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Saroya J, Humwell M, Gardi A, Chae R, Wong D, Allen I, Sharon JD. A Month of Vestibular Migraine: Symptom Characterization Using Ecological Momentary Assessment. Laryngoscope 2024. [PMID: 39105370 DOI: 10.1002/lary.31679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/15/2024] [Accepted: 07/25/2024] [Indexed: 08/07/2024]
Abstract
OBJECTIVE(S) This study investigated the frequency and intensity of vestibular migraine (VM) symptoms using Ecological Momentary Assessment (EMA). This approach was intended to provide insights into the day-to-day experiences of individuals with VM, contributing to a more comprehensive understanding of this condition. METHODS Participants reported symptoms to an automated text system, rating their dizziness over the prior 24 h as none, mild, moderate, or severe. Definitive Dizzy Days (DDDs) were defined as days with moderate or severe dizziness. A student's independent group t-test was used to compare the number of DDDs between VM and probable VM subjects. RESULTS Sixty-six subjects were included, with an average of 29 days of pre-intervention data (SD = 1.4). The average number of days with no dizziness was 3.5 (SD = 6.5), mild dizziness was 9.1 (SD = 6.7), moderate dizziness was 11 (SD = 6.1), and severe dizziness was 5.4 (SD = 6.3). Out of the 66 patients, 52 were classified as VM and 14 as pVM. The average number of DDDs was not significantly different between VM (17.0, SD = 8.3) and pVM (15.3, SD = 10.0) patients, with a two-tailed p-value of 0.44. CONCLUSION With EMA, we found that the average subject with VM had some degree of dizziness almost every day, and more than 15 DDDs per month. LEVEL OF EVIDENCE III Laryngoscope, 2024.
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Affiliation(s)
- Jasmeet Saroya
- School of Medicine, University of California, San Francisco, California, U.S.A
- Department of Otorhinolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - Max Humwell
- School of Medicine, University of California, San Francisco, California, U.S.A
- Department of Otorhinolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - Adam Gardi
- School of Medicine, University of California, San Francisco, California, U.S.A
- Department of Otorhinolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - Ricky Chae
- School of Medicine, University of California, San Francisco, California, U.S.A
- Department of Otorhinolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - Daniel Wong
- School of Medicine, University of California, San Francisco, California, U.S.A
- Department of Otorhinolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - Isabel Allen
- School of Medicine, University of California, San Francisco, California, U.S.A
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, U.S.A
| | - Jeffrey D Sharon
- School of Medicine, University of California, San Francisco, California, U.S.A
- Department of Otorhinolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
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Kouga T, Miwa T, Sunami K, Itoh Y. Effectiveness of Anti-Calcitonin Gene-Related Peptide Medication in Vestibular Migraine: A Retrospective Cohort Study in an Asian Population. CNS Drugs 2024; 38:637-648. [PMID: 38809343 DOI: 10.1007/s40263-024-01094-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Migraine and dizziness often coexist, with vestibular migraine (VM) presenting with vestibular symptoms and headaches. Calcitonin gene-related peptide (CGRP) may be involved in motion-induced symptoms; however, studies on the use of anti-CGRP monoclonal antibodies (mAbs) for the treatment of VM have yielded conflicting results. This study aimed to clarify the effectiveness of anti-CGRP mAbs in VM treatment. METHODS This retrospective observational cohort study, conducted between 1 January 2021 and 31 March 2023, assessed 12 Japanese patients with VM who were treated with anti-CGRP mAbs (CGRP group) for 6 months and 11 Japanese patients who received standard of care for VM and served as controls. Clinical questionnaires and equilibrium tests were administered, with primary outcomes including changes in Dizziness Handicap Inventory (DHI) scores compared with baseline values. Objective variables included the DHI score and explanatory variables included demographic data, balance test results, head-up tilt (HUT) test results, vestibular test results and questionnaire survey results. Analysis of variance was used to assess the treatment effects of anti-CGRP mAbs, and multivariate regression analysis was performed to identify mAb responders. RESULTS After 6 months, the CGRP group showed significant improvements in DHI scores [0 versus 6 months, odds ratio (95% confidence interval): 22.01 (0.13-43.88)] and number of vertigo/dizziness attacks per month [0 versus 6 months: 10.28 (2.80-17.76)]. No significant difference was observed in the control group [DHI scores, 0 versus 6 months: 0.65 (-26.84 to 28.14); number of vertigo/dizziness attacks per month, 0 versus 6 months: - 8.07 (- 23.77 to 7.62)]. Multivariate regression analysis showed that autonomic function at baseline was associated with mAb response in patients [β estimates (95% confidence interval): 3.63 (0.21-7.06)]. CONCLUSIONS Treatment with anti-CGRP mAbs was more effective than conventional treatment in preventing migraine in patients with VM. While the identified factors associated with treatment responsiveness offer valuable insights into personalised treatment approaches, further prospective studies are warranted to validate the findings due to our study's retrospective design and limited sample size.
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Affiliation(s)
- Teppei Kouga
- Department of Otolaryngology, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Toru Miwa
- Department of Otolaryngology, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
- Department of Otolaryngology-Head and Neck Surgery, Graduate of School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Kishiko Sunami
- Department of Otolaryngology, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yoshiaki Itoh
- Department of Neurology, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
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Zou X, He J, Zhou M, Zhao F, Tian X, Xu X, Hong W, Wang F, Chen J, Qin C, Xia J, Xie Y, Xiao Y, Liu K, Guo L. Photophobia and Visual Triggers in Vestibular Migraine. Neurol Ther 2024; 13:1191-1201. [PMID: 38819614 PMCID: PMC11263323 DOI: 10.1007/s40120-024-00631-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/09/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION Vestibular migraine (VM) is a prevalent vestibular disorder characterized by episodic vertigo. However, the relationship between photophobia and visual triggers in VM remains unexplored. We investigated the correlation of photophobia during the VM attack with interictal photosensitivity and visually triggering dizziness in patients with VM. METHODS We enrolled patients diagnosed with VM, with or without photophobia, across seven specialized vertigo and headache clinics in China. Healthy individuals were also included as a control group. Using a cross-sectional survey design, we collected data related to light intensity and dizziness frequency triggered by flicker, glare, and eyestrain using the Headache Triggers Sensitivity and Avoidance Questionnaire. RESULTS A total of 366 patients were recruited. The photosensitivity and frequency of dizziness induced by flicker, glare, and eyestrain observed in patients with VM and photophobia were significantly elevated compared with those in patients without photophobia and control participants (P < 0.001). A significant positive correlation was observed between photosensitivity levels and dizziness frequency triggered by flicker, glare, and eyestrain in patients with VM and photophobia (P < 0.001). CONCLUSIONS This study unequivocally established a positive association of ictal photophobia with interictal photosensitivity and visually triggering dizziness, strongly advocating the need for further research on exposure-based therapies for managing VM. CLINICAL TRIALS REGISTRATION ClinicalTrial.gov Identifier, NCT04939922, retrospectively registered, 14th June 2021.
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Affiliation(s)
- Xiaodong Zou
- Department of Neurology, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, Zhejiang, China
- Key Laboratory of Cancer Prevention and Therapy Combining Traditional Chinese and Western Medicine of Zhejiang Province, Hangzhou, 310012, Zhejiang, China
| | - Jiahui He
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China
| | - Mengting Zhou
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China
| | - Fangling Zhao
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China
| | - Xiulin Tian
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China
| | - Xiaopei Xu
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China
| | - Wenwu Hong
- Department of Neurology, Tiantai People's Hospital of Zhejiang Province, Tiantai, 317200, Zhejiang, China
| | - Faming Wang
- Department of Neurology, Tiantai People's Hospital of Zhejiang Province, Tiantai, 317200, Zhejiang, China
| | - Juanyan Chen
- Department of Neurology, Dongyang People's Hospital, Dongyang, 322103, Zhejiang, China
| | - Chenghui Qin
- Department of Neurology, Affiliated Hospital of Shaoxing University, Shaoxing, 312099, Zhejiang, China
| | - Jinjin Xia
- Department of Neurology, Changxing People's Hospital of Zhejiang Province, Changxing, 313199, Zhejiang, China
| | - Yuying Xie
- Department of Neurology, Shanghang County Hospital, Shanghang, 364299, Fujian, China
| | - Yujin Xiao
- Department of Neurology, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, 314033, Zhejiang, China
| | - Kaiming Liu
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.
| | - Liang Guo
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China.
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Chang TP, Hong YC, Schubert MC. Visual vertigo and motion sickness is different between persistent postural-perceptual dizziness and vestibular migraine. Am J Otolaryngol 2024; 45:104321. [PMID: 38696894 DOI: 10.1016/j.amjoto.2024.104321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/18/2024] [Indexed: 05/04/2024]
Abstract
INTRODUCTION Persistent postural-perceptual dizziness (PPPD) and vestibular migraine (VM) share symptoms of visual vertigo and motion sickness that can be confusing for clinicians to distinguish. We compare the severity of these symptoms and dynamic subjective visual vertical (dSVV) in these two common vestibular conditions. METHOD Twenty-nine patients with PPPD, 37 with VM, and 29 controls were surveyed for subjective symptoms using the visual vertigo analogue scale (VVAS) and motion sickness susceptibility questionnaire during childhood (MSA) and the past 10 years (MSB). dSVV is a measure of visual dependence measures perception of verticality against a rotating background (5 deg./s). RESULTS VVAS revealed contextual differences for dizziness between those with PPPD and VM. Ratings of visual vertigo were most severe in PPPD, less in VM, and mild in controls (VVAS PPPD 27.1, VM 11.2, control 4.6, p < 0.001). MSA was more severe in VM than in PPPD or control (12.8 vs 7.6 vs 8.5, p = 0.01). MSB was more severe in VM than controls (MSB score 12.9 VS 8.1 p = 0.009) but was not different than PPPD (MSB score 10.0, p = 0.10). dSVV alignment was similar among the three groups (p = 0.83). Both VM and PPPD groups had greater simulator sickness than controls after completing the dSVV. CONCLUSIONS Patients with PPPD report more visual vertigo than those with VM, but a history of motion sickness as a child is more common in VM. Additionally, the environmental context that induces visual vertigo is different between PPPD and VM.
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Affiliation(s)
- Tzu-Pu Chang
- Department of Neurology/Neuro-medical Scientific Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; Department of Neurology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ying-Chi Hong
- Department of Research, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Michael C Schubert
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Ceriani CEJ. Beyond Vertigo: Vestibular, Aural, and Perceptual Symptoms in Vestibular Migraine. Curr Pain Headache Rep 2024; 28:633-639. [PMID: 38780828 PMCID: PMC11271338 DOI: 10.1007/s11916-024-01245-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To review the vestibular, aural, and perceptual symptoms of vestibular migraine (VM) that may present alongside vertigo. RECENT FINDINGS Increased research attention to the wide spectrum of symptoms presenting in VM patients has improved understanding of this disorder, with recent identification of five different VM phenotypes. Research into the clinical overlap between VM and other chronic vestibular syndromes such as persistent postural-perceptual dizziness and mal-de-debarquement syndrome reveals a range of vestibular symptoms and hints at pathophysiological connections between migraine and vestibular dysfunction. Studies of migraine treatment for hearing loss suggest patients presenting with aural symptoms may have an underlying diagnosis of migraine and deserve a trial of migraine preventives. Research into the neurologic basis of the perceptual disorder Alice in Wonderland syndrome has revealed brain areas that are likely involved and may help explain its prevalence in VM patients. VM is a sensory processing disorder that presents with more than just vertigo. Understanding the range of potential symptoms improves diagnosis and treatment for migraine patients whose diagnosis may be missed when only the symptoms identified in the diagnostic criteria are considered.
