1
|
Goto F, Wasano K, Kaneda S, Okami K. Prognostic significance vestibular examination results in patients with vestibular migraine. Front Neurol 2024; 15:1370940. [PMID: 38660093 PMCID: PMC11039844 DOI: 10.3389/fneur.2024.1370940] [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: 01/15/2024] [Accepted: 03/27/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Vestibular migraine (VM) is a newly defined clinical condition. Several vestibular abnormalities have been reported in patients with VM. However, to date, no specific vestibular examinations are used to define VM. Therefore, the utility of vestibular examinations is limited. Currently, the role of vestibular examination has not been clearly defined. We speculated that the results of vestibular examinations could predict the prognosis of VM. We investigated the relationship between the vestibular examination results and clinical outcomes in patients with VM. Methods This study included 25 patients with VM. Vestibular examinations, including the video head impulse test (V-HIT), cervical and ocular vestibular evoked myogenic potential (c-VEMP and o-VEMP), posturography, and several questionnaires, including the Dizziness Handicap Inventory (DHI), were conducted at the initial evaluation. Lifestyle modifications for VM and conventional pharmacological prophylactic treatments, including lomerizine, amitriptyline, and valproic acid, were performed. After 4 weeks of treatment, clinical improvements were evaluated using the Clinical Global Improvement Scale (CGI-s). The relationships among the CGI-S score, several clinical variables, and the results of several vestibular examinations were evaluated. Each patient was further classified into two subgroups according to treatment outcomes concerning vertigo and headache: CGI-S score from 0 to 2 (good response [GR]) and CGI-S score > 3 (poor response [PR]). Results Overall, after treatment, most of the patients had improved dizziness and headache, and the CGI-s was 2.7 ± 1.3. There were 12 GRs, and 13 had PRs. Thus, neither V-HIT nor posturography predicted the prognosis. For c-VEMP, patients with GRs had significantly small AR concerning PR (19.2 ± 12.8 and 62.5 ± 42.5, respectively, [p < 0.01]). There were five normal, six unilateral, and 14 bilateral no response in 500hz o-VEMP. CGI-s of normal, unilateral, and bilateral no response was 1.4 ± 0.5, 2.8 ± 1.3, and 3.1 ± 1.2, respectively. There was a statistically significant difference between the normal and bilateral non-response o-VEMP groups (p < 0.05). Conclusion Patients with VM had improvements in both headache and vertigo through a combination of lifestyle changes and prophylactic medications. Vestibular examinations, especially o- or c-VEMP, are beneficial for predicting the treatment outcomes of VM. The pathophysiology of VM is closely related to vestibular abnormalities, particularly the otolith-related pathways.
Collapse
Affiliation(s)
- Fumiyuki Goto
- Department of Otolaryngology, School of Medicine, Tokai University, Isehara, Kanagawa, Japan
| | | | | | | |
Collapse
|
2
|
Yeo SS, Kim CJ, Yun SH, Son SM, Kim YJ. Effects of Transcranial Direct Current Stimulation on Clinical Features of Dizziness and Cortical Activation in a Patient with Vestibular Migraine. Brain Sci 2024; 14:187. [PMID: 38391761 PMCID: PMC10887163 DOI: 10.3390/brainsci14020187] [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: 01/18/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Vestibular migraine (VM) is common migraine that occurs in patients with dizziness. Vestibular rehabilitation for managing VM generally remains unclear. Recently, it has been reported that transcranial direct current stimulation (tDCS) has positive effects in alleviating dizziness. This study investigated the effects of tDCS on dizziness and cortical activation in a patient with VM. METHODS We recruited a male patient aged 31 years with no dizziness. The patient watched a video to induce dizziness using a virtual reality device. The study applied the intervention using tDCS for 4 weeks and measured 4 assessments: functional near-infrared spectroscopy (fNIRS), quantitative electroencephalography (qEEG), dizziness handicap inventory, and visual vertigo analog scale. RESULTS We showed the activation in the middle temporal gyrus and inferior temporal gyrus (ITG) of the left hemisphere and in the superior temporal gyrus and ITG of the right hemisphere in the pre-intervention. After the intervention, the activation of these areas decreased. In the results of qEEG, excessive activation of C3, P3, and T5 in the left hemisphere and C4 in the right hemisphere before intervention disappeared after the intervention. CONCLUSIONS This study indicated that tDCS-based intervention could be considered a viable approach to treating patients with vestibular dysfunction and dizziness caused by VM.
Collapse
Affiliation(s)
- Sang Seok Yeo
- Department of Physical Therapy, College of Health Sciences, Dankook University, Cheonan-si 31116, Republic of Korea
| | - Chang Ju Kim
- Department of Physical Therapy, College of Health Science, Cheongju University, Cheongju-si 28503, Republic of Korea
| | - Seong Ho Yun
- Department of Health, Graduate School, Dankook University, Cheonan-si 31116, Republic of Korea
| | - Sung Min Son
- Department of Physical Therapy, College of Health Science, Cheongju University, Cheongju-si 28503, Republic of Korea
| | - Yoon Jae Kim
- Department of Health, Graduate School, Dankook University, Cheonan-si 31116, Republic of Korea
| |
Collapse
|
3
|
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.
