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Carvalho GF, Luedtke K, Bevilaqua-Grossi D. Balance disorders and migraine. Musculoskelet Sci Pract 2023; 66:102783. [PMID: 37263900 DOI: 10.1016/j.msksp.2023.102783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Migraine is associated with motion sensitivity symptoms such as kinetosis, vestibular symptoms and balance alterations. While focus is given to headache management, addressing these symptoms is often neglected, although they are related to additional migraine burden and increased disability. PURPOSE Our aim is to disseminate the current understanding of the motion sensitivity symptoms among patients with migraine, with focus on balance impairments. We discuss the susceptibility of migraine to motion sensitivity, its suggested mechanisms, the balance alterations during quiet standing, mobility tasks and reactions to external perturbations. The role of migraine subdiagnosis, implications for clinical practice and future perspectives are also acknowledged. IMPLICATIONS Balance disorders are one of the signs reflecting a broader and complex spectrum of motion sensitivity, which are present even between attacks. Migraineurs are especially inherent to these symptoms probably due to brain hyperexcitability and to shared pathophysiological mechanisms. Patients, especially with aura and chronic migraine, exhibit balance instability during quiet standing under different surface and visual input conditions. Migraineurs demonstrated reduced limits of stability and lower performance on walk, transposing obstacles and sit to stand tasks. Only patients with aura present impairment of motor control reactions following external perturbations. Balance alterations are associated with falls and are influenced by aura, migraine frequency and psychosocial aspects, but not by vestibular symptoms or vestibular migraine diagnosis. There is a high demand for high quality of evidence regarding the assessment and care of motion sensitivity symptoms in migraineurs, considering approaches to manage not just the pain, but its associated symptoms.
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Affiliation(s)
- Gabriela F Carvalho
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), Universität zu Lübeck, Lübeck, Germany.
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), Universität zu Lübeck, Lübeck, Germany
| | - Debora Bevilaqua-Grossi
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Blaeser AS, Sugden AU, Zhao J, Carneiro-Nascimento S, Shipley FB, Carrié H, Andermann ML, Levy D. Trigeminal afferents sense locomotion-related meningeal deformations. Cell Rep 2022; 41:111648. [PMID: 36384109 PMCID: PMC9713852 DOI: 10.1016/j.celrep.2022.111648] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/24/2022] [Accepted: 10/20/2022] [Indexed: 11/18/2022] Open
Abstract
The trigeminal sensory innervation of the cranial meninges is thought to serve a nociceptive function and mediate headache pain. However, the activity of meningeal afferents under natural conditions in awake animals remains unexplored. Here, we used two- and three-dimensional two-photon calcium imaging to track the activity of meningeal afferent fibers in awake mice. Surprisingly, a large subset of afferents was activated during non-noxious conditions such as locomotion. We estimated locomotion-related meningeal deformations and found afferents with distinct dynamics and tuning to various levels of meningeal expansion, compression, shearing, and Z-axis motion. Further, these mechanosensitive afferents were often tuned to distinct directions of meningeal expansion or compression. Thus, in addition to their role in headache-related pain, meningeal sensory neurons track the dynamic mechanical state of the meninges under natural conditions.