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Affiliation(s)
- Claire E J Ceriani
- Department of Neurology, Jefferson Headache Center, Thomas Jefferson University, 900 Walnut St., Ste 200, Philadelphia, PA, 19107, USA.
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Li H, Xu X, Xu R, Fan PX, Zhou J, Dong L. Latent class analysis of migraine associated vestibular-auditory symptoms. Cephalalgia 2024; 44:3331024241262488. [PMID: 38887813 DOI: 10.1177/03331024241262488] [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: 06/20/2024]
Abstract
OBJECTIVE This study aimed to identify the potential subgroups of migraines based on the patterns of migraine associated symptoms, vestibular and auditory symptoms using latent class analysis and to explore their characteristics. METHOD A total of 555 patients with migraine participated in the study. Symptoms such as nausea, vomiting, photophobia, phonophobia, osmophobia, visual symptoms, vestibular symptoms (dizziness, vertigo), and auditory symptoms (tinnitus, hearing loss, aural fullness) were assessed. Latent class analysis was performed to identify subgroups of migraines. Covariates such as gender, age of migraine onset, frequency of migraine attacks per month, and family history were also considered. RESULTS The analysis revealed four latent classes: the Prominent Vestibular; Prominent Nausea; Presenting Symptoms but not prominent or dominant; and Sensory Hypersensitivity groups. Various covariates, such as gender, age of migraine onset, and frequency of migraine attacks, demonstrated significant differences among the four groups. The Sensory Hypersensitivity group showed the presence of multiple sensory symptoms, earlier age of migraine onset, and higher proportion of females. The Prominent Vestibular group had the highest probability of dizziness or vertigo but lacked the presence of auditory symptoms. The Prominent Nausea group exhibited prominent nausea. The Presenting Symptoms but not prominent or dominant group comprised individuals with the highest migraine attacks per month and proportion of chronic migraine. CONCLUSION This study identifies four subgroups of migraines based on the patterns of symptoms. The findings suggest potential different but overlapped mechanisms behind the vestibular and auditory symptoms of migraine. Considering the different patterns of migraine-related symptoms may provide deeper insights for patients' prognosis and clinical decision-making.
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Affiliation(s)
- Hui Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University Department of Neurology, Chongqing, China
| | - Xiaonuo Xu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University Department of Neurology, Chongqing, China
| | - Rongjiang Xu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University Department of Neurology, Chongqing, China
| | - Ping Xiao Fan
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University Department of Neurology, Chongqing, China
| | - Jiying Zhou
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University Department of Neurology, Chongqing, China
| | - Liang Dong
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University Department of Neurology, Chongqing, China
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Villar-Martinez MD, Goadsby PJ. Vestibular migraine: an update. Curr Opin Neurol 2024; 37:252-263. [PMID: 38619053 PMCID: PMC11064914 DOI: 10.1097/wco.0000000000001257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
PURPOSE OF REVIEW We performed a narrative review of the recent findings in epidemiology, clinical presentation, mechanisms and treatment of vestibular migraine. RECENT FINDINGS Vestibular migraine is an underdiagnosed condition that has a high prevalence among general, headache and neuro-otology clinics. Vestibular migraine has a bimodal presentation probably associated with a hormonal component in women. These patients could have a complex clinical phenotype including concomitant autonomic, inflammatory or connective tissue conditions that have a higher prevalence of psychological symptoms, which may mistakenly lead to a diagnosis of a functional neurological disorder. A high proportion of patients with postural perceptual persistent dizziness have a migraine phenotype. Independently of the clinical presentation and past medical history, patients with the vestibular migraine phenotype can respond to regular migraine preventive treatments, including those targeting the calcitonin gene-related peptide pathways. SUMMARY Vestibular migraine is an underdiagnosed migraine phenotype that shares the pathophysiological mechanisms of migraine, with growing interest in recent years. A thorough anamnesis is essential to increase sensitivity in patients with unknown cause of dizziness and migraine treatment should be considered (see supplemental video-abstract).
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Affiliation(s)
- Maria D. Villar-Martinez
- NIHR King's Clinical Research Facility, SLaM Biomedical Research Centre and Wolfson Sensory Pain and Regeneration, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Peter J. Goadsby
- NIHR King's Clinical Research Facility, SLaM Biomedical Research Centre and Wolfson Sensory Pain and Regeneration, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- Department of Neurology, University of California, Los Angeles, California, USA
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Pajaniappane A. Assessment and management of vestibular migraine within ENT. J Laryngol Otol 2024; 138:S22-S26. [PMID: 38291947 DOI: 10.1017/s0022215123002062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
OBJECTIVE Vestibular migraine is a newly recognised and debilitating condition. This article aims to provide an overview of what is known of vestibular migraine, delineating its diagnostic criteria and presenting some initial management strategies to aid ENT professionals in delivering optimal care when patients first present to the otolaryngology clinic. METHOD Although traditionally underdiagnosed, there are now clearly defined diagnostic criteria to aid accurate diagnosis of vestibular migraine. RESULTS A detailed history and clinical examination are the cornerstone of the diagnostic process, but supportive evidence is required from appropriate audio-vestibular tests and imaging. CONCLUSION This is a unique condition that commonly initially presents to ENT. This article provides a summary of diagnostic and management strategies to facilitate early diagnosis and first-line treatment that can be employed in general ENT settings, which may be particularly useful given the limited availability of specialist audio-vestibular medicine and neuro-otology services.
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Affiliation(s)
- Arun Pajaniappane
- Department of Audiovestibular Medicine, St George's University Hospitals NHS Trust, Tooting, UK
- Harley Street Audiovestibular Clinic, London, UK
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Edlow JA, Bellolio F. Recognizing Posterior Circulation Transient Ischemic Attacks Presenting as Episodic Isolated Dizziness. Ann Emerg Med 2024:S0196-0644(24)00214-2. [PMID: 38795083 DOI: 10.1016/j.annemergmed.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/26/2024] [Accepted: 04/05/2024] [Indexed: 05/27/2024]
Abstract
Diagnosing patients presenting to the emergency department with self-limited episodes of isolated dizziness (the episodic vestibular syndrome) requires a broad differential diagnosis that includes posterior circulation transient ischemic attack. Because these patients are, by definition, asymptomatic without new neurologic findings on examination, the diagnosis, largely based on history and epidemiologic context, can be challenging. We review literature that addresses the frequency of posterior circulation transient ischemic attack in this group of patients compared with other potential causes of episodic vestibular syndrome. We present ways of distinguishing posterior circulation transient ischemic attack from vestibular migraine, the most common cause of episodic vestibular syndrome. We also present a diagnostic algorithm that may help clinicians to work their way through the differential diagnosis.
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Affiliation(s)
- Jonathan A Edlow
- Emergency Medicine, Harvard Medical School, Boston, MA; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
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Çakır S, Sahin A, Gedik-Soyuyuce O, Gence Gumus Z, Sertdemir İ, Korkut N, Yalınay Dikmen P. Assessing the impact of migraine on benign paroxysmal positional vertigo symptoms and recovery. BMC Neurol 2024; 24:148. [PMID: 38698310 PMCID: PMC11064330 DOI: 10.1186/s12883-024-03606-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 03/18/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND During episodes of benign paroxysmal positional vertigo (BPPV), individuals with migraine, compared with individuals without migraine, may experience more severe vestibular symptoms because of their hyperexcitable brain structures, more adverse effects on quality of life, and worse recovery processes from BPPV. METHODS All patients with BPPV were assigned to the migraine group (MG, n = 64) and without migraine group (BPPV w/o MG, n = 64) and completed the Vertigo Symptom Scale (VSS), Vertigo Dizziness Imbalance Symptom Scale (VDI-SS), VDI Health-Related Quality of Life Scale (VDI-HRQoLS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI) at the time of BPPV diagnosis (baseline) and on the one-month follow-up. Headache Impact Test-6 and Migraine Disability Assessment Scale were used for an assessment of headache. Motion sickness was evaluated based on the statement of each patient as present or absent. RESULTS Compared with the BPPV w/o MG, the MG had higher VSS scores at baseline [19.5 (10.7) vs. 11.3 (8.5); p < 0.001] and on one-month follow-up [10.9 (9.3) vs. 2.2 (2.7), p < 0.001]; experienced more severe dizziness and imbalance symptoms based on the VDI-SS at baseline (61.9% vs. 77.3%; p < 0.001) and after one month (78.9% vs. 93.7%, p < 0.001); and more significantly impaired quality of life according to the VDI-HRQoLS at baseline (77.4% vs. 91.8%, p < 0.001) and after one month (86.3% vs. 97.6%, p < 0.001). On the one-month follow-up, the subgroups of patients with moderate and severe scores of the BAI were higher in the MG (39.2%, n = 24) than in the BPPV w/o MG (21.8%, n = 14) and the number of patients who had normal scores of the BDI was lower in the MG than in the BPPV w/o MG (67.1% vs. 87.5%, p = 0.038). CONCLUSION Clinicians are advised to inquire about migraine when evaluating patients with BPPV because it may lead to more intricate and severe clinical presentation. Further studies will be elaborated the genuine nature of the causal relationship between migraine and BPPV.
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Affiliation(s)
- Seda Çakır
- Department of Neurology, Acıbadem University School of Medicine, İçerenköy. Kayışdağı Cad. No: 32. Ataşehir, İstanbul, 34752, Turkey
| | - Aysenur Sahin
- Department of Neurology, Acıbadem University School of Medicine, İçerenköy. Kayışdağı Cad. No: 32. Ataşehir, İstanbul, 34752, Turkey
| | | | | | - İbrahim Sertdemir
- Department of Biostatistics and Bioinformatics, Acıbadem University, İstanbul, Turkey
| | - Nazım Korkut
- Department of Otorhinolaryngology, Acıbadem Maslak Hospital, İstanbul, Turkey
| | - Pınar Yalınay Dikmen
- Department of Neurology, Acıbadem University School of Medicine, İçerenköy. Kayışdağı Cad. No: 32. Ataşehir, İstanbul, 34752, Turkey.