Collapse
|
4
|
Yiannakis C, Hamilton L, Slim M, Kontorinis G. A systematic review and meta-analysis of prophylactic medication of vestibular migraine. J Laryngol Otol 2023; 137:953-961. [PMID: 36200521 DOI: 10.1017/s0022215122001979] [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: 06/16/2023]
Abstract
OBJECTIVE Vestibular migraine is in the process of recognition as an individual clinical entity. At present, no guidelines exist for its management. This study aimed to conduct a systematic review and meta-analysis to determine the effectiveness of available prophylactic medication. METHOD A literature search was performed using PubMed, Ovid and Embase databases. Qualitative and quantitative analysis were performed as well as risk of bias analysis. Meta-analysis for the mean differences for pre- and post-treatment impact based on Dizziness Handicap Inventory and Vertigo Symptom Scale were performed. Proportionate transformation meta-analysis for the successful event rate based on complete symptoms control was explored. RESULTS Thirteen publications were identified: 3 were randomised, controlled trials and 10 were non-randomised, controlled trials. Propranolol and venlafaxine improved the Vertigo Symptom Scale score by -13.31 points and -4.16 points, respectively, and the Dizziness Handicap Inventory score by -32.24 and -21.24, respectively. Only propranolol achieved statistically significant impact with 60 per cent of patients achieving complete symptom control. CONCLUSION Propranolol should be offered as the first-line treatment for vestibular migraine followed by venlafaxine. Amitriptyline, flunarizine and cinnarizine showed a trend for symptom improvement, but this was not statistically significant.
Collapse
Affiliation(s)
- C Yiannakis
- Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - L Hamilton
- Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - M Slim
- Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - G Kontorinis
- Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| |
Collapse
|
5
|
Alyahya D, Kashoo FZ. Perception, knowledge, and attitude of medical doctors in Saudi Arabia about the role of physiotherapists in vestibular rehabilitation: a cross-sectional survey. PeerJ 2022; 10:e13035. [PMID: 35282282 PMCID: PMC8908887 DOI: 10.7717/peerj.13035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/08/2022] [Indexed: 01/11/2023] Open
Abstract
Objectives There is compelling scientific evidence about the role of physiotherapists in vestibular rehabilitation. However, patients with vestibular-associated dizziness and balance disturbances are seldom referred to physiotherapists in Saudi Arabia. Therefore, this study aims to achieve insight into perceptions, knowledge, attitudes, and referral practices among Saudi Arabian medical doctors relating to the role of physiotherapists in vestibular rehabilitation. Methods A sample of 381 medical doctors practicing in Saudi Arabia participated in this nationwide cross-sectional study. The sample was obtained from 226 hospitals across 13 provinces of Saudi Arabia by stratified sampling method. The 23-item questionnaire developed by a team of experts was emailed to medical doctors practicing in various hospitals across Saudi Arabia. Results Out of 1,231 medical doctors invited, 381 medical doctors responded, giving a response rate of 30.9%. One hundred ninety-three (50.6%) medical doctors reported managing patients with vestibular rehabilitation. The most preferred specialist for managing patients with vestibular disorders was an Ear Nose Throat (ENT) specialist (n = 173, 89.6%). Related Sample Cochran's Q test showed statistically significant difference between preferred specialist for managing patients with vestibular disorders (ENT specialists, physiotherapists, nurses, occupational therapists and audiologists) (χ2(4) = 482.476, p = 0.001). Out of 193 medical doctors, 153 (79.2%) reported no role of the physiotherapist in vestibular rehabilitation. One hundred forty-five (75.1%) of medical doctors reported that they were not aware of the role of physiotherapists in vestibular rehabilitation. Only 27 (15.5%) medical doctors reported referring patients with vestibular disorders to physiotherapists. Conclusion The study reports that physiotherapy services are underutilized in vestibular rehabilitation due to limited referral from Saudi Arabian medical doctors. Therefore, there is a need to increase the awareness among Saudi Arabian doctors about the physiotherapist's role in vestibular rehabilitation.