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Affiliation(s)
- Andrew S Blaeser
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Arthur U Sugden
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Jun Zhao
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Simone Carneiro-Nascimento
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Frederick B Shipley
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Hanaé Carrié
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Mark L Andermann
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
| | - Dan Levy
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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Risk of Vestibulocochlear Disorders in Patients with Migraine or Non-Migraine Headache. J Pers Med 2021; 11:jpm11121331. [PMID: 34945803 PMCID: PMC8707905 DOI: 10.3390/jpm11121331] [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: 11/05/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 11/23/2022] Open
Abstract
Headaches, especially migraines, have been associated with various vestibular symptoms and syndromes. Tinnitus and hearing loss have also been reported to be more prevalent among migraineurs. However, whether headaches, including migraine or non-migraine headaches (nMH), are associated with vestibular and cochlear disorders remains unclear. Thus, we sought to investigate possible associations between headache and vestibulocochlear disorders. We analyzed 10 years of data from the Smart Clinical Data Warehouse. In patients with migraines and nMH, meniere’s disease (MD), BPPV, vestibular neuronitis (VN) and cochlear disorders, such as sensorineural hearing loss (SNHL) and tinnitus, were collected and compared to clinical data from controls who had health check-ups without headache. Participants included 15,128 with migraines, 76,773 patients with nMH and controls were identified based on propensity score matching (PSM). After PSM, the odds ratios (OR) in subjects with migraine versus controls were 2.59 for MD, 2.05 for BPPV, 2.98 for VN, 1.74 for SNHL, and 1.97 for tinnitus, respectively (p < 0.001). The OR for MD (1.77), BPPV (1.73), VN (2.05), SNHL (1.40), and tinnitus (1.70) in patients with nMH was also high after matching (p < 0.001). Our findings suggest that migraines and nMH are associated with an increased risk of cochlear disorders in addition to vestibular disorders.
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Klein A, Schankin CJ. Visual snow syndrome, the spectrum of perceptual disorders, and migraine as a common risk factor: A narrative review. Headache 2021; 61:1306-1313. [PMID: 34570907 PMCID: PMC9293285 DOI: 10.1111/head.14213] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/06/2021] [Accepted: 08/19/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this narrative review is to explore the relationship between visual snow syndrome (VSS), migraine, and a group of other perceptual disorders. BACKGROUND VSS is characterized by visual snow and additional visual and nonvisual disturbances. The clinical picture suggests a hypersensitivity to internal and external stimuli. Imaging and electrophysiological findings indicate a hyperexcitability of the primary and secondary visual areas of the brain possibly due to an impairment of inhibitory feedback mechanisms. Migraine is the most frequent comorbidity. Epidemiological and clinical studies indicate that other perceptual disorders, such as tinnitus, fibromyalgia, and dizziness, are associated with VSS. Clinical overlaps and parallels in pathophysiology might exist in relation to migraine. METHODS We performed a PubMed and Google Scholar search with the following terms: visual snow syndrome, entoptic phenomenon, fibromyalgia, tinnitus, migraine, dizziness, persistent postural-perceptual dizziness (PPPD), comorbidities, symptoms, pathophysiology, thalamus, thalamocortical dysrhythmia, and salience network. RESULTS VSS, fibromyalgia, tinnitus, and PPPD share evidence of a central disturbance in the processing of different stimuli (visual, somatosensory/pain, acoustic, and vestibular) that might lead to hypersensitivity. Imaging and electrophysiological findings hint toward network disorders involving the sensory networks and other large-scale networks involved in the management of attention and emotional processing. There are clinical and epidemiological overlaps between these disorders. Similarly, migraine exhibits a multisensory hypersensitivity even in the interictal state with fluctuation during the migraine cycle. All the described perceptual disorders are associated with migraine suggesting that having migraine, that is, a disorder of sensory processing, is a common link. CONCLUSION VSS, PPPD, fibromyalgia, and chronic tinnitus might lie on a spectrum of perceptual disorders with similar pathophysiological mechanisms and the common risk factor migraine. Understanding the underlying network disturbances might give insights into how to improve these currently very difficult to treat conditions.