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Kim TS, Lee WH, Heo Y. Prevalence and Contributing Factors of Anxiety and Depression in Patients with Vestibular Migraine. EAR, NOSE & THROAT JOURNAL 2024; 103:305-312. [PMID: 37329273 DOI: 10.1177/01455613231181219] [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: 06/19/2023] Open
Abstract
Objective: Anxiety and depression are psychiatric comorbidities potentially associated with dizziness and migraine, which can influence disease state, prognosis, and clinical outcomes. Vestibular migraine (VM) is a disease that causes repeated vestibular symptoms in people with a history of migraines. We investigated the prevalence and contributing factors of anxiety and depression in patients with VM. Methods: A total of 74 patients with VM were enrolled in this study. All patients underwent pure-tone audiometry, the examination of spontaneous nystagmus, Dix-Hallpike maneuver or supine-roll test, video head impulse test, and caloric testing on the day of the visit. We used the Hospital Anxiety and Depression Scale (HADS) to assess the symptoms of anxiety and depression. Dizziness Handicap Inventory was used to measure the intensity of vestibular symptoms. The participants were divided into normal and abnormal groups based on their HADS anxiety and depression scores, and demographic and clinical factors were analyzed. To identify factors associated with anxiety and depression, multivariate logistic regression analyses were performed. Results: A total of 36 (48.6%) patients demonstrated clinically relevant anxiety levels, and 24 (32.4%) demonstrated depression. Twenty-five (33.8%) patients were diagnosed with peripheral vestibular dysfunction. In the multivariable analyses, peripheral vestibular dysfunction and severe intensity vestibular symptoms were significantly associated with anxiety and depression. None of migraine features were significantly associated with anxiety and depression. Conclusion: The prevalence of anxiety in patients with VM is considerably higher than in the depression. VM patients with peripheral vestibular dysfunction are particularly susceptible to anxiety and depression. Therefore, timely screening for vestibular function and psychiatric disorders in VM patients should be considered.
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Affiliation(s)
- Tae Su Kim
- Department of Otolaryngology, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Woo Hyun Lee
- Department of Otolaryngology, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Yoon Heo
- Department of Otolaryngology, Kangwon National University Hospital, Chuncheon, Republic of Korea
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Futami S, Miwa T. Comprehensive Equilibrium Function Tests for an Accurate Diagnosis in Vertigo: A Retrospective Analysis. J Clin Med 2024; 13:2450. [PMID: 38730980 PMCID: PMC11084401 DOI: 10.3390/jcm13092450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024] Open
Abstract
Background/Objectives: An accurate diagnosis of vertigo is crucial in patient care. Traditional balance function tests often fail to offer independent, conclusive diagnoses. This study aimed to bridge the gap between traditional diagnostic approaches and the evolving landscape of automated diagnostic tools, laying the groundwork for advancements in vertigo care. Methods: A cohort of 1400 individuals with dizziness underwent a battery of equilibrium function tests, and diagnoses were established based on the criteria by the Japanese Society for Vertigo and Equilibrium. A multivariate analysis identified the key diagnostic factors for various vestibudata nlar disorders, including Meniere's disease, vestibular neuritis, and benign paroxysmal positional vertigo. Results: This study underscored the complexity of diagnosing certain disorders such as benign paroxysmal positional vertigo, where clinical symptoms play a crucial role. Additionally, it highlighted the utility of specific physical balance function tests for differentiating central diseases. These findings bolster the reliability of established diagnostic tools, such as audiometry for Meniere's disease and spontaneous nystagmus for vestibular neuritis. Conclusions: This study concluded that a multifaceted approach integrating multiple diagnostic indicators is crucial for accurate clinical decisions in vestibular disorders. Future studies should incorporate novel tests, quantitative assessments, and advanced technologies to enhance the diagnostic capabilities of vestibular medicine.
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Affiliation(s)
- Shumpei Futami
- Department of Otolaryngology, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan;
| | - Toru Miwa
- Department of Otolaryngology, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan;
- Department of Otolaryngology-Head and Neck Surgery, Graduate of School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
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13
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Hannigan IP, Rosengren SM, Bharathy GK, Prasad M, Welgampola MS, Watson SRD. Subjective and objective responses to caloric stimulation help separate vestibular migraine from other vestibular disorders. J Neurol 2024; 271:887-898. [PMID: 37847290 PMCID: PMC10828018 DOI: 10.1007/s00415-023-12027-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Nystagmus generated during bithermal caloric test assesses the horizontal vestibulo-ocular-reflex. Any induced symptoms are considered unwanted side effects rather than diagnostic information. AIM We hypothesized that nystagmus slow-phase-velocity (SPV) and subjective symptoms during caloric testing would be higher in vestibular migraine (VM) patients compared with peripheral disorders such as Meniere's disease (MD) and non-vestibular dizziness (NVD). METHODS Consecutive patients (n = 1373, 60% female) referred for caloric testing were recruited. During caloric irrigations, patients scored their subjective sensations. We assessed objective-measures, subjective vertigo (SVS), subjective nausea (SNS), and test completion status. RESULTS Nystagmus SPV for VM, MD (unaffected side), and NVD were 29 ± 12.8, 30 ± 15.4, and 28 ± 14.2 for warm irrigation and 24 ± 8.9, 22 ± 10.0, and 25 ± 12.8 for cold-irrigation. The mean SVS were 2.5 ± 1.1, 1.5 ± 1.33, and 1.5 ± 1.42 for warm irrigation and 2.2 ± 1.1, 1.1 ± 1.19, and 1.1 ± 1.16 for cold-irrigation. Age was significantly correlated with SVS and SNS, (p < 0.001) for both. The SVS and SNS were significantly higher in VM compared with non-VM groups (p < 0.001), and there was no difference in nystagmus SPV. VM patients SVS was significantly different to the SVS of migraineurs in the other diagnostic groups (p < 0.001). Testing was incomplete for 34.4% of VM and 3.2% of MD patients. To separate VM from MD, we computed a composite value representing the caloric data, with 83% sensitivity and 71% specificity. Application of machine learning to these metrics plus patient demographics yielded better separation (96% sensitivity and 85% specificity). CONCLUSION Perceptual differences between VM and non-VM patients during caloric stimulation indicate that subjective ratings during caloric testing are meaningful measures. Combining objective and subjective measures could provide optimal separation of VM from MD.
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Affiliation(s)
- I P Hannigan
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, 2006, Australia
- Blacktown Neurology Clinic, Blacktown, NSW, 2148, Australia
| | - S M Rosengren
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, 2006, Australia
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, 2006, Australia
| | - G K Bharathy
- School of Computer Science, Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, 2007, Australia
| | - M Prasad
- School of Computer Science, Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, 2007, Australia
| | - M S Welgampola
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, 2006, Australia
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, 2006, Australia
| | - S R D Watson
- Prince of Wales Clinical School, University of New South Wales, Randwick, 2013, Australia.
- Blacktown Neurology Clinic, Blacktown, NSW, 2148, Australia.
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14
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Kobel MJ, Wagner AR, Oas JG, Merfeld DM. Characterization of Vestibular Perception in Patients with Persistent Postural-Perceptual Dizziness. Otol Neurotol 2024; 45:75-82. [PMID: 38013457 DOI: 10.1097/mao.0000000000004053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To assess vestibular (i.e., passive self-motion) perception in patients diagnosed with persistent postural-perceptual dizziness (PPPD). STUDY DESIGN Case-controlled, cross-sectional, observational investigation. SETTING Single-center laboratory-based study. PATIENTS Thirteen patients with PPPD, 13 age-matched healthy control volunteers. Of those with PPPD, eight had co-occurring vestibular migraine (VM). INTERVENTIONS All participants completed a vestibular threshold test battery reflecting perception with predominant inputs from ( a ) the otoliths (1-Hz interaural y -axis translation, 1-Hz superior-inferior z -axis translation), ( b ) the semicircular canals (2-Hz yaw rotation, 2-Hz tilts in the planes of the vertical canal pairs), and ( c ) and canal-otolith integration (0.5-Hz roll tilt). MAIN OUTCOME MEASURES Direction-recognition thresholds for each vestibular threshold test condition. RESULTS Across all patients with PPPD, higher thresholds for superior-inferior z -translations thresholds in comparison to age-matched healthy control participants were identified ( p < 0.001). Those patients with co-occurring VM and PPPD (PPPD/+VM) displayed significantly higher z -translation thresholds ( p = 0.006), whereas patients with PPPD without VM (PPPD/-VM) displayed significantly higher roll tilt thresholds ( p = 0.029). CONCLUSIONS Patients with PPPD did not display a global worsening of passive self-motion perception as quantified by vestibular perceptual thresholds. Instead, patients with PPPD displayed elevated thresholds for only roll tilt and z -translation thresholds, with the relative change in each threshold impacted by the co-occurrence of VM. Because both z -translation and roll tilt motions are reliant on accurate gravity perception, our data suggest that patients with PPPD may exhibit impaired processing of graviceptive cues.
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Affiliation(s)
- Megan J Kobel
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus
| | - Andrew R Wagner
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus
| | - John G Oas
- Naval Aerospace Medical Research Laboratory, Naval Medical Research Unit-Dayton, Dayton, Ohio
| | - Daniel M Merfeld
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus
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15
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Tarnutzer AA, Kaski D. What's in a Name? Chronic Vestibular Migraine or Persistent Postural Perceptual Dizziness? Brain Sci 2023; 13:1692. [PMID: 38137140 PMCID: PMC10741489 DOI: 10.3390/brainsci13121692] [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: 11/14/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Current consensus diagnostic criteria for vestibular migraine (VM) describes this as an episodic disorder. However, a minority of patients report prolonged (>72 h duration) or even persistent VM symptoms, prompting whether a chronic variant of vestibular migraine (CVM) should be introduced to the current classification and how best to define it. Here we summarize current evidence of such a potential chronic variant of VM and critically review proposed definitions for CVM. Potential approaches to establish a diagnostic framework for CVM include (a) following the distinction between episodic and chronic migraine headaches, namely, frequent and/or prolonged episodes of VM (but not persistent vertigo or dizziness) in the context of chronic migraine headaches or (b) daily dizzy spells over more than 6 months that responded well to prophylactic anti-migraine therapy. A key challenge when defining diagnostic criteria for CVM is how to distinguish it from other chronic vestibular syndromes such as motion sickness, persistent postural-perceptual dizziness (PPPD), and mal de débarquement syndrome. Indeed, more than 50% of patients with PPPD and up to 46% with mal de débarquement syndrome fulfil diagnostic criteria for episodic migraine headaches, suggesting these disorders may all lie along a spectrum. We propose that when VM becomes persistent, it is best classified as PPPD but that VM and PPPD are not mutually exclusive, such that patients with PPPD need not have features of VM, and the triggering event for persistent dizziness may be independent of migraine. However, further research is needed to better characterize the spectrum of clinical phenotypes in patients with chronic dizziness, migraine headaches and anxiety, to define whether a chronic variant of VM sufficiently differs from current persistent dizziness definitions.