Collapse
|
6
|
ÇAVUŞ ME, TANYELİ TT, AKCAN FA, BAYIR Ö, GÖKKURT D. Increased mean platelet volume in patients with vestibular migraine. THE EUROPEAN RESEARCH JOURNAL 2020; 6:99-104. [DOI: 10.18621/eurj.463535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Objectives:
The purpose of this study was to investigate relation
between mean platelet volume, platelet distribution width, platelet-to-lymphocyte
ratio, neutrophil-to-lymphocyte ratio and vestibular migraine. Methods: This study was planned in prospective
manner and conducted
in Ankara Polatlı State Hospital between April 2017 and May 2018. Thirty patients
diagnosed with vestibular migraine and thirty healthy, age and sex-matched
subjects were enrolled to the study. Mean platelet volume, platelet
distribution width, platelet count, neutrophil count and lymphocyte count in
blood samples were measured. Results: The mean age of the patients with vestibular
migraine was 39.90 ± 7.16 and the study group consisted
of 11 males and 19 females. The mean platelet volume and platelet
distribution width values in patients with vestibular
migraine were significantly higher than the control group
(p < 0.001). There were no difference
on mean neutrophil/lymphocyte ratio and platelet/lymphocyte ratio values between
patient group and control group.
Conclusions: We found a positive relation of
increased levels of mean
platelet volume and platelet distribution width with vestibular
migraine. Higher mean platelet volume is associated with atherosclerosis and thromboembolism.
Vascular pathologies are blamed for both headache syndromes like migraine and vertiginous
syndromes. This theory supports our study but pathophysiological mechanism is
not clear.
Collapse
Affiliation(s)
- Mehmet Emin ÇAVUŞ
- Department of Otorhinolaryngology, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Talip Talha TANYELİ
- Department of Otorhinolaryngology, Ministry of Health Polatlı State Hospital, Ankara, Turkey
| | - Fatih Alper AKCAN
- Department of Otorhinolaryngology, Düzce University School of Medicine, Düzce, Turkey
| | - Ömer BAYIR
- Department of Otorhinolaryngology, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Didem GÖKKURT
- Department of Neurology, Ministry of Health Polatlı State Hospital, Ankara, Turkey
| |
Collapse
|
7
|
Barometric pressure and the incidence of benign paroxysmal positional vertigo. Am J Otolaryngol 2019; 40:641-644. [PMID: 31147143 DOI: 10.1016/j.amjoto.2019.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/14/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To investigate the relationship between barometric pressure and the incidence of benign paroxysmal positional vertigo (BPPV). METHODS 181 patients diagnosed with classic BPPV seen between 2011 and 2016 were identified. Demographic information, data of onset, and date of presentation were recorded. Historical barometric data for each of the 60 months were recorded. In addition, monthly counts of other atmospheric, infectious, and allergic variables for that time period were recorded. Correlation analysis compared monthly incidence of BPPV with absolute and relative changes in atmospheric conditions. RESULTS The incidence of BPPV onset demonstrated a statistically significant positive correlation with barometric pressure, where every one-unit increase in barometric pressure leads to an expected increase of 6.1 diagnoses (p = 0.0008). The correlation coefficient (r) between barometric pressure and BPPV diagnoses was 0.66 (95% CI 0.14-0.90) with a p-value of 0.0131. Other seasonal variables demonstrated correlation, though none as strong as barometric pressure. CONCLUSIONS Barometric pressure has been long been associated with conditions of the inner ear, though its relationship to the pathogenesis of BPPV has not been investigated. Monthly changes in barometric pressure, rather than the absolute value, may be responsible for the observed changes in incidence. These findings demonstrate a clear association between barometric pressure and BPPV that may help to explain both the etiology of BPPV and its possible connection to migraine-related conditions.
Collapse
|
8
|
Gupta SN, Gupta VS, Borad N. Spectrum of migraine variants and beyond: The individual syndromes in children. Brain Dev 2016; 38:10-26. [PMID: 26081103 DOI: 10.1016/j.braindev.2015.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 05/07/2015] [Accepted: 05/10/2015] [Indexed: 01/03/2023]
Abstract
"Migraine-related conditions" are probably the second most common condition after seizure encountered in pediatric neurology requiring frequent Emergency Department visits. Among migraines, migraine-related condition presents with an acute onset sign or symptom other than headache or visual aura of unknown etiology. A delay in diagnosis is a common occurrence. Previously, the authors proposed a common clinical profile and suggested that the future review should seek the applicability of the common profile in aid to clinical diagnosis of migraine-related individual syndromes. Authors describe the clinical characteristics and differential diagnosis of the spectrum of migraine variants and beyond in children.