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Affiliation(s)
- Antonia Klein
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph J Schankin
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Rojas Castro MY, Avalos M, Contrand B, Dupuy M, Sztal-Kutas C, Orriols L, Lagarde E. Health conditions and the risk of home injury in French adults: results from a prospective study of the MAVIE cohort. Inj Prev 2021; 28:141-147. [PMID: 34413074 DOI: 10.1136/injuryprev-2020-044033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 08/10/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Home injury (HI) is a significant cause of mortality and morbidity in adults of all ages. Health conditions significantly impact HI among old adults, but little is known for other adults. STUDY DESIGN Prospective cohort study. OBJECTIVE We assessed the associations between health-related factors and HI's risk in a French study, the MAVIE (Mutualistes pour la recherche contre les Accidents de la VIE courante) cohort. METHODS Poisson mixed models were fitted using health-related data information (diseases, treatments and disabilities) at baseline and the number of injuries prospectively recorded during the follow-up, adjusting for significant sociodemographics and exposure to a range of home activities. Attributable fractions were estimated based on risk ratio (RR) estimations measured in the fully adjusted models. RESULTS A total of 6146 dwelling adults aged 15 or older were followed up for 5.1 years on average. Vertigo or dizziness (RR=2.36, 95% CI 1.06 to 5.01) and sciatica or back pain (RR=1.49, 95% CI 1.08 to 2.05) were independently associated with an increased risk of HI. These two groups of conditions showed the most significant associations among people aged 15-49, whereas musculoskeletal diseases other than rachialgias and arthropathies were the most significant health-related risk factor in people aged 50 and older. Sciatica or back pain represented the highest burden of HIs in overall adults (8%) and among people aged 15-49 (12%). CONCLUSION Our results suggest that adults with musculoskeletal disorders and vertigo or dizziness symptoms have a higher risk of HI, regardless of age.
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Affiliation(s)
- Madelyn Yiseth Rojas Castro
- U1219, INSERM, Bordeaux, Nouvelle-Aquitaine, France.,U1219, Universite de Bordeaux, Bordeaux, Aquitaine, France
| | - Marta Avalos
- U1219, INSERM, Bordeaux, Nouvelle-Aquitaine, France.,SISTM Team, Inria, Talence, Aquitaine, France
| | - Benjamin Contrand
- U1219, INSERM, Bordeaux, Nouvelle-Aquitaine, France.,U1219, Universite de Bordeaux, Bordeaux, Aquitaine, France
| | - Marion Dupuy
- Calyxis, Centre of Risk Expertise, Niort, France
| | | | - Ludivine Orriols
- U1219, INSERM, Bordeaux, Nouvelle-Aquitaine, France.,U1219, Universite de Bordeaux, Bordeaux, Aquitaine, France
| | - Emmanuel Lagarde
- U1219, INSERM, Bordeaux, Nouvelle-Aquitaine, France .,U1219, Universite de Bordeaux, Bordeaux, Aquitaine, France
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Sufrinko A, McAllister-Deitrick J, Elbin RJ, Collins MW, Kontos AP. Family History of Migraine Associated With Posttraumatic Migraine Symptoms Following Sport-Related Concussion. J Head Trauma Rehabil 2019; 33:7-14. [PMID: 28520665 PMCID: PMC5693792 DOI: 10.1097/htr.0000000000000315] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine whether family history of migraine increased the likelihood of posttraumatic migraine (PTM) symptom presentation in adolescents following concussion, and examine the influence of family history of migraine and PTM on postinjury outcomes. SETTING Outpatient concussion clinic. PARTICIPANTS A total of 153 patients with concussion (103 males and 50 females) aged 15.72 ± 1.48 years (range 12-18 years). DESIGN Cross-sectional, observational study of patients presenting for initial evaluation 4.72 ± 3.05 days (range 1-14) postinjury. MAIN MEASURES Computerized neurocognitive testing, symptom report, and vestibular/oculomotor screening. RESULTS Patients with a family history of migraine were 2.6 times (odds ratio = 2.60, confidence interval = 1.35-5.02, P = .003) more likely to present with PTM compared with patients without a family history. Results of multivariate analyses of covariance, controlling for concussion history, revealed significant main effects for PTM on (1) Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT)/Post-Concussion Symptom Scale (PCSS) (F = 15.43, P <.001) and (2) Vestibular/Ocular Motor Screening (VOMS) (F = 8.52, P < .001). There was no main effect for family history of migraine on ImPACT/PCSS (P = .22) and VOMS (P = .83) or interaction between family history of migraine and PTM on ImPACT/PCSS (P = .84) and VOMS (P = .52). CONCLUSION Family history of migraine is associated with PTM symptoms following sport-related concussion, suggesting a genetic predisposition for migraine may serve as a catalyst or trigger for onset of PTM. However, only presence of PTM, rather than family history of migraine, was related to worse neurocognitive and vestibular/oculomotor outcomes.