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Affiliation(s)
- Alexander A. Tarnutzer
- Neurology, Cantonal Hospital of Baden, 5404 Baden, Switzerland
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
| | - Diego Kaski
- SENSE Research Unit, Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, 33 Queen Square, London WC1N 3BG, UK;
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16
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Kim EK, Hum M, Sharon JD. Correlating Vestibular Migraine Patient Assessment Tool and Handicap Inventory to Daily Dizziness Symptoms. Otol Neurotol 2023; 44:1052-1056. [PMID: 37733970 DOI: 10.1097/mao.0000000000004014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
OBJECTIVE Investigate the relationship between Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI) scores and daily dizziness symptoms. STUDY DESIGN Prospective cohort analysis of 52 patients with vestibular migraine (VM). SETTING Tertiary referral center. PATIENTS Fifty-two patients diagnosed with VM or probable VM according to Barany Society criteria. INTERVENTIONS Subjects reported their dizzy symptoms (on a scale of 0 [no symptoms], 1 [mild], 2 [moderate], and 3 [severe]) every day for 1 month via automated text messaging linked to a cloud-based research database. Subjects completed VM-PATHI and Dizziness Handicap Inventory (DHI) scores at the end of the month. We examined the correlation between a composite of daily dizziness scores with VM-PATHI and DHI scores through linear regression and correlation analysis. MAIN OUTCOME MEASURES Pearson correlation coefficient, R2 value. RESULTS VM-PATHI showed a moderate correlation with daily dizziness symptoms (correlation coefficient, 0.51). DHI showed a lower correlation with daily dizziness (correlation coefficient, 0.38). VM-PATHI score was a strong predictor of daily dizziness with univariate linear regression ( R2 = 0.26, p = 0.001). In a multiple linear regression model with age, history of anxiety and/or depression, and VM-PATHI, the VM-PATHI score was the only statistically significant predictor of daily dizziness ( p < 0.001). CONCLUSIONS Daily dizziness symptoms are better correlated with VM-PATHI score than the DHI, providing further validation of VM-PATHI as a disease-specific outcome measure for patients with VM.
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Affiliation(s)
- Eric K Kim
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
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17
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Benjamin T, Gardi A, Sharon JD. Recent Developments in Vestibular Migraine: A Narrative Review. Am J Audiol 2023; 32:739-745. [PMID: 36701806 DOI: 10.1044/2022_aja-22-00120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE The aim of this study was to review current literature regarding the epidemiology of vestibular migraine (VM), patient presentation, pathogenesis, and treatment. RECENT FINDINGS VM is becoming an increasingly recognized condition in the United States, currently affecting 2.7% of people. Patients may experience vestibular symptoms, such as vertigo and imbalance, with or without other migrainous symptoms. Recent evidence has also shown that patients with VM are at higher risk for cochlear dysfunction, such as sudden deafness, sensorineural hearing loss, and tinnitus. The heritability and genetics are not well understood, and the pathogenesis may involve calcitonin gene-related peptide, which is also implicated in migraine headaches. A disease-specific patient reported outcome measure, the Vestibular Migraine Patient Assessment Tool and Handicap Inventory, was recently developed and validated. A limited number of controlled trials have assessed various therapies for VM, including triptans and beta-blockers. More data are needed to understand whether or not currently available migraine treatments are effective for VM. SUMMARY VM is a common etiology of vertigo and dizziness, presenting with a characteristic spectrum of symptoms. Early data suggest that migraine treatments may be helpful in some cases.
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Affiliation(s)
- Tania Benjamin
- Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco
| | - Adam Gardi
- Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco
| | - Jeffrey D Sharon
- Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco
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18
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Li Y, Wang Y, Chen M, Jiang R, Ju Y. Eye Movement Abnormalities During Different Periods in Patients with Vestibular Migraine. J Pain Res 2023; 16:3583-3590. [PMID: 37908779 PMCID: PMC10614654 DOI: 10.2147/jpr.s422255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 10/10/2023] [Indexed: 11/02/2023] Open
Abstract
Purpose The aim of this study was to assess abnormal eye movement signs during different periods, namely, ictal periods and symptom-free intervals, in patients with vestibular migraine. Patients and Methods We assessed oculomotor signs using videonystagmography in 90 patients with VM (40 during ictal periods and 50 during symptom-free intervals) according to validated diagnostic criteria. Results Abnormal saccades, smooth pursuit and optokinetic test results; spontaneous nystagmus; and positional nystagmus were all observed in vestibular migraine patients, and there was no significant difference between different periods. Positional nystagmus was the most common in both the ictal and asymptomatic periods (60% and 36%, respectively). Positional nystagmus was induced in a variety of positions during both periods, and the slow-phase velocity ranged from <2 to 10°/s. The duration of positional nystagmus was over 60s in most cases. Overall, central oculomotor dysfunctions occurred in 27.5% of patients during VM attacks and 4% of patients during symptom-free intervals; this difference was statistically significant (p = 0.002). Conclusion In patients with VM, abnormal oculomotor signs can be found during both vertigo attacks and asymptomatic intervals. Positional nystagmus is the most common of these abnormalities and can be induced in different positions. The amplitude of these patients' positional nystagmus tends to be low, and the duration tends to be long. Observing changes in eye movements by videonystagmography may be helpful in the diagnosis of VM.
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Affiliation(s)
- Yiqing Li
- Department of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People’s Republic of China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Meimei Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Ruixuan Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yi Ju
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
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19
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Tian E, Li F, Liu D, Wang J, Guo Z, Chen J, Guo J, Zhang S. Dispelling Mist That Obscures Positional Vertigo in Vestibular Migraine. Brain Sci 2023; 13:1487. [PMID: 37891854 PMCID: PMC10605638 DOI: 10.3390/brainsci13101487] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/15/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: Patients with vestibular migraine (VM) often present with positional vertigo. A portion of these patients have features of benign paroxysmal positional vertigo (BPPV). It is a challenge to rapidly identify the BPPV component of VM associated with positional vertigo. (2) Methods: Retrospective data collected from 60 VM and 47 VM + BPPV patients were used to build a diagnostic model, and then prospective data from 47 patients were used for the external validation. All patients had VM manifesting as positional vertigo, with or without accompanying BPPV. The clinical manifestations and the results of vestibular function tests were comprehensively analyzed using logistic regression. (3) Results: The univariate and multivariate analyses showed that the age, symptom duration, tinnitus, ear fullness, nausea, head shaking nystagmus, the direction of the Dix-Hallpike and roll tests, and horizontal gain could help differentiate between the two groups. A nomogram and an online calculator were generated. The C-index was 0.870. The diagnostic model showed good discriminative power and calibration performance during internal and external validation. (4) Conclusions: This study provided a new perspective for diagnosing VM with positional vertigo by identifying the BPPV component and, for the first time, offers a prediction model integrating multiple predictors.
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Affiliation(s)
- E Tian
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (E.T.); (D.L.); (J.W.); (Z.G.); (J.C.); (J.G.)
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Fei Li
- Department of Neurology, Changzheng Hospital, Naval Medical University, Shanghai 200003, China;
| | - Dan Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (E.T.); (D.L.); (J.W.); (Z.G.); (J.C.); (J.G.)
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jun Wang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (E.T.); (D.L.); (J.W.); (Z.G.); (J.C.); (J.G.)
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zhaoqi Guo
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (E.T.); (D.L.); (J.W.); (Z.G.); (J.C.); (J.G.)
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jingyu Chen
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (E.T.); (D.L.); (J.W.); (Z.G.); (J.C.); (J.G.)
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jiaqi Guo
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (E.T.); (D.L.); (J.W.); (Z.G.); (J.C.); (J.G.)
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Sulin Zhang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (E.T.); (D.L.); (J.W.); (Z.G.); (J.C.); (J.G.)
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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20
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Waissbluth S, Sepúlveda V, Leung JS, Oyarzún J. Vestibular and Oculomotor Findings in Vestibular Migraine Patients. Audiol Res 2023; 13:615-626. [PMID: 37622929 PMCID: PMC10452030 DOI: 10.3390/audiolres13040053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Vestibular migraine (VM) is the most frequent etiology of recurrent spontaneous episodic vertigo. Vestibular and oculomotor abnormalities have been described in VM; however, the diagnosis is currently based on symptoms. The objective of this study was to determine the most frequent abnormalities in videonystagmography (VNG), caloric testing (Cal) and video head impulse test (vHIT) in patients with VM. METHODS A retrospective cohort study was conducted, including all VM and probable VM patients seen from January 2021 to July 2022. Demographics, auditory symptoms and results via VNG, Cal and vHIT were evaluated. VNG results were compared with a control group. RESULTS Sixty patients, 81.7% with VM and 18.3% with probable vestibular migraine, were included. VNG revealed the following abnormalities: 21.7% spontaneous nystagmus; 33.3% positional nystagmus, mostly central; 26.7% optokinetic nystagmus; 56.7% smooth pursuit abnormalities and 70% saccade test abnormalities, mostly velocity and latency. An abnormal unilateral caloric response was seen in 22.9%, while vHIT revealed a low gain in at least one canal in 21.7%, and saccades were seen in at least one canal with normal gains in 18.3%. Concordant results between Cal and lateral vHIT were seen in 77.1% of cases. CONCLUSIONS Although VM is a clinical diagnosis, vestibular and oculomotor abnormalities are commonly seen. The most frequent oculomotor findings were an abnormal saccade test, abnormal smooth pursuit and central positional nystagmus.
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Affiliation(s)
- Sofia Waissbluth
- Department of Otolaryngology, Pontificia Universidad Católica de Chile, Santiago 8330033, Chile
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21
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Wu Y, Ling X, Song N, Yan S, Wang W, Yang X, Gu P. Comparison of clinical characteristics and vestibular function test results in patients with vestibular migraine and Menière's disease. Braz J Otorhinolaryngol 2023; 89:101274. [PMID: 37331235 PMCID: PMC10300291 DOI: 10.1016/j.bjorl.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 03/31/2023] [Accepted: 05/03/2023] [Indexed: 06/20/2023] Open
Abstract
OBJECTIVES The differentiation between Vestibular Migraine (VM) and Meniere's Disease (MD) is difficult because of overlapping symptoms. The study aimed to compare the clinical characteristics and vestibular function test results between VM and MD patients. METHODS Seventy-one patients with definite VM and 31 patients with definite unilateral MD were included. All patients received Caloric Test (CT), Video Head Impulse Test (vHIT) and Vestibular Evoked Myogenic Potential (VEMP) test within 7 days after visiting the hospital. Results of these tests were compared between groups. RESULTS Most VM patients (64.0%) experienced spontaneous internal vertigo, while most MD patients (66.7%) experienced spontaneous external vertigo. MD patients had more severe vestibular symptoms and autonomic responses compared to VM patients during attacks (p = 0.03, p = 0.00, respectively). The nystagmus intensity of CT-induced was greater in VM patients than in MD patients (p = 0.003). More VM patients had CT intolerance and Central Positional Nystagmus (CPN) compared to MD patients (p = 0.002, p = 0.006, respectively). More MD patients had CT(+) and vHIT saccades wave compared to VM patients (p < 0.001, p = 0.002, respectively). The non-elicitation rate of cervical VEMP was higher, and the ocular VEMP amplitudes were lower in MD patients than in VM patients (p = 0.002, p = 0.018). CONCLUSIONS Vestibular symptoms during attacks combined with the results of vestibular function tests may be used to differentiate between VM and MD. The diverse nature of vestibular symptoms (especially internal vertigo), history of motion sickness and CT intolerance may provide clues to the diagnosis of VM, whereas spontaneous external vertigo, CT(+) with vHIT(-), and the presence of saccades may provide clues to the diagnosis of MD. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Yuexia Wu
- The First Hospital of Hebei Medical University, Department of Neurology, Shijiazhuang, China; Peking University Aerospace School of Clinical Medicine, Aerospace Center Hospital, Department of Neurology, Beijing, China
| | - Xia Ling
- Peking University First Hospital, Department of Neurology, Beijing, China
| | - Ning Song
- Peking University Aerospace School of Clinical Medicine, Aerospace Center Hospital, Department of Neurology, Beijing, China
| | - Shuangmei Yan
- The First Hospital of Hebei Medical University, Department of Neurology, Shijiazhuang, China
| | - Wenting Wang
- The First Hospital of Hebei Medical University, Department of Neurology, Shijiazhuang, China
| | - Xu Yang
- Peking University Aerospace School of Clinical Medicine, Aerospace Center Hospital, Department of Neurology, Beijing, China.
| | - Ping Gu
- The First Hospital of Hebei Medical University, Department of Neurology, Shijiazhuang, China; The First Hospital of Hebei Medical University, Department of Vertigo Center, ShiJiazhuang, China.