Collapse
Affiliation(s)
- Surya N Gupta
- Section of Child Neurology, Women's and Children's Hospital, Charleston Area Medical Center, Charleston, WV, USA.
| | - Vikash S Gupta
- MS-IV, Texila American University, Woolford Ave, Georgetown, Guyana.
| | - Nirali Borad
- Department of Physiology, P.D.U. Government Medical College, Rajkot, Gujarat, India.
| |
Collapse
|
9
|
Headache and Dizziness: How to Differentiate Vestibular Migraine from Other Conditions. Curr Pain Headache Rep 2015; 19:31. [DOI: 10.1007/s11916-015-0502-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
10
|
Abstract
Vestibular migraine is now considered a distinct diagnostic entity by both the Barany Society and the International Headache Society. The recognition of vestibular migraine as a diagnostic entity required decades and was presaged by several reports indicating that a large proportion of patients with migraine headaches have vestibular symptoms and that a large proportion of patients with undiagnosed episodic vestibular symptoms have migraine headache. Despite the availability of diagnostic criteria for vestibular migraine, challenges to diagnosis include variability in terms of the character of dizziness, the presence or absence of clearly defined attacks, the duration of attacks, and the temporal association between headache or other migrainous features and vestibular symptoms. Also, symptoms of vestibular migraine often overlap with symptoms of other causes of dizziness, especially Ménière's disease and benign paroxysmal positional vertigo (BPPV). This article will discuss the demographics, epidemiology, clinical manifestations, physical examination findings, laboratory testing, comorbidities, treatment options, and pathophysiology of vestibular migraine. Future research in the field of vestibular migraine should include both clinical and basic science efforts to better understand the pathophysiology of this condition. Controlled treatment trials for vestibular migraine are desperately needed.
Collapse
Affiliation(s)
- Joseph M Furman
- Departments of Otolaryngology, Neurology, Bioengineering, and Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | |
Collapse
|
11
|
Prognostic Significance of Vestibulospinal Abnormalities in Patients With Vestibular Migraine. Otol Neurotol 2015; 36:282-8. [DOI: 10.1097/mao.0000000000000656] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Abstract
PURPOSE OF REVIEW Awareness of the importance of migraine in patients with symptoms of vestibular dysfunction is increasing. This article gives an overview of the multiple facets of the link between migraine and vestibular dysfunction. RECENT FINDINGS The vestibular and the headache community have published a consensual definition of vestibular migraine, which is an important step to promote research on the topic and the awareness of clinicians. Vestibular migraine is considered the most common cause of spontaneous recurrent vertigo. So far, the evidence for vestibular migraine has been mainly epidemiological, but the recent follow-up of a cohort over 9 years could show the robustness of the diagnosis over time.Additionally, migraine and vestibular dysfunction have multiple potential interactions and links through a range of comorbidities such as Menière's disease, benign paroxysmal positional vertigo, anxiety and motion sickness, which go beyond the diagnostic entity of vestibular migraine. SUMMARY The further refinement and wider acceptance of the diagnostic entity of vestibular migraine is an important development as it is one the most common vestibular disorders. But the relationship between migraine and vestibular dysfunction is complex and has many aspects beyond vestibular migraine.
Collapse
|
13
|
Furman JM, Marcus DA, Balaban CD. Vestibular migraine: clinical aspects and pathophysiology. Lancet Neurol 2013; 12:706-15. [DOI: 10.1016/s1474-4422(13)70107-8] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
14
|
Comorbidity profiles of chronic migraine sufferers in a national database in Taiwan. J Headache Pain 2012; 13:311-9. [PMID: 22527034 PMCID: PMC3356468 DOI: 10.1007/s10194-012-0447-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 03/27/2012] [Indexed: 11/16/2022] Open
Abstract
Chronic migraine (CM; ≥15 headache days per month, ≥3 months) is associated with a higher prevalence of comorbidities than episodic migraine (<15 headache days per month). However, it is unclear whether a similar pattern exists in Asian patients. To examine this, a retrospective matched cohort study was conducted using the Taiwan National Health Insurance Research Database. CM cases were defined as patients with at least one neurological outpatient visit with a primary or secondary ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) code of 346.11, diagnosed by neurologists at medical centers during 2007–2008. The study group was compared with patients suffering from other migraine subtypes and non-migraineurs in the general population. Both comparison groups were matched with CM sufferers at a 4:1 ratio by age, gender, urbanization level of the residence, income, and hospital setting. Relative risk (RR) was calculated using conditional logistic regression. Compared with patients with other migraines (n = 2,226), CM sufferers (n = 681) had a higher risk of hyperlipidemia (RR = 1.32; P = 0.041), asthma (RR = 1.77; P = 0.007), depression (RR = 1.88; P < 0.0001), bipolar disorder (RR = 1.81; P = 0.022) and anxiety disorders (RR = 1.48; P = <0.0001). Compared with the non-migraineurs (n = 3,790), CM sufferers (n = 948) had significantly increased risks of cardiovascular disease, sinusitis, asthma, gastrointestinal ulcers, vertigo and psychiatric disorders by 1.6–3.9-fold. In conclusion, CM is associated with significant comorbidities in Asian patients. Differences in the comorbidity profiles of CM compared with other migraines have highlighted that patients with CM differ not just in terms of headache frequency but also in other important aspects.