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Affiliation(s)
- Alicia Sufrinko
- UPMC Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pennsylvania (Drs Sufrinko, McAllister-Deitrick, Collins, and Kontos); and Department of Health, Human Performance and Recreation/Office for Sport Concussion Research, University of Arkansas, Fayetteville (Dr Elbin)
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Lee SH, Kang Y, Sohn JH, Cho SJ. Dizziness Handicap and Its Contributing Factors in Patients With Migraine. Pain Pract 2019; 19:484-490. [PMID: 30659725 DOI: 10.1111/papr.12767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 12/27/2018] [Accepted: 01/05/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Dizziness is frequently reported in patients with migraine. However, its assessment is often neglected in clinical practice. We investigated the dizziness handicap experienced by patients with migraine and its contributing factors. METHODS A total of 361 migraine outpatients (270 women, 91 men; mean age 39.01 ± 11.2 years) were given the Korean Dizziness Handicap Inventory (KDHI) questionnaire (total score: 100 points; cutoff: 29). The Headache Impact Test, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Pittsburgh Sleep Quality Index were also administered. Clinical data such as age, sex, number of headache attacks per month, pain intensity on the visual analog scale, and average sleep hours were collected to find contributing factors. Comparisons were made between chronic and episodic migraine. RESULTS A total of 153 patients were classified as having dizziness handicap (M+DH) and 208 had migraine without dizziness handicap (M-DH). Patients with M+DH experienced more headache attacks per month than patients with M-DH (P = 0.010). The proportion of patients with chronic migraine was larger in the M+DH group (29.4% vs. 17.3%, P = 0.006). Patients with M+DH showed higher scores than patients with M-DH in all the KDHI subscales. Multivariable logistic regression showed headache impact, pain intensity, anxiety, and depression to be significantly associated with dizziness handicap. CONCLUSION The data suggest that patients with migraine, especially those with chronic-type migraine, experience physical, emotional, and functional handicaps due to dizziness. Dizziness handicap is related to headache impact, anxiety, and depression. Targeted management of such factors is required to reduce the severity of subjective discomfort.
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Affiliation(s)
- Sun Hwa Lee
- Department of Neurology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Yeonwook Kang
- Department of Psychology, Hallym University, Chuncheon, South Korea.,Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Jong-Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea
| | - Soo-Jin Cho
- Department of Neurology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
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8
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Multidisciplinary experts consensus for assessment and management of vestibular migraine. Chin Med J (Engl) 2019; 132:183-189. [PMID: 30614869 PMCID: PMC6365265 DOI: 10.1097/cm9.0000000000000064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Indexed: 01/03/2023] Open
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9
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Carvalho G, Almeida C, Florencio L, Pinheiro C, Dach F, Bigal M, Bevilaqua-Grossi D. Do patients with migraine experience an increased prevalence of falls and fear of falling? A cross-sectional study. Physiotherapy 2018; 104:424-429. [DOI: 10.1016/j.physio.2018.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 09/12/2017] [Accepted: 10/17/2017] [Indexed: 01/03/2023]
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10
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Carvalho GF, Vianna-Bell FH, Florencio LL, Pinheiro CF, Dach F, Bigal ME, Bevilaqua-Grossi D. Presence of vestibular symptoms and related disability in migraine with and without aura and chronic migraine. Cephalalgia 2018; 39:29-37. [DOI: 10.1177/0333102418769948] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective To assess the presence and handicap due to vestibular symptoms in three subgroups of patients with migraine and controls. Methods Women between 18–55 years old were diagnosed by headache specialists and stratified as migraine with aura (n = 60), migraine without aura (n = 60), chronic migraine (n = 60) and controls (n = 60). Information regarding demographics, headache and vestibular symptoms were collected in this cross-sectional study. The self-perceived handicap related to vestibular