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22
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Ritz H. Evaluating patients with vertigo. JAAPA 2023; 36:1-6. [PMID: 37229589 DOI: 10.1097/01.jaa.0000918772.20883.9e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
ABSTRACT Dizziness and vertigo are among the most common complaints in medicine. Patients often provide vague descriptions of symptoms, making clinicians' jobs challenging. However, a patient with vertigo also can be one of the most rewarding encounters of a clinician's day. In most cases, a focused history and bedside vestibular testing provide enough information to make a diagnosis and identify patients for appropriate referral. Canalith repositioning maneuvers often resolve symptoms, leaving patients and clinicians satisfied.
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Affiliation(s)
- Howard Ritz
- Howard Ritz practices in otolaryngology at Glens Falls (N.Y.) Hospital. The author has disclosed no potential conflicts of interest, financial or otherwise
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23
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Li H, Xu X, Zhou J, Dong L. Cluster and network analysis of non-headache symptoms in migraine patients reveals distinct subgroups based on onset age and vestibular-cochlear symptom interconnection. Front Neurol 2023; 14:1184069. [PMID: 37305749 PMCID: PMC10251495 DOI: 10.3389/fneur.2023.1184069] [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: 03/10/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Objective The present study endeavors to identify natural subgroups of migraine patients based on the patterns of non-headache symptoms, utilizing cluster analysis. Subsequently, network analysis was performed to estimate the structure of symptoms and explore the potential pathophysiology of these findings. Method A total of 475 patients who met the diagnostic criteria for migraine were surveyed face-to-face during the period of 2019 to 2022. The survey included collecting demographic and symptom data. Four different solutions were generated by the K-means for mixed large data (KAMILA) clustering algorithm, from which the final cluster solutions were selected based on a series of cluster metrics. Subsequently, we performed network analysis using Bayesian Gaussian graphical models (BGGM) to estimate the symptom structure across subgroups and conducted global and pairwise comparisons between structures. Result Cluster analysis identified two distinct patient groups, and the onset age of migraine proved to be an effective characteristic differentiating the two patient groups. Participants assigned to late-onset group showed a longer course of migraine, higher frequency of monthly headache attacks, and greater tendency toward medication overuse. In contrast, patients in early-onset group exhibited a higher frequency of nausea, vomiting, and phonophobia compared to their counterparts in the other group. The network analysis revealed a different symptom structure between the two groups globally, while the pairwise differences indicated an increasing connection between tinnitus and dizziness, and a decreasing connection between tinnitus and hearing loss in the early-onset group. Conclusion Utilizing clustering and network analysis, we have identified two distinct non-headache symptom structures of migraine patients with early-onset age and late-onset age. Our findings suggest that the vestibular-cochlear symptoms may differ in the context of different onset ages of migraine patients, which may contribute to a better understanding of the pathology of vestibular-cochlear symptoms in migraine.
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Chen JY, Guo ZQ, Wang J, Liu D, Tian E, Guo JQ, Kong WJ, Zhang SL. Vestibular migraine or Meniere's disease: a diagnostic dilemma. J Neurol 2023; 270:1955-1968. [PMID: 36562849 PMCID: PMC10025214 DOI: 10.1007/s00415-022-11532-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
Meniere's disease (MD) represents one of the vertigo disorders characterized by triad symptoms (recurrent vertigo, fluctuating hearing loss, tinnitus or ear fullness). The diagnosis of MD relies on the accurate and detailed taking of medical history, and the differentiation between MD and vestibular migraine (VM) is of critical importance from the perspective of the treatment efficacy. VM is a highly prevalent vertigo condition and its typical symptoms (headache, vestibular symptoms, cochlear symptoms) mimic those of MD. Furthermore, the misdiagnosis in MD and VM could lead to VM patients mistakenly receiving the traumatic treatment protocol designed for MD, and sustaining unnecessary damage to the inner ear. Fortunately, thanks to the advances in examination technologies, the barriers to their differentiation are being gradually removed. These advances enhance the diagnostic accuracy of vertigo diseases, especially VM and MD. This review focused on the differentiation of VM and MD, with an attempt to synthesize existing data on the relevant battery of differentiation diagnosis (covering core symptoms, auxiliary tests [audiometry, vestibular tests, endolymphatic hydrops tests]) and longitudinal follow-up. Since the two illnesses are overlapped in all aspects, no single test is sufficiently specific on its own, however, patterns containing all or at least some features boost specificity.
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Affiliation(s)
- Jing-Yu Chen
- Department of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan City, 430022, Hubei Province, People's Republic of China
- Institute of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhao-Qi Guo
- Department of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan City, 430022, Hubei Province, People's Republic of China
- Institute of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Wang
- Department of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan City, 430022, Hubei Province, People's Republic of China
- Institute of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Dan Liu
- Department of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan City, 430022, Hubei Province, People's Republic of China
- Institute of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - E Tian
- Department of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan City, 430022, Hubei Province, People's Republic of China
- Institute of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jia-Qi Guo
- Department of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan City, 430022, Hubei Province, People's Republic of China
- Institute of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Wei-Jia Kong
- Department of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan City, 430022, Hubei Province, People's Republic of China.
- Institute of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.
| | - Su-Lin Zhang
- Department of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan City, 430022, Hubei Province, People's Republic of China.
- Institute of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.
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Alsarhan H. A scoring chart to evaluate cases of probable vestibular migraine. HEARING, BALANCE AND COMMUNICATION 2023. [DOI: 10.1080/21695717.2023.2169371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Haider Alsarhan
- Department of Surgery, College of Medicine, Mustansiriyah University, Baghdad, Iraq
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26
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Ling X, Wu YX, Feng YF, Zhao TT, Zhao GP, Kim JS, Yang X, Wang ZX. Spontaneous nystagmus with an upbeat component: Central or peripheral vestibular disorders? Front Neurol 2023; 14:1106084. [PMID: 36908595 PMCID: PMC9995393 DOI: 10.3389/fneur.2023.1106084] [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: 11/23/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Objective To determine the topical diagnosis and etiologies of spontaneous nystagmus (SN) with an upbeat component. Methods We retrospectively recruited 43 patients with SN with an upbeat component at a university hospital in China from 2020 to 2022. SN with an upbeat component was divided into pure upbeat nystagmus (UBN), SN with a predominant upbeat component, and SN with a non-predominant upbeat component. We analyzed their clinical and neurotologic findings and the final diagnosis. Results Fourteen (32.6%) of them showed pure UBN, while 29 (67.4%) exhibited SN mixed with an upbeat component, mixed upbeat-horizontal in 15, mixed upbeat-horizontal-torsional in 13, and upbeat-torsional in the remaining one. Pure UBN and SN with a predominant upbeat component were more common in central than in peripheral vestibular disorders [16 (80.0%) vs. 0 (0%), Chi-Square test, p < 0.001]. Central vestibular disorders were diagnosed in 20 (46.5%) patients, peripheral in 14 (32.6%), and undetermined in nine (20.9%) patients. The underlying causes mainly included acute unilateral peripheral vestibulopathy (n = 11), posterior circulation infarction (n = 9), benign recurrent vertigo (n = 4), vestibular migraine (VM, n = 3), and VM of childhood (n = 2). Conclusion SN with an upbeat component can be seen in both central and peripheral vestibular disorders. Pure UBN was a characteristic sign of central vestibular dysfunction. Central vestibular disorders should be highly suspected when patients show pure UBN or SN with a predominant upbeat component.
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Affiliation(s)
- Xia Ling
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yue-Xia Wu
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Yu-Fei Feng
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Tong-Tong Zhao
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Gui-Ping Zhao
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Ji-Soo Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Dizziness Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Xu Yang
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Zhao-Xia Wang
- Department of Neurology, Peking University First Hospital, Beijing, China
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27
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Kulesh AA, Parfenov VA. Vestibular migraine: epidemiology, pathogenesis, clinical picture, diagnosis and treatment. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2022. [DOI: 10.14412/2074-2711-2022-6-4-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- A. A. Kulesh
- Department of neurology and medical genetics, Acad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia
| | - V. A. Parfenov
- Department of Nervous Diseases and Neurosurgery, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
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28
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Preysner TA, Gardi AZ, Ahmad S, Sharon JD. Vestibular Migraine: Cognitive Dysfunction, Mobility, Falls. Otol Neurotol 2022; 43:1216-1221. [PMID: 36136612 DOI: 10.1097/mao.0000000000003700] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Recent evidence has shown that vestibular migraine is strongly associated with cognitive difficulties. However, limited data exist on real-world effects of that dysfunction. The objective of this study is to understand the epidemiology of cognitive dysfunction with vestibular migraine and associated sequelae using National Health Interview Survey data. STUDY DESIGN Randomized, population-based survey study of US adults. SETTING We generated a case definition approximating probable vestibular migraine based on Bárány Society criteria and validated that definition in a tertiary care vestibular clinic. PATIENTS Adult respondents to the 2016 NHIS, which queries a representative sample of the civilian, noninstitutionalized US population. INTERVENTION Diagnostic. MAIN OUTCOME MEASURES We evaluated incidence of self-reported cognitive dysfunction with vestibular migraine and whether individuals were more likely to have impaired mobility, falls, and work absenteeism than those without either condition. RESULTS Among individuals with vestibular migraine, 40% reported "some" and 12% reported "a lot" of difficulty thinking versus 13% and 2% of those without vestibular migraine, respectively. Vestibular migraine sufferers were more likely to have difficulty thinking or remembering compared with respondents without dizziness (odds ratio, 7.43; 95% confidence interval, 6.06-9.10; p < 0.001) when controlled for age, sex, education, stroke, smoking, heart disease, and diabetes. Individuals with both vestibular migraine and cognitive dysfunction had fivefold increased odds of falls and 10-fold increased odds of mobility issues compared with those without either condition. Furthermore, individuals with both vestibular migraine and cognitive dysfunction missed 12.8 more days of work compared to those without either condition. CONCLUSION Our findings indicate vestibular migraine is not only associated with cognitive dysfunction, but they are together associated with mobility issues, fall risk, and work absenteeism.