Collapse
|
15
|
Abstract
Vestibular migraine is considered to be the second most common cause of vertigo and the most common cause of spontaneous episodic vertigo. The duration of attacks varies from seconds to days, usually lasting minutes to hours, and they mostly occur independently of headaches. Long-lasting individual attacks are treated with generic antivertiginous and antiemetic drugs. Specific antimigraine drugs are unlikely to be very effective for rescue. The mainstay of the management of vestibular migraine is prophylactic medication. To date, there are no controlled trials available; the body of knowledge builds on case series and retrospective or observational studies. Most drugs are also used for the prevention of migraine headaches. The choice of medication should be guided by its side effect profile and the comorbidities of patients. Betablockers such as propanolol or metoprolol are preferred in patients with hypertension but in the absence of asthma. Anticonvulsants include topiramate when patients are obese, valproic acid and lamotrigine. Lamotrigine is preferred if vertigo is more frequent than headaches. Calcium antagonists include verapamil and flunarizine. If patients have anxiety, tricyclic antidepressants such as amitryptiline or nortryptiline or SSRIs and benzodiazepines such as clonazepam are recommended. Acetazolamide is effective in rare genetic disorders related to migraine-like episodic ataxia; however, its place in vestibular migraine is still to be established. Nonpharmacological measures such as diet, sleep, hygiene and avoidance of triggers are recommended as they are for migraine. Vestibular rehabilitation might be useful when there are complications such as loss of confidence in balance or visual dependence.
Collapse
Affiliation(s)
- Alexandre R Bisdorff
- Centre Hospitalier Emile Mayrisch, rue Emile Mayrisch, Esch-sur-Alzette, 4003 Luxembourg
| |
Collapse
|
16
|
Brantberg K, Baloh RW. Similarity of vertigo attacks due to Meniere's disease and benign recurrent vertigo, both with and without migraine. Acta Otolaryngol 2011; 131:722-7. [PMID: 21469911 DOI: 10.3109/00016489.2011.556661] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Vertigo attacks in patients with benign recurrent vertigo (BRV) cannot be distinguished from those in patients with Meniere's disease on the basis of duration, triggers or associated symptoms (other than auditory). A subset of BRV is associated with migraine. OBJECTIVE To investigate whether clinical features of vertigo attacks can distinguish patients with BRV from those with Meniere's disease and whether subtypes of BRV can be identified. METHODS A structured interview was used to analyze features in patients with BRV, i.e. those who have normal audiograms and caloric test results even though they have had recurrent vertigo (n = 63). A group of patients with definite Meniere's disease (n = 112) served as the comparison group. RESULTS Compared with the Meniere's disease group, patients with BRV had a female preponderance, earlier age of onset, and increased incidence of migraine headaches (IHS criteria). With regard to the vertigo attacks, duration tended to be shorter in patients with BRV but there was a large overlap in the duration of attacks between the two groups. Triggers (stress/emotional upset, fatigue, menstrual periods) and associated symptoms (imbalance, nausea and vomiting, headache, sensitivity to light) were not significantly different in the two groups.
Collapse
|
17
|
Abstract
AIM AND OBJECTIVES To provide an overview of vertigo and its management and identify its impact on individuals to offer strategies for managing the condition. BACKGROUND Dizziness and vertigo are symptoms common to many pathologies/dysfunctions ranging from the benign to the potentially serious; many are poorly understood. Although rarely life-threatening, vertigo is debilitating and significantly affects quality of life; it may be as disabling as paralysis or loss of a limb. Although 40-80% of cases remain unexplained, referral for specific investigation is rare. DESIGN A narrative literature review including descriptive, theoretical and empirical material reliant on the keywords 'dizziness' and 'vertigo' and the phrase 'vestibular disorders'. This provided diverse information that was used to address the research questions. RESULTS Vertigo is a widespread and potentially distressing symptom that may arise at any age and be acute or chronic. For most, it resolves spontaneously; for others, dizziness persists, causing significant distress. Its management is challenging, especially when the underlying cause is unclear. Pharmacological interventions, physiotherapy, psychotherapy or, rarely, surgery can be used in its management. Few nursing studies are available, suggesting that nursing knowledge may be limited. RELEVANCE TO CLINICAL PRACTICE Although nurses may frequently encounter patients with vertigo, there are few relevant nursing studies in this area; few consider appropriate nursing interventions or approaches to patient care. The information provided reveals that understanding the full impact of the condition and identification of patients' needs are essential to effective care. Some strategies to help affected patients are outlined. CONCLUSIONS Vertigo, a widespread, often intractable condition, affects significant numbers of people; diagnosis and management can be challenging. Treatment, care and support must be selected on an individual basis taking individuals into account. The primary goals are to maintain physical status, psychosocial interaction and quality of life.
Collapse
Affiliation(s)
- Susan Holmes
- Faculty of Health and Social Care, Canterbury Christ Church University, Canterbury, Kent CT1 1QU, UK.
| | | |
Collapse
|
18
|
Abstract
Migraine headache can be a debilitating condition that confers a substantial burden to the affected individual and to society. Despite significant advancements in the medical management of this challenging disorder, clinical data have revealed a proportion of patients who do not adequately respond to pharmacologic intervention and remain symptomatic. Recent insights into the pathogenesis of migraine headache argue against a central vasogenic cause and substantiate a peripheral mechanism involving compressed craniofacial nerves that contribute to the generation of migraine headache. Botulinum toxin injection is a relatively new treatment approach with demonstrated efficacy and supports a peripheral mechanism. Patients who fail optimal medical management and experience amelioration of headache pain after injection at specific anatomical locations can be considered for subsequent surgery to decompress the entrapped peripheral nerves. Migraine surgery is an exciting prospect for appropriately selected patients suffering from migraine headache and will continue to be a burgeoning field that is replete with investigative opportunities.
Collapse
|
19
|
Donaldson CJ, Hoffer ME, Balough BJ, Gottshall KR. Prognostic assessments of medical therapy and vestibular testing in post-traumatic migraine-associated dizziness patients. Otolaryngol Head Neck Surg 2010; 143:820-5. [PMID: 21109084 DOI: 10.1016/j.otohns.2010.09.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 08/25/2010] [Accepted: 09/13/2010] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to characterize our clinical population of patients suffering with post-traumatic migraine-associated dizziness (PTMAD) and determine any associations with medical interventions and vestibular testing metrics to help predict response to treatments. STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. SUBJECTS AND METHODS The electronic medical records of 83 patients presenting to a tertiary referral center who were given a diagnosis of PTMAD and who had been treated were retrospectively reviewed. General characteristics, clinical treatment, pre- and post-vestibular therapy testing metrics, and success and failure outcomes were assessed. Patients were assigned into responder and nonresponder groups related to their headaches and evaluated at two specific time points. Medication failures and vestibular test metrics were compared to identify and predict clinical outcomes. RESULTS Seventy-two of 82 patients (88%) were analyzed at two time points. Use of verapamil, topiramate, gabapentin, amitryptiline, and valproic acid showed no comparative treatment benefit in responders compared to nonresponders (P = 0.294). Findings associated with successful treatments include response to initial medication (P = 0.001), final dynamic gait index (DGI) scores (P = 0.029), final vertical dynamic visual acuity test (DVAT) scores (up, 0.007; down, 0.006), and both final and change in computerized dynamic posturography-sensory organization test (CDP-SOT) scores (P = 0.001, P = 0.032). The antipsychotic quetiapine was specifically associated with outcome failures (P = 0.003). CONCLUSION Specific prophylactic antimigraine medications were not associated with improved outcomes in PTMAD patients. Initial clinical responses and vestibular test metrics may guide physicians to predict successful outcomes.
Collapse
Affiliation(s)
- Chadwick J Donaldson
- Spatial Orientation Center, Department of Otolaryngology, Naval Medical Center San Diego, San Diego, CA, USA.
| | | | | | | |
Collapse
|
20
|
Abstract
Vertigo and migraine are known to be frequently associated. However, only recently, the etiological links between the two diseases are being investigated and explained. More and more interest is being attracted by migrainous vertigo, an isolated entity that might deserve inclusion in the International Classification of Headache Disorders. The authors briefly review the main links between migraine and vertigo.
Collapse
|
21
|
Abstract
Vestibular migraine is a chameleon among the episodic vertigo syndromes because considerable variation characterizes its clinical manifestation. The attacks may last from seconds to days. About one-third of patients presents with monosymptomatic attacks of vertigo or dizziness without headache or other migrainous symptoms. During attacks most patients show spontaneous or positional nystagmus and in the attack-free interval minor ocular motor and vestibular deficits. Women are significantly more often affected than men. Symptoms may begin at any time in life, with the highest prevalence in young adults and between the ages of 60 and 70. Over the last 10 years vestibular migraine has evolved into a medical entity in dizziness units. It is the most common cause of spontaneous recurrent episodic vertigo and accounts for approximately 10% of patients with vertigo and dizziness. Its broad spectrum poses a diagnostic problem of how to rule out Menière's disease or vestibular paroxysmia. Vestibular migraine should be included in the International Headache Classification of Headache Disorders (ICHD) as a subcategory of migraine. It should, however, be kept separate and distinct from basilar-type migraine and benign paroxysmal vertigo of childhood. We prefer the term "vestibular migraine" to "migrainous vertigo," because the latter may also refer to various vestibular and non-vestibular symptoms. Antimigrainous medication to treat the single attack and to prevent recurring attacks appears to be effective, but the published evidence is weak. A randomized, double-blind, placebo-controlled study is required to evaluate medical treatment of this condition.
Collapse
Affiliation(s)
- Michael Strupp
- Department of Neurology and Integrated Center for Research and Treatment of Vertigo, Dizziness and Ocular Motor Disorders, Ludwig-Maximilians University, Münich, Germany.
| | | | | |
Collapse
|
22
|
Bahmad F, DePalma SR, Merchant SN, Bezerra RL, Oliveira CA, Seidman CE, Seidman JG. Locus for familial migrainous vertigo disease maps to chromosome 5q35. Ann Otol Rhinol Laryngol 2009; 118:670-6. [PMID: 19810609 DOI: 10.1177/000348940911800912] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Migrainous vertigo (episodic vertigo associated with migraine) is sometimes inherited as an autosomal dominant trait. However, neither disease genes nor loci that might be responsible have been reported. We sought to map the genetic locus for familial migrainous vertigo in a 4-generation family and to define the progression of disease in this family. METHODS We studied 23 members in a family in whom migrainous vertigo was inherited as an autosomal dominant trait. Clinical information obtained included case histories and results of otolaryngological, neurologic, audiometric, and imaging evaluations. Genome-wide linkage analysis was performed with Affymetrix Genechip Human Mapping 10K microarrays. Genotyping of family members' DNA with microsatellite markers was used to further assess candidate loci identified from the whole-genome scan. RESULTS Of 23 family members, 10 suffered from migrainous vertigo beginning after 35 years of age. Migraine headaches usually preceded the onset of vertigo by 15 to 20 years. Longitudinal audiometric studies over 12 years showed stable, high-frequency sensorineural hearing loss consistent with presbycusis. Low-frequency or fluctuating hearing loss was not observed. The results of vestibular testing and imaging studies were unremarkable. Genetic analysis defined a 12.0 MB interval on chromosome 5q35 between loci rs244895 and D5S2073 that contained the disease gene (logarithm of odds score, 4.21). CONCLUSIONS We report the first locus for familial migrainous vertigo, which mapped to 5q35.
Collapse
Affiliation(s)
- Fayez Bahmad
- Department of Genetics, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
| | | | | | | | | | | | | |
Collapse
|
23
|
Prakash S, Shah ND. Migrainous Vertigo Responsive to Intravenous Methylprednisolone: Case Reports. Headache 2009; 49:1235-9. [DOI: 10.1111/j.1526-4610.2009.01474.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
24
|
Tilikete C, Vighetto A. [Vertigo treatment according to their mechanisms]. Neurochirurgie 2009; 55:259-67. [PMID: 19303115 DOI: 10.1016/j.neuchi.2009.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 01/08/2009] [Indexed: 10/21/2022]
Abstract
Vertigo is an illusion of rotatory or linear movement that demonstrates a functional or lesional disturbance of the vestibular system, from periphery to central connections. According to the ANAES report (1997), benign paroxysmal positional vertical vertigo, vestibular neuronitis and Ménière's disease account for 40-50% of all mixed vertigo etiologies. Central etiologies may account for 20-40% of causes and 10-40% remain more difficult to classify, and are usually classified under the term of "peripheral vestibulopathy." These include vertigo due to neurovascular compression syndrome of the VIIIth nerve. Clinical manifestations, differential diagnosis, and treatment of the main etiologies of vertigo will be developed in this chapter. A specific section will discuss the subject of neurovascular compression syndrome of the VIIIth nerve. Even though some publications should be challenged, it appears that neurovascular compression syndrome of the VIIIth nerve might explain some cases of vertigo or chronic instability, with or without cochlear signs. The diagnosis is difficult and must be established on multiple clinical, electrophysiological and radiological arguments. A therapeutic test with antiepileptic drugs is helpful. The treatment includes these drugs as a first option but may require a neurosurgical approach if medical treatment fails.
Collapse
|
25
|
Fotuhi M, Glaun B, Quan SY, Sofare T. Vestibular migraine: a critical review of treatment trials. J Neurol 2009; 256:711-6. [PMID: 19252785 DOI: 10.1007/s00415-009-5050-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Revised: 12/26/2008] [Accepted: 01/13/2009] [Indexed: 11/27/2022]
Abstract
Vestibular migraine (VM), also known as migraine-associated vertigo, is a common cause of dizziness in adults. We performed a comprehensive literature search regarding treatment for VM or migraine-associated vertigo during the period of 1990-2008 and used, individually or in combination, the search terms VM, migraine-associated vertigo, migraine-associated dizziness, migrainous vertigo, migraine and vertigo, migraine and disequilibrium, and headache and vertigo. We found nine publications that address treatment strategies for VM. One small randomized clinical trial found some benefit from the use of zolmitriptan for abortive treatment of VM. The other eight observational studies showed marginal improvement with migraine prophylactic medications such as nortriptyline, verapamil, or metoprolol. Until more specific treatment options become available, patients with VM need to be managed with similar prophylactic and abortive strategies as those used for migraine in adults.
Collapse
Affiliation(s)
- Majid Fotuhi
- Center for Balance, Dizziness, and Vertigo, LifeBridge Health Brain & Spine Institute, 5051 Greenspring Avenue, Baltimore, MD 21209, USA.
| | | | | | | |
Collapse
|
26
|
Abstract
PURPOSE OF REVIEW In the past few years, otologists have been seeing an increasing number of patients with vestibular disorders due to migraine-associated vestibulopathy. This article reviews some of the latest developments in the understanding of this disease process, specifically its incidence, symptoms, diagnosis, and treatment. RECENT FINDINGS Migraine-associated vestibular symptoms may include episodic true vertigo, movement-provoked dysequilibrium, imbalance/unsteadiness, and complaints of lightheadedness. The pathophysiology of migraine-associated vestibulopathy is not completely understood; however, both peripheral and central deficits have been observed. Although the International Headache Society classification does not include migraine-associated vestibulopathy as a subclassification of migraine, there is emerging evidence to support this development, which should then lead toward improved diagnosis and treatment. Currently, migraine-associated vestibulopathy is still considered a diagnosis of exclusion. SUMMARY Treatment of migraine-associated vestibulopathy is effective and includes lifestyle changes, such as reducing triggers that increase susceptibility to migraines (e.g. stress, poor diet, nicotine, or irregular sleep patterns), prophylactic and abortive medications, vestibular therapy, or a combination of these. Further research is needed to better understand migraine-associated vestibulopathy and improve treatment.
Collapse
|
27
|
Abstract
Despite its high prevalence and individual as well as societal burden, migraine remains underdiagnosed and undertreated. In recent years, the options for the management of migraine patients have greatly expanded. A number of drugs belonging to various pharmacological classes and deliverable by several routes are now available both for the acute and the preventive treatments of migraine. Nevertheless, disability and satisfaction remain low in many subjects because treatments are not accessible, not optimized, not effective, or simply not tolerated. There is thus still considerable room for better education, for more efficient therapies and for greater support from national health systems. In spite of useful internationally accepted guidelines, anti-migraine treatment has to be individually tailored to each patient taking into account the migraine subtype, the ensuing disability, the patient's previous history and present expectations, and the co-morbid disorders. In this article we will summarize the phenotypic presentations of migraine and review recommendations for acute and preventive treatment, highlighting recent advances which are relevant for clinical practice in terms of both diagnosis and management.
Collapse
Affiliation(s)
- Arnaud Fumal
- Departments of Neurology and Functional Neuroanatomy, Headache Research Unit, University of Liège, CHR Citadelle, B-4000 Liege, Belgium.
| | | |
Collapse
|
28
|
Edlow JA, Newman-Toker DE, Savitz SI. Diagnosis and initial management of cerebellar infarction. Lancet Neurol 2008; 7:951-64. [DOI: 10.1016/s1474-4422(08)70216-3] [Citation(s) in RCA: 214] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
29
|
Brainstem auditory-evoked potential habituation and intensity-dependence related to serotonin metabolism in migraine: a longitudinal study. Clin Neurophysiol 2008; 119:1190-200. [PMID: 18316245 DOI: 10.1016/j.clinph.2008.01.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Revised: 11/20/2007] [Accepted: 01/19/2008] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Reduced habituation and increased intensity-dependence of cortical auditory-evoked potentials have been reported in migraine, but it is not known if brainstem mechanisms are chiefly or partly responsible for this hypersensitivity, if brainstem excitability or habituation changes across the migraine cycle, or how excitability relates to symptoms and serotonin metabolism. METHODS Brainstem auditory-evoked potentials (BAEPs) to 40, 55, and 70dB binaural rarefaction clicks were recorded in four blocks of 750 stimuli in a blinded longitudinal study in 41 migraine patients. Serotonin was measured in a blood sample from the cubital vein. The test day was classified as baseline, attack, pre-attack or post-attack. RESULTS Pre-attack BAEP changes were not found. Wave I, V and interpeak III-V latency increased after the attack. III-V latency correlated with headache history duration and usual headache attack duration. Habituation in wave IV-V dispersion to 40dB was found in controls but not in migraine (p=0.04). Serotonin correlated with BAEP amplitude in controls. Low serotonin correlated with more autonomic symptoms. BAEP intensity-dependence was normal in migraine. CONCLUSIONS BAEP latencies, but not amplitude, increase temporarily after a migraine attack. Abnormal habituation of brainstem wave IV-V dispersion in migraine may suggest increased excitation in colliculus inferior at low sound intensities, but no relation to the migraine cycle was found for wave IV-V amplitude, dispersion or habituation. The correlation between BAEP amplitude and serotonin was deranged in migraine patients, but reappeared temporarily within 72h after an attack. SIGNIFICANCE No evidence for pre-attack brainstem auditory sensitization was found in migraine. Intensity-dependence of AEP in migraine is probably not a passive reflection of brainstem dysfunction. BAEP changes seem to reflect a slight impact of migraine on serotonergic brainstem pathways.
Collapse
|