symptoms was assessed through the Dizziness Handicap Inventory questionnaire. Results A total of 85% of women with migraine with aura and chronic migraine had vestibular symptoms contrasted to 70% of the migraine without aura group ( p < 0.05), and 12% of the control group reported symptoms ( p < 0.0001). Patients with migraine exhibited greater Dizziness Handicap Inventory scores than controls ( p < 0.001); and migraine with aura and chronic migraine groups reached greater scores than migraine without aura ( p < 0.01). Presence of migraine is associated with a greater risk of vestibular symptoms (migraine without aura: 5.20, migraine with aura: 6.60, chronic migraine:6.20, p < 0.0003) and with a greater risk of moderate-to-severe handicap (migraine without aura: 20.0, migraine with aura: 40.0, chronic migraine: 40.0, p < 0.0003). The presence of aura and greater migraine frequency adds to the risk of any handicap (migraine with aura: 1.9, chronic migraine: 1.7, p < 0.04) and to the risk of moderate-to-severe handicap (migraine with aura: 2.0, chronic migraine: 2.0, p < 0.0003). Migraine aura, intensity and frequency predict 36% of the dizziness handicap. Conclusion The prevalence of vestibular symptoms is increased in migraine during and between headache attacks, particularly in migraine with aura and chronic migraine along with an increased handicap due to those symptoms. Vestibular symptoms among subgroups of migraine should be considered when evaluating the functional impact of migraine.
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Affiliation(s)
- Gabriela F Carvalho
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation – Ribeirão Preto Medical School, , Ribeirão Preto, Sao Paulo, Brazil
| | - Flávia Heck Vianna-Bell
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation – Ribeirão Preto Medical School, , Ribeirão Preto, Sao Paulo, Brazil
| | - Lidiane L Florencio
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation – Ribeirão Preto Medical School, , Ribeirão Preto, Sao Paulo, Brazil
| | - Carina F Pinheiro
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation – Ribeirão Preto Medical School, , Ribeirão Preto, Sao Paulo, Brazil
| | - Fabiola Dach
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, , Ribeirão Preto, Sao Paulo, Brazil
| | - Marcelo E Bigal
- Research and Development Department, Teva Pharmaceuticals, Frazer, PA, USA
| | - Debora Bevilaqua-Grossi
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation – Ribeirão Preto Medical School, , Ribeirão Preto, Sao Paulo, Brazil
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Teggi R, Manfrin M, Balzanelli C, Gatti O, Mura F, Quaglieri S, Pilolli F, Redaelli de Zinis LO, Benazzo M, Bussi M. Point prevalence of vertigo and dizziness in a sample of 2672 subjects and correlation with headaches. ACTA OTORHINOLARYNGOLOGICA ITALICA 2017; 36:215-9. [PMID: 27214833 PMCID: PMC4977009 DOI: 10.14639/0392-100x-847] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 12/09/2015] [Indexed: 12/03/2022]
Abstract
Vertigo and dizziness are common symptoms in the general population, with an estimated prevalence between 20% and 56%. The aim of our work was to assess the point prevalence of these symptoms in a population of 2672 subjects. Patients were asked to answer a questionnaire; in the first part they were asked about demographic data and previous vertigo and or dizziness. Mean age of the sample was 48.3 ± 15 years, and 46.7% were males. A total of 1077 (40.3%) subjects referred vertigo/dizziness during their lifetime, and the mean age of the first vertigo attack was 39.2 ± 15.4 years; in the second part they were asked about the characteristics of vertigo (age of first episode, rotational vertigo, relapsing episodes, positional exacerbation, presence of cochlear symptoms) and lifetime presence of moderate to severe headache and its clinical features (hemicranial, pulsatile, associated with phono and photophobia, worse on effort). An age and sex effect was demonstrated, with symptoms 4.4 times more elevated in females and 1.8 times in people over 50 years. In the total sample of 2672 responders, 13.7% referred a sensation of spinning, 26.3% relapsing episodes, 12.9% positional exacerbation and 4.8% cochlear symptoms; 34.8% referred headache during their lifetime. Subjects suffering from headache presented an increased rate of relapsing episodes, positional exacerbation, cochlear symptoms and a lower age of occurrence of the first vertigo/dizziness episode. In the discussion, our data are compared with those of previous studies, and we underline the relationship between vertigo/dizziness from one side and headache with migrainous features on the other.
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Affiliation(s)
- R Teggi
- ENT Division, San Raffaele Scientific Institute, Milan, Italy
| | - M Manfrin
- UOC of ORL, Fondazione IRCCS Policlinico San Matteo e Università di Pavia, Italy
| | - C Balzanelli
- Divisione di Otorinolaringoiatria, Università degli Studi di Brescia, Italy
| | - O Gatti
- ENT Division, San Raffaele Scientific Institute, Milan, Italy
| | - F Mura
- UOC of ORL, Fondazione IRCCS Policlinico San Matteo e Università di Pavia, Italy
| | - S Quaglieri
- UOC of ORL, Fondazione IRCCS Policlinico San Matteo e Università di Pavia, Italy
| | - F Pilolli
- ENT Division, San Raffaele Scientific Institute, Milan, Italy
| | | | - M Benazzo
- UOC of ORL, Fondazione IRCCS Policlinico San Matteo e Università di Pavia, Italy
| | - M Bussi
- ENT Division, San Raffaele Scientific Institute, Milan, Italy
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Dizziness is more prevalent than autophony among patients who have undergone repair of superior canal dehiscence. Otol Neurotol 2015; 36:126-32. [PMID: 25122596 DOI: 10.1097/mao.0000000000000531] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Studies have reported high early success rates in rectifying dizziness and autophony after primary repair of superior canal dehiscence (SCD). We sought to identify the prevalence of dizziness and autophony at later time points in patients who had undergone SCD repair. We also assessed any problems with hearing in this population, along with prevalence of headaches and decreases in overall quality of life. STUDY QUALITY DESIGN Identification of patients via retrospective chart review, followed by administration of multiple validated surveys. SETTING Tertiary, hospital-based neurotology practice. PATIENTS All 62 patients who had undergone primary SCD repair at Massachusetts Eye and Ear Infirmary with follow-up time of at least 3 months were contacted, with 38 responses from 22 women and 16 men. The average follow-up was 34 months (range, 3-155 mo). INTERVENTIONS Patient surveys. MAIN OUTCOME MEASURES Dizziness Handicap Inventory and Autophony Index. SECONDARY OUTCOME MEASURES Hearing Handicap Survey, MIDAS headache survey, and Short Form-36 Quality of Life Survey. RESULTS Twenty patients reported low DHI scores, whereas 18 patients reported elevated DHI scores corresponding to moderate-to-severe dizziness. Autophony was less prevalent, as 3 patients experienced autophony in the operated ear, whereas 3 patients experienced "unmasking" of autophony in the contralateral ear. HHI scores were not significantly different between the low DHI and high DHI group. There were significantly more female subjects in the high DHI group, which was also characterized by significantly more severe MIDAS grades and significantly worse SF-36 scores. CONCLUSION Dizziness is more prevalent than autophony among patients who have undergone SCD repair, although the majority of these patients are satisfied with their decision to undergo surgery. Female sex and migraine headaches are associated with dizziness in this patient population. Further work is necessary to determine causal relationships among these associations.
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Chu CH, Liu CJ, Lin LY, Chen TJ, Wang SJ. Migraine is associated with an increased risk for benign paroxysmal positional vertigo: a nationwide population-based study. J Headache Pain 2015; 16:62. [PMID: 26141381 PMCID: PMC4491067 DOI: 10.1186/s10194-015-0547-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 06/24/2015] [Indexed: 11/26/2022] Open
Abstract
Background There is evidence suggesting that migraine may be associated with vertigo. The aim of this study was to assess the risk of benign paroxysmal positional vertigo (BPPV), the most common form of vertigo, in patients with migraine using a population-based dataset. Methods The National Health Insurance Research Database in Taiwan was searched for migraine patients and was also used to select an age- and sex-matched cohort of subjects without migraine. The analyses included 8266 migraine patients and 8266 controls. The incidence rates of BPPV in the two cohorts were compared. Cox proportional hazard models were used to identify risk factors for BPPV in migraine patients. Results In the migraine cohort, 1.11 % of the patients developed BPPV compared to 0.5 % of the controls. The incidence rate ratio was 2.03 (95 % CI 1.41–2.97; p <0.001). Cox proportional hazards analysis showed that age ≥40 years (HR 2.20; 95 % CI 1.40–3.45; p = 0.001), coronary artery disease (HR 4.62; 95 % CI 1.12–19.01; p = 0.034), and the number of outpatient department visits to neurologists because of migraine (HR 2.93; 95 % CI 2.50–3.44; p >0.001) were associated with an increased risk for BPPV. Conclusion The results showed that patients with migraine had a 2.03-fold increased risk of developing BPPV compared with age- and sex-matched controls. Although BPPV may not be a common condition in migraine patients, migraine sufferers with vestibular symptoms should alert physicians to the possibility of BPPV, particularly if patients are aged ≥40 years, have a history of coronary artery disease, or have frequent visits to neurologists clinics because of migraine.
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Affiliation(s)
- Chia-Huei Chu
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan,
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14
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Espinosa-Sanchez JM, Lopez-Escamez JA. New insights into pathophysiology of vestibular migraine. Front Neurol 2015; 6:12. [PMID: 25705201 PMCID: PMC4319397 DOI: 10.3389/fneur.2015.00012] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 01/19/2015] [Indexed: 11/30/2022] Open
Abstract
Vestibular migraine (VM) is a common disorder in which genetic, epigenetic, and environmental factors probably contribute to its development. The pathophysiology of VM is unknown; nevertheless in the last few years, several studies are contributing to understand the neurophysiological pathways involved in VM. The current hypotheses are mostly based on the knowledge of migraine itself. The evidence of trigeminal innervation of the labyrinth vessels and the localization of vasoactive neuropeptides in the perivascular afferent terminals of these trigeminal fibers support the involvement of the trigemino-vascular system. The neurogenic inflammation triggered by activation of the trigeminal-vestibulocochlear reflex, with the subsequent inner ear plasma protein extravasation and the release of inflammatory mediators, can contribute to a sustained activation and sensitization of the trigeminal primary afferent neurons explaining VM symptoms. The reciprocal connections between brainstem vestibular nuclei and the structures that modulate trigeminal nociceptive inputs (rostral ventromedial medulla, ventrolateral periaqueductal gray, locus coeruleus, and nucleus raphe magnus) are critical to understand the pathophysiology of VM. Although cortical spreading depression can affect cortical areas involved in processing vestibular information, functional neuroimaging techniques suggest a dysmodulation in the multimodal sensory integration and processing of vestibular and nociceptive information, resulting from a vestibulo-thalamo-cortical dysfunction, as the pathogenic mechanism underlying VM. The elevated prevalence of VM suggests that multiple functional variants may confer a genetic susceptibility leading to a dysregulation of excitatory–inhibitory balance in brain structures involved in the processing of sensory information, vestibular inputs, and pain. The interactions among several functional and structural neural networks could explain the pathogenic mechanisms of VM.
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Affiliation(s)
- Juan M Espinosa-Sanchez
- Otology and Neurotology Group CTS495, Human DNA Variability Department, GENYO Centre for Genomics and Oncological Research Pfizer - University of Granada - Junta de Andalucia , Granada , Spain ; Department of Otolaryngology, Hospital San Agustin , Linares , Spain
| | - Jose A Lopez-Escamez
- Otology and Neurotology Group CTS495, Human DNA Variability Department, GENYO Centre for Genomics and Oncological Research Pfizer - University of Granada - Junta de Andalucia , Granada , Spain ; Department of Otolaryngology, Hospital de Poniente , El Ejido , Spain
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15
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Lopez-Escamez JA, Dlugaiczyk J, Jacobs J, Lempert T, Teggi R, von Brevern M, Bisdorff A. Accompanying Symptoms Overlap during Attacks in Menière's Disease and Vestibular Migraine. Front Neurol 2014; 5:265. [PMID: 25566172 PMCID: PMC4265699 DOI: 10.3389/fneur.2014.00265] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 11/25/2014] [Indexed: 01/03/2023] Open
Abstract
Menière’s disease and vestibular migraine (VM) are the most common causes of spontaneous recurrent vertigo. The current diagnostic criteria for the two disorders are mainly based on patients’ symptoms, and no biological marker is available. When applying these criteria, an overlap of the two disorders is occasionally observed in clinical practice. Therefore, the present prospective multicenter study aimed to identify accompanying symptoms that may help to differentiate between MD, VM, and probable vestibular migraine (pVM). Two hundred and sixty-eight patients were included in the study (MD: n = 119, VM: n = 84, pVM: n = 65). Patients with MD suffered mainly from accompanying auditory symptoms (tinnitus, fullness of ear, and hearing loss), while accompanying migraine symptoms (migraine-type headache, photo-/phonophobia, visual aura), anxiety, and palpitations were more common during attacks of VM. However, it has to be noted that a subset of MD patients also experienced (migraine-type) headache during the attacks. On the other hand, some VM/pVM patients reported accompanying auditory symptoms. The female/male ratio was statistically higher in VM/pVM as compared to MD, while the age of onset was significantly lower in the former two. The frequency of migraine-type headache was significantly higher in VM as compared to both pVM and MD. Accompanying headache of any type was observed in declining order in VM, pVM, and MD. In conclusion, the present study confirms a considerable overlap of symptoms in MD, VM, and pVM. In particular, we could not identify any highly specific symptom for one of the three entities. It is rather the combination of symptoms that should guide diagnostic reasoning. The identification of common symptom patterns in VM and MD may help to refine future diagnostic criteria for the two disorders.
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Affiliation(s)
- Jose Antonio Lopez-Escamez
- Otology and Neurotology Group CTS495, Department of Genomic Medicine, Centre for Genomics and Oncology Research, Pfizer/Universidad de Granada/Junta de Andalucía (GENyO) , Granada , Spain ; Department of Otolaryngology, Hospital de Poniente, El Ejido , Almeria , Spain
| | - Julia Dlugaiczyk
- Department of Otorhinolaryngology, Saarland University Medical Center , Homburg , Germany
| | - Julien Jacobs
- Public Research Centre for Health (CRP-Santé), Center for Health Studies , Luxembourg , Luxembourg
| | - Thomas Lempert
- Department of Neurology, Schlosspark-klinik , Berlin , Germany
| | - Roberto Teggi
- ENT Division, San Raffaele Scientific Institute , Milan , Italy
| | | | - Alexandre Bisdorff
- Department of Neurology, Centre Hospitalier Emile Mayrisch , Esch-sur-Alzette , Luxembourg
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