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Affiliation(s)
- Thi A Preysner
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco School of Medicine
| | - Adam Z Gardi
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco School of Medicine
| | - Sarah Ahmad
- Division of Headache Medicine, Department of Neurology, University of California-San Francisco School of Medicine, San Francisco, California
| | - Jeffrey D Sharon
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco School of Medicine
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29
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Vivek S, Prem G, Dorasala S, Faizal B, Joy M, Nair AS. Videonystagmography (VNG) Findings in Patients with Vestibular Migraine: A Hospital-Based Study. Indian J Otolaryngol Head Neck Surg 2022; 74:4290-4297. [PMID: 36742522 PMCID: PMC9895201 DOI: 10.1007/s12070-021-02953-7] [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: 05/01/2021] [Accepted: 10/19/2021] [Indexed: 02/07/2023] Open
Abstract
Vestibular migraine (VM) is a disorder where vestibular symptoms are causally related to migraine. It is one of the common causes of recurrent vertigo in the general population. It has often remained as an under-recognized condition with largely unknown pathophysiology. Accurate diagnosis is essential in vestibular pathologies as it determines the management in each case. The aim of this reasearch was to compare vestibular functions of patients with VM and healthy controls using VNG and to study the VNG patterns of patients diagnosed with VM. This study is a retrospective analysis of subjects who have undergone videonystagmography (VNG) testing from October 2018 to October 2020 done in a tertiary referral hospital. Those patients satisfying diagnostic criteria for vestibular migraine were subjected to VNG testing. Group 1 consisted of 35 vestibular migraine patients, and group 2 consisted of 35 age and sex-matched healthy controls. Statistical comparison of parameters of these groups were made.We found that the mean age of VM patients in the study was 40 ± 9.9, and the females were predominantly affected (Female: Male = 2.8:1). Statistically significant difference was obtained between VM patients and healthy controls in vertical smooth pursuit and in the positional tests using the Dix Hallpike test on the right side (p value < 0.05). We conclude that a careful study of VNG patterns can serve as a valuable tool in hard to diagnose cases of vestibular migraine.
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Affiliation(s)
- S. Vivek
- Department of ENT, Amrita Institute of Medical Sciences, Kochi, Kerala 682041 India
| | - G. Prem
- Department of Speech Pathology and Audiology, Amrita Institute of Medical Sciences, Kochi, Kerala India
| | - Srinivas Dorasala
- Ear, Nose and Throat (ENT) Department, Jawaharlal Nehru Medical College (JNMC), Belagavi, Karnataka India
| | - Bini Faizal
- Department of ENT, Amrita Institute of Medical Sciences, Kochi, Kerala India
| | - Mereena Joy
- Department of Speech Pathology and Audiology, Amrita Institute of Medical Sciences, Kochi, Kerala India
| | - Anjaly S. Nair
- Department of Biostatistics, Amrita Institute of Medical Sciences, Kochi, Kerala India
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30
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Shin SH, Byun SW, Lee ZY, Kim MJ, Kim EH, Lee HY. Clinical Findings That Differentiate Co-Occurrence of Hyperacusis and Tinnitus from Tinnitus Alone. Yonsei Med J 2022; 63:1035-1042. [PMID: 36303312 PMCID: PMC9629898 DOI: 10.3349/ymj.2022.0274] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/03/2022] [Accepted: 08/27/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE We aimed to assess the characteristics of patients with concurrent tinnitus and hyperacusis, determine the best audiological criteria for predicting hyperacusis, and confirm whether objective evidence of changes in the brain exists. MATERIALS AND METHODS The medical records of patients with tinnitus who visited the hospital between March 2020 and December 2021 were reviewed. Data on accompanying hyperacusis, audiological profiles, and questionnaires including the Tinnitus Handicap Inventory (THI), Beck Depression Inventory, and numerical rating scale were analyzed. Resting-state quantitative electroencephalography (qEEG) using power spectral density (PSD) and event-related spectral perturbation (ERSP) were performed to objectively quantify changes in the brain. RESULTS A total of 194 patients were analyzed. Among them, 51 (26.3%) reported combined subjective hyperacusis with tinnitus. However, the proportions widely varied from 7.4% to 68.4% based on three audiological criteria for assessment. A higher score on the THI questionnaire was independently associated with the co-occurrence of tinnitus and hyperacusis. Fair agreement was observed between subjective hyperacusis and the audiological criterion based on a loudness discomfort level (LDL) of ≤90 dB at two or more frequencies for the diagnosis of hyperacusis. An increased beta-PSD and decreased levels of gamma-PSD, all-ERSP, and delta-ERSP were observed in patients with hyperacusis (p<0.05). CONCLUSION Patients with co-occurring tinnitus and hyperacusis had more severe tinnitus distress. An LDL of ≤90 dB at two or more frequencies may be applicable to predict accompanying hyperacusis in subjects with tinnitus, and qEEG also provides more objective information.
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Affiliation(s)
- Seung-Ho Shin
- Department of Otorhinolaryngology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sung Wan Byun
- Department of Otorhinolaryngology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Zoo Young Lee
- Department of Otorhinolaryngology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Min-Jee Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, Ulsan University College of Medicine, Seoul, Korea
| | - Eun Hye Kim
- Department of Otorhinolaryngology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Ho Yun Lee
- Department of Otorhinolaryngology, Ewha Womans University School of Medicine, Seoul, Korea.
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31
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Frank AJ, Hoppes CW, Dunlap PM, Costa CM, Whitney SL. Categorizing individuals based on the severity of Visual Vertigo Analogue Scale symptoms. J Vestib Res 2022; 32:433-441. [PMID: 35466914 DOI: 10.3233/ves-210131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The Visual Vertigo Analogue Scale (VVAS) assesses visual vertigo. Instead of the original scoring methods (positive VVAS > 1), we propose categorizing patients as having No (0), Mild (0.1-40), Moderate (40.01-70), or Severe (70.01-100) symptoms. OBJECTIVE Our primary aim was to validate an alternative interpretation of the VVAS by exploring the relationship between categories of visual vertigo symptoms and measures of activity and participation, dizziness handicap, anxiety, and depression. We aimed to describe the severity of visual vertigo reported by patients in different vestibular diagnostic categories. METHODS Participants with vestibular disorders (n = 250) completed the VVAS, Vestibular Activities and Participation (VAP) Measure, Dizziness Handicap Inventory (DHI), and the Hospital Anxiety and Depression Scale (HADS). RESULTS Patients with central disorders were more symptomatic than those with peripheral vestibular disorders. As evaluated by one-way ANOVA, the scores on the VAP, HADS, and DHI significantly differed among mild, moderate, severe, and no visual vertigo categories (p < 0.001). As VVAS severity increased, activity and participation decreased (r = 0.582, p < 0.001); dizziness handicap increased (r = 0.597, p < 0.001, n = 199); anxiety increased (r = 0.405, p < 0.001); and depression increased (r = 0.521, p < 0.001). CONCLUSIONS The findings of this study support the use of an alternative VVAS interpretation method of categorizing symptoms as none, mild, moderate, and severe visual vertigo.
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Affiliation(s)
- Amanda J Frank
- Hearing Center of Excellence, San Antonio, TX, USA.,zCore Business Solutions, Inc., Round Rock, TX, USA
| | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX, USA
| | - Pamela M Dunlap
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cláudia M Costa
- Ph.D. Program in Neuroscience, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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32
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Chae R, Krauter R, Pasquesi LL, Sharon JD. Broadening vestibular migraine diagnostic criteria: A prospective cohort study on vestibular migraine subtypes. J Vestib Res 2022; 32:453-463. [PMID: 35124629 DOI: 10.3233/ves-210117] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Current Bárány Society criteria for vestibular migraine (VM) include only episodic symptoms. Anecdotal observations suggest that some patients have episodic forms and others have chronic forms of VM, with interplay and evolution of both subtypes over time. OBJECTIVE To better understand VM subtypes and evaluate a more inclusive diagnostic schema. METHODS Four VM groups were studied: definite episodic (dVM), probable episodic (pVM), definite chronic (dCVM), and probable chronic (pCVM). Chronic VM was defined as having more than 15 dizzy days per month. Sociodemographic and clinical characteristics were analyzed, along with Dizziness Handicap Inventory (DHI) and Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI) scores. RESULTS 54 adults with a mean age of 47.0 years (SD 13.7) were enrolled. 10 met criteria for dVM, 11 pVM, 22 dCVM, and 11 pCVM. Overall, there were strong similarities in clinical characteristics between dVM, pVM, dCVM, and pCVM. Compared to subjects with episodic VM, those with chronic VM had a higher average number of VM triggers (8.7 vs. 6.4, P = 0.019), including motion (93.9% vs. 66.7%, P = 0.009), scrolling on a screen (78.8% vs. 47.6%, P = 0.018), skipped meal (57.6% vs. 23.8%, P = 0.015), and air travel (57.6% vs. 23.8%, P = 0.015). They also had higher symptom severity (DHI = 53.3, P = 0.194) and burden of disease (VM-PATHI = 48.2, P = 0.030) scores. CONCLUSIONS Many patients do not meet current Bárány Society criteria for VM based on their duration of vestibular symptoms. Yet, these patients with chronic VM endorse several indistinguishable symptoms from those who do meet criteria. A more inclusive diagnostic schema should be adopted where patients with vestibular symptoms shorter than 5 minutes or longer than 72 hours are also recognized as having VM.
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Affiliation(s)
- Ricky Chae
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - Roseanne Krauter
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - Lauren L Pasquesi
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - Jeffrey D Sharon
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, USA
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Lee A, Abouzari M, Akbarpour M, Risbud A, Lin HW, Djalilian HR. A proposed association between subjective nonpulsatile tinnitus and migraine. World J Otorhinolaryngol Head Neck Surg 2022. [DOI: 10.1002/wjo2.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ariel Lee
- Department of Otolaryngology—Head and Neck Surgery University of California Irvine USA
| | - Mehdi Abouzari
- Department of Otolaryngology—Head and Neck Surgery University of California Irvine USA
| | - Meleeka Akbarpour
- Department of Otolaryngology—Head and Neck Surgery University of California Irvine USA
| | - Adwight Risbud
- Department of Otolaryngology—Head and Neck Surgery University of California Irvine USA
| | - Harrison W. Lin
- Department of Otolaryngology—Head and Neck Surgery University of California Irvine USA
| | - Hamid R. Djalilian
- Department of Otolaryngology—Head and Neck Surgery University of California Irvine USA
- Department of Biomedical Engineering University of California Irvine USA
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Abstract
PURPOSE OF REVIEW To explore recent developments in vestibular migraine (VM). RECENT FINDINGS This review discusses the current diagnostic criteria for VM in the adult and pediatric populations, as proposed by the International Headache Society and Bárány Society. Recent VM studies confirm the prior findings and reveal new insights, including the wide range of vestibular symptoms, symptoms in the attack-free period, and triggers. Many patients experience persistent vestibular symptoms, even in the absence of acute attacks, which often significantly impact patients' quality of life. The syndrome of benign recurrent vertigo and its relationship to migraine, VM, and Meniere's disease is also discussed. There is a dearth of randomized controlled trials in VM treatment. Prospective and retrospective studies support the benefit of many migraine treatments are effective in VM, including neuromodulation, and calcitonin gene-related peptide monoclonal antibodies. VM affects almost 3% of the population, but remains under-diagnosed. Recent diagnostic criteria can help clinicians diagnose VM in adults and children.
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Affiliation(s)
- Shin C Beh
- Beh Center for Vestibular & Migraine Disorders, 4500 Hillcrest Rd Ste 145, Frisco, TX, 75035, USA.
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35
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Waissbluth S, Sepúlveda V, Leung JS, Oyarzún J. Caloric and video head impulse test dissociated results in dizzy patients. Front Neurol 2022; 13:1000318. [PMID: 36226081 PMCID: PMC9548977 DOI: 10.3389/fneur.2022.1000318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction We are now able to detect abnormalities for any semicircular canal with the use of the video head impulse test (vHIT). Prior to the vHIT, the gold standard for unilateral canal paresis of the lateral canal was considered the caloric test. Clinical cases where the caloric test and vHIT are discordant are not uncommon. Methods Retrospective study. All consecutive cases of dizziness seen from 11/2020 to 12/2021 for which the patient underwent both caloric and vHIT tests performed within 10 days, were reviewed. Patients with discordant results were included. We evaluated the caloric response, vHIT gains for all canals and saccades, with and without gain abnormalities. Results We included 74 cases of dizziness with dissociated results. The most common finding was a normal caloric response with abnormal vHIT results (60.8%); the main abnormal finding on vHIT was the presence of saccades. In this group, 37.7% of patients had normal gains and refixation saccades. In addition, the most found low gain was for the posterior canal. The main diagnosis in this group was vestibular migraine. For the group with unilateral caloric paresis and normal vHIT gain in the lateral canal, the main diagnosis was Ménière's disease. Discussion The most common disorders with discordant results were Ménière's disease and vestibular migraine. The caloric test and vHIT are complementary and combining both tests provide greater clinical information. Further research is needed to understand refixation saccades with normal gains.
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36
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Development and Validation of the Predictive Model for the Differentiation between Vestibular Migraine and Meniere's Disease. J Clin Med 2022; 11:jcm11164745. [PMID: 36012984 PMCID: PMC9410183 DOI: 10.3390/jcm11164745] [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: 07/20/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/29/2022] Open
Abstract
(1) Background: Vestibular migraine (VM) and Meniere’s disease (MD) share multiple features in terms of clinical presentations and auditory-vestibular dysfunctions, e.g., vertigo, hearing loss, and headache. Therefore, differentiation between VM and MD is of great significance. (2) Methods: We retrospectively analyzed the medical records of 110 patients with VM and 110 patients with MD. We at first established a regression equation by using logistic regression analysis. Furthermore, sensitivity, specificity, accuracy, positive predicted value (PV), and negative PV of screened parameters were assessed and intuitively displayed by receiver operating characteristic curve (ROC curve). Then, two visualization tools, i.e., nomograph and applet, were established for convenience of clinicians. Furthermore, other patients with VM or MD were recruited to validate the power of the equation by ROC curve and the Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva (GiViTI) calibration belt. (3) Results: The clinical manifestations and auditory-vestibular functions could help differentiate VM from MD, including attack frequency (X5), phonophobia (X13), electrocochleogram (ECochG) (X18), head-shaking test (HST) (X23), ocular vestibular evoked myogenic potential (o-VEMP) (X27), and horizontal gain of vestibular autorotation test (VAT) (X30). On the basis of statistically significant parameters screened by Chi-square test and multivariable double logistic regression analysis, we established a regression equation: P = 1/[1 + e−(−2.269× X5 − 2.395× X13 + 2.141× X18 + 3.949 × X23 + 2.798× X27 − 4.275× X30(1) − 5.811× X30(2) + 0.873)] (P, predictive value; e, natural logarithm). Nomographs and applets were used to visualize our result. After validation, the prediction model showed good discriminative power and calibrating power. (4) Conclusions: Our study suggested that a diagnostic algorithm based on available clinical features and an auditory-vestibular function regression equation is clinically effective and feasible as a differentiating tool and could improve the differential diagnosis between VM and MD.
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Dissociation between Caloric and Video Head Impulse Tests in Dizziness Clinics. Audiol Res 2022; 12:423-432. [PMID: 36004951 PMCID: PMC9404865 DOI: 10.3390/audiolres12040043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/31/2022] [Accepted: 08/05/2022] [Indexed: 11/17/2022] Open
Abstract
Vestibular assessment tests such as the video head impulse test (vHIT) for the horizontal semicircular canal, and caloric test (Cal), both evaluate horizontal canal function. One would assume that the outcomes for these tests should lead to concordant results, yet several studies have suggested that dissociation can occur in certain pathological conditions. As this topic remains inconclusive, this review aims to analyze the scientific evidence regarding the patterns of hypofunction observed in vHIT and Cal in different otoneurological diseases. A comprehensive review of the literature regarding dissociation between these tests in common neurotological diseases was carried out. Articles were analyzed when data for vHIT and Cal were described in a way that it was possible to calculate discordance rates; both retrospective and prospective studies were analyzed. In this review, the discordance rates were as follows: 56% in Ménière’s disease, 51.5% in vestibular migraine, 37.2% in vestibular schwannoma, and 20.8% in vestibular neuritis. These results highlight the benefit of using both Cal and vHIT, and that they are complementary tests.
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Shi S, Wang D, Ren T, Wang W. Auditory Manifestations of Vestibular Migraine. Front Neurol 2022; 13:944001. [PMID: 35911900 PMCID: PMC9334870 DOI: 10.3389/fneur.2022.944001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/17/2022] [Indexed: 11/22/2022] Open
Abstract
Objectives To investigate the auditory features of patients with vestibular migraine (VM) and to analyze the possible relevant factors of hearing loss. Methods A total of 166 patients with VM were enrolled. Demographic variables, age of onset, disease course, distribution of vestibular attacks, characteristics of hearing loss, and the coexistence of related disorders, such as visual aura, familial history, motion sickness, nausea, headache, photophobia, otalgia, tinnitus, aural fullness, and phonophobia, were analyzed and compared. Results Patients with VM can manifest otalgia (8.4%), tinnitus (51.8%), aural fullness (41%), and phonophobia (31.9%). Of 166 patients, the prevalence of VMw was 21.1% (n = 35). Patients with VMw mainly manifested mild and easily reversible low-frequency hearing loss. The proportions of tinnitus and aural fullness were significantly larger in patients with VMw than that in patients with VMo (P < 0.05). The duration of vestibular symptoms was significantly shorter in patients with VMw (P < 0.05). However, the age of onset, disease course, gender, frequency of vestibular attacks, the coexistence of visual aura, familial history, motion sickness, nausea, headache, photophobia, otalgia, and phonophobia had no significant difference between the two groups. Conclusion Auditory symptoms were common in patients with VM. The hearing loss of VM was characterized by a mild and easily reversible low-frequency hearing loss, accompanied by higher proportions of tinnitus and aural fullness, and a shorter duration of vestibular symptoms compared with patients with VMo.
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Affiliation(s)
- Suming Shi
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, China
| | - Dan Wang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, China
| | - Tongli Ren
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, China
| | - Wuqing Wang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, China
- *Correspondence: Wuqing Wang
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Outcome of vestibular rehabilitation in vestibular migraine. J Neurol 2022; 269:6246-6253. [PMID: 35802200 DOI: 10.1007/s00415-022-11250-4] [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: 10/06/2021] [Revised: 04/01/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To investigate the effects of an individualized vestibular rehabilitation (VR) program on balance and gait performance and on self-perceived handicap in a group of vestibular migraine (VM) patients with associated anxiety. METHODS An 8-week prospective clinical trial of a VR program was conducted on 74 VM patients. The effects were evaluated with the modified Clinical Test of Sensory Integration in Balance (mCTSIB), the Dynamic Gait Index (DGI), and the Dizziness Handicap Inventory (DHI) before and after VR. The Panic Agoraphobic Spectrum Self-Report version (PAS-SR) was used to assess the patients' level of anxiety. RESULTS DGI and DHI parameters significantly improved after VR (p < 0.05). The fall rates of mCTSIB were significantly decreased on foam with eyes closed (chi-square: 4.934, p = 0.026), and on foam with head back and eyes closed (chi-square: 7.451, p = 0.006). Forty-three (58.1%) of 74 VM patients had panic-anxiety complaints in terms of PAS scores (a score of > 46 points indicates the presence of anxiety). Balance and gait performance as measured by DGI (p = 0.000), DHI (p = 0.000), and mCTSIB (p < 0.05) improved significantly after VR in both groups of VM patients: those with and without anxiety complaints (PAS scores > 46 points and < 46 points, respectively). CONCLUSION Even VM patients with anxiety complaints benefited from vestibular exercises, and their imbalance complaints and perceived levels of handicap/disability improved. Individual specific vestibular exercises created with a clinical decision-making process provide functional improvement through vestibular compensation mechanisms. VR should be included in the treatment programs of VM patients with either high or low anxiety levels to improve vestibular function.
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Bogle JM, King AZ, Deep N, Weisskopf P, Starling AJ. Static Subjective Visual Vertical (SVV) in Patients with Vestibular Migraine. J Am Acad Audiol 2022; 33:396-404. [PMID: 36070782 DOI: 10.1055/a-1938-1161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Vestibular migraine (VM) is one of the common causes of episodic dizziness, but it is underdiagnosed and poorly understood. Previous research suggests that otolith reflex pathway performance is often impaired in this patient group, leading to altered perception of roll plane stimuli. Clinically, this perception can be measured with subjective visual vertical (SVV) testing. PURPOSE The aim of this study is to compare static SVV performance (absolute mean SVV tilt, variance) in a cohort of patients diagnosed with VM to results obtained from clinically derived normative data. STUDY DESIGN Retrospective case review. STUDY SAMPLE Ninety-four consecutive patients between 18 and 65 years of age diagnosed with VM were included in this comparison to clinically derived normative data. DATA COLLECTION AND ANALYSIS Retrospective chart review was completed. Demographic data, symptom report, and vestibular laboratory results were documented. SVV performance was documented in terms of absolute mean SVV tilt and response variance. RESULTS Abnormal mean SVV tilt was described in 54% (n = 51) of patients with VM. Including abnormal response variance increased those identified with abnormal presentation to 67% (n = 63). Laboratory findings were insignificant for semicircular canal function, but of those with abnormal ocular vestibular myogenic potential results (n = 30), 77% (n = 23) demonstrated both abnormal SVV and utriculo-ocular reflex performance. There were no associations noted for SVV performance and demographic or other self-report variables. CONCLUSION Absolute mean SVV tilt and response variance are often abnormal in patients diagnosed with VM. These findings support theories suggesting atypical intralabyrinthine integration within the vestibular nuclei and cerebellar nodular pathways.
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Affiliation(s)
- Jamie M Bogle
- Department of Otorhinolaryngology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Ashley Zaleski King
- Department of Speech-Language/Audiology, Towson University, Towson, Maryland
| | - Nicholas Deep
- Department of Otorhinolaryngology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Peter Weisskopf
- Department of Otorhinolaryngology, Mayo Clinic Arizona, Scottsdale, Arizona
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Cokyaman T, Cetin H. Pediatric vestibular migraine: Diagnosis according to ICHD-3 criteria and the effectiveness of short-term CH prophylaxis. Eur J Paediatr Neurol 2022; 39:19-24. [PMID: 35636099 DOI: 10.1016/j.ejpn.2022.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 03/04/2022] [Accepted: 05/09/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Vestibular migraine (VM) is a rare migraine variant with limited information about its treatment in children. This study, it was aimed to evaluate the diagnostic characteristics of VM in children and the effectiveness of cyproheptadine hydrochloride (CH) prophylaxis. METHODS Patients aged 6-18 years who were diagnosed with VM and other primary headaches (OPHs) according to ICHD-3 diagnostic criteria and given oral CH prophylaxis for at least 3 months were included in the study. Response to CH prophylaxis was defined by the change in symptoms (worsening, no change, and improvement) monthly. RESULTS A total of 64 cases diagnosed with primary headache and given CH prophylaxis were identified. 40.6% (29) migraine without aura of patients, 34.4% (22) VM, 14.1% (9) tension type headache, 4.7% (3) benign paroxysmal vertigo, 3.1% (2) migraine with aura and 3.1% (2) were diagnosed with abdominal migraine. Compared to OPHs, it was found that the duration of headache attack was shorter (p .013) and vomiting, which is one of the associated symptoms, was observed less in pediatric VM (p .032). The positive response of the whole study population to CH prophylaxis was 85.9%. However, CH prophylaxis responses were higher in VM compared to OPHs at the end of 1 month (63.6%) and 2 months (86.3%). CONCLUSION In the pediatric population, the migrainous characters of VM may show differences, but its response to short-term CH prophylaxis is quite good.
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Affiliation(s)
- Turgay Cokyaman
- Çanakkale Onsekiz Mart University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Neurology, Turkey.
| | - Huriye Cetin
- Çanakkale Onsekiz Mart University, Faculty of Medicine, Department of Pediatrics, Turkey.
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Abstract
PURPOSE OF REVIEW In this review, we illustrate and discuss the recent findings regarding the epidemiology and pathophysiology of migraine triggers and their implications in clinical practice. RECENT FINDINGS Data from the literature suggest that individual triggers fail to provoke migraine attack in experimental settings. It is therefore possible that more triggers acting in combination are needed to induce an attack by promoting some degree of brain dysfunction and thus increasing the vulnerability to migraine. Caution is however needed, because some of the factors rated as triggers by the patients may actually be a component of the clinical picture of migraine attacks. SUMMARY Trigger factors of migraine are endogenous or exogenous elements associated with an increased likelihood of an attack in a short period of time and are reported by up to 75.9% of patients. Triggers must be differentiated from premonitory symptoms that precede the headache phase but do not have a causative role in attack provocation, being rather the very first manifestations of the attack. Identification of real triggers is an important step in the management of migraine. Vice versa, promoting an active avoiding behaviour toward factors whose role as triggers is not certain would be ineffective and even frustrating for patients.
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Filippopulos FM, Zwergal A, Huppert D. Is There an “Acquired Idiopathic Head-Shaking Nystagmus”?—A Discussion of Mechanisms and Clinical Implications Based on a Case Report. Front Neurol 2022; 13:897012. [PMID: 35669878 PMCID: PMC9163310 DOI: 10.3389/fneur.2022.897012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background Head-shaking nystagmus (HSN) occurs in both peripheral and central vestibular disorders. In most cases, HSN can be attributed to an asymmetric peripheral vestibular input or a structural lesion mostly in the cerebellum affecting the central velocity storage mechanism. An isolated HSN is very rare. Case Presentation We report on a young female patient with the clinical picture of recurrent episodes of vertigo, which were induced by fast head movements and were accompanied by a severe right-beating HSN with a long time constant of 60 s. There was no other clinical and instrument-based evidence of peripheral vestibular dysfunction (including video head impulse test, caloric test, vestibular-evoked myogenic potentials) or indication of a structural lesion in the nodulus, uvula or pontomedullary brainstem on fine-slice magnetic resonance imaging. She had no previous history of migraine, hearing deficits, or other focal neurological symptoms. Diagnostic criteria for vestibular paroxysmia, vestibular migraine, benign peripheral paroxysmal vertigo, or any other known vestibular disorders were not fulfilled. Chart review in the database of the German Center for Vertigo and Balance Disorders indicated eight additional patients with a similar clinical phenotype between 2018 and 2022. Conclusion We propose a clinical entity called acquired idiopathic head shaking nystagmus (aiHSN) as a rare cause of episodic vertigo induced by fast head movements. Nystagmus characteristics suggest a subtle functional pathology of the central velocity storage mechanism in the nodulus and uvula, which is exacerbated during symptomatic episodes.
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Affiliation(s)
- Filipp M. Filippopulos
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital LMU Munich, Munich, Germany
- Department of Neurology, University Hospital Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
- *Correspondence: Filipp M. Filippopulos
| | - Andreas Zwergal
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital LMU Munich, Munich, Germany
- Department of Neurology, University Hospital Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Doreen Huppert
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital LMU Munich, Munich, Germany
- Department of Neurology, University Hospital Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
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Patel N, Talewar K, Bahra A, Kaski D. Vestibular migraine. ADVANCES IN CLINICAL NEUROSCIENCE & REHABILITATION 2022. [DOI: 10.47795/litm2615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Vestibular migraine is an under-diagnosed but increasingly recognised neurological condition that causes episodic vertigo, associated with migrainous features. Making a diagnosis of VM relies on a clinical history, including the presence of recurrent episodes of vertigo or dizziness, on a background of migraine headaches, and associated migraine features that accompany the vestibular symptoms. It is the most common cause of spontaneous (non-positional) episodic vertigo, affecting up to 1% of the population, but remains under-diagnosed outside specialist centres, partly due to an absence of diagnostic biomarkers. Its pathophysiology remains poorly understood, and there is a paucity of high-quality treatment trials. Here we review the clinical features of vestibular migraine, highlight current theories that account for vestibular symptoms, and outline treatment guidelines.
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Silva VPR, Castro LHM, Calderaro M. Vestibular migraine. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:232-237. [PMID: 35976301 PMCID: PMC9491429 DOI: 10.1590/0004-282x-anp-2022-s111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
Vestibular migraine (VM) remains an underdiagnosed condition, often mistaken with brainstem aura. VM is defined by recurrent vestibular symptoms in at least 50% of migraine attacks. Diagnosis is established by clinical criteria based on the International Classification of Headache Disorders (ICHD-3). Estimated prevalence of VM is 1 to 2.7% of the adult population. Vestibular symptoms usually appear after the headache. VM pathophysiology remains poorly understood. Vertigo may occur before, during, after the migraine attack, or even independently, and may last seconds to hours or days. Pathophysiological mechanisms for VM are still poorly understood and are usually extrapolated from migraines. Differential diagnoses include Ménière's disease, benign paroxysmal positional vertigo, brainstem aura, transient ischemic attack, persistent perceptual postural vertigo, and episodic type 2 ataxia. Specific treatment recommendations for vestibular migraine are still scarce.
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Affiliation(s)
| | - Luiz Henrique Martins Castro
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brazil
| | - Marcelo Calderaro
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Ambulatório de Cefaleia, São Paulo SP, Brazil
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Bassett A, Vanstrum E. Exploring Vestibular Assessment in Patients with Headache and Dizziness. Otolaryngol Clin North Am 2022; 55:549-558. [PMID: 35490043 DOI: 10.1016/j.otc.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Patients often report symptoms of headache and dizziness concomitantly. Symptoms of dizziness can be explored with a comprehensive vestibular assessment, allowing for the investigation of central and peripheral vestibular system contributions to symptoms of dizziness. Patients who report both symptoms of headache and dizziness demonstrate abnormalities of the vestibular system which can be measured quantitatively. Completion of comprehensive vestibular testing can help to guide diagnosis and strategies for intervention.
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Affiliation(s)
- Alaina Bassett
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine of the University of Southern California, 1640 Marengo Street, Suite 100, Los Angeles, CA 90033, USA.
| | - Erik Vanstrum
- Keck School of Medicine of the University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90033, USA
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Moen U, Magnussen LH, Wilhelmsen KT, Goplen FK, Nordahl SHG, Meldrum D, Knapstad MK. Prevalence and distribution of musculoskeletal pain in patients with dizziness-A systematic review. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 27:e1941. [PMID: 35191148 PMCID: PMC9286866 DOI: 10.1002/pri.1941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/28/2021] [Accepted: 01/29/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND AND PURPOSE Musculoskeletal disorders are among the leading causes of disability globally, but their role in patients with dizziness and imbalance is not well understood or explored. Such knowledge may be important as musculoskeletal pain and dizziness can mutually influence each other, leading to a complex condition requiring more comprehensive approaches to promote successful recovery. We conducted a systematic review to examine the extent and characteristic of reported musculoskeletal pain in patients with dizziness. METHODS A comprehensive literature search in Medline, Embase, Cochrane, Scopus, Amed, Google Scholar, SveMed+, and Web of Science was conducted in March 2021. Inclusion criteria were studies examining patients with a vestibular diagnosis, patients with cervicogenic dizziness and patients included based on having dizziness as a symptom; and reported musculoskeletal pain. Data regarding age, sex, sample size, diagnosis and musculoskeletal pain was extracted. The Crowe Critical Appraisal Tool was used for assessing methodical quality of the included studies. RESULTS Out of 1507 screened studies, 16 studies met the inclusion criteria. The total sample consisted of 1144 individuals with dizziness. The frequency of patients reporting pain ranged between 43% and 100% in the included studies. Pain intensity were scored between 5 and 7 on a 0-10 scale. Pain in the neck and shoulder girdle was most often reported, but musculoskeletal pain in other parts of the body was also evident. DISCUSSION In the included studies, musculoskeletal pain was highly prevalent in patