibular migraine (pVM) and definite vestibular migraine (dVM), and 22 controls.

RESULTS

The average score on the MSQ was 5.9 for VM, 4.25 for MD, and 0.4 for controls. Both the VM and MD scored significantly higher than the controls (P = 0.0001), but results were not statistically different from each other (P = 0.17). However, the average score for subjects with dVM was 7.1, which was significantly higher than subjects with pVM whose average score was 4.2 (P = 0.045) and higher than subjects with MD (P = 0.048). When each question of the MSQ was analyzed, motion sensitivity to riding in a car was found to be significantly different between VM (average score 1.1) and MD (average score 0.5), with P value of 0.048. Scores of MSQ did not correlate with the total eye speed (TES) on caloric testing.

CONCLUSIONS

Subjects with VM and MD had elevated levels of motion sensitivity compared to controls. Subjects with VM had more motion sensitivity to riding in a car than those with MD, but their TES was not different.

LEVEL OF EVIDENCE

3b.

A clinical epidemiological study in 187 patients with vertigo

A retrospective study to investigate the clinical epidemiological characteristics of vertigo was carried out on 187 patients with vertigo. A clinical history for each patient was recorded precisely about the attack, frequency, and development of vertigo, its duration, intensity, and the accompanied symptoms including the risk factors for cerebrovascular disease, etc. All the patients were subjected to physical examination with special attention to neurologic systems and Dix-Hallpike maneuver, computed tomography/computed tomography-angiography (CT/CTA) and MRI scan were performed when necessary. Majority of the patients in this study suffered with posterior circulation ischemia (59.89%) and benign paroxysmal positional vertigo (16.04%). Other ailments that affected these patients included migraine, Meniere's disease (1.6%), sudden hearing loss (1.07%), vestibular neuronitis, multiple sclerosis, acute viral encephalitis, meningioma, neurosis, posttraumatic vertigo, acute myocardial infarction (0.53%), and neurosis (14.97%). It appeared that in comparison to younger patients the elderly population is likely to be more susceptible to vertigo. Vertigo attacks patients with various diseases, which pre-dispose the patients to this disease. Presentation of vertigo can be clinically diagnosed in most cases of patients suffering from posterior circulation ischemia.

Different types of dizziness in patients with peripheral vestibular diseases--their prevalence and relation to migraine

CONCLUSIONS

Besides spontaneous attacks of vertigo or unsteadiness, other symptoms, i.e. drop attacks, lateropulsion, illusions that the room or body is tilted, 'walking on pillows' or 'stepping into a hole', occur without precipitating head movement in almost 50% of patients with peripheral vestibular dysfunctions. The sensation of static tilt was closely connected to migraine and Meniere's disease (MD).

OBJECTIVES

To record the prevalence of the different symptoms with respect to vestibular diagnosis and its relation to migraine.

METHODS

Data from 100 patients with MD, benign paroxysmal positional vertigo (BPPV), or unilateral peripheral vestibular impairment (UPVI) were analyzed with respect to vestibular diagnosis and migraine as a secondary diagnosis.

RESULTS

Spontaneous attacks of vertigo or unsteadiness occurred in 74% and 48% of patients, respectively. Vertigo was significantly more often reported in patients with MD and BPPV. In patients with BPPV, the duration of spontaneous vertigo was shorter than in patients with MD. The relative incidence of other symptoms were: unsteadiness, 48%; 'stepping into a hole', 46%; lateropulsion, 35%; 'walking on pillows', 21%; and drop attacks, 19%. Only the sensation of static tilt, which occurred in 8% of patients, was significantly correlated to MD or to migraine.

Prevalence and impact of migrainous vertigo in mid-life women: A community-based study

We surveyed 1436 women aged 40–54 years in the community. Of these, 278 (19.4%) were diagnosed with migraine or probable migraine based on the International Classification of Headache Disorder criteria. The diagnoses of migrainous vertigo (MV) were modified from Neuhauser’s criteria. Of the 278 women, 238 (85.6%) underwent an interview and 72 (30.3%) of those with migraine or probable migraine had MV. The 1-year prevalence of MV among mid-life women was 5.0% (95% CI, 4.0–6.3%). The MV subjects had a higher proportion of aura (23.6% vs 9.6%; OR, 2.9), nausea (76.4% vs 55.8%; OR, 2.6) and photophobia (61.1% vs 41.7%; OR, 2.2) compared with the migraine subjects without MV. The migrainous subjects with and without MV had similar Short-Form 36 (SF-36) scores. Our study showed that MV was common in mid-life women. Their health-related quality of life was similar in migrainous subjects with MV and those without MV.

Migraine in Multiple Sclerosis

Headache and migraine are common features in multiple sclerosis (MS) and can influence the diagnosis, radiological evaluation, treatment, and quality of life of these patients. Similarities in symptoms between patients with migraine and MS presenting with headache can lead to misdiagnosis. Likewise, MRI lesions which may be found in migraine patients without other neurological symptoms or signs may cause diagnostic confusion and patient anxiety. Studies addressing the pathophysiology of these comorbid conditions have not found a clear link, but brainstem lesions and inflammatory processes have been proposed. Management of de novo or treatment-induced headache in the MS patient is fairly straightforward if the physician is aware of the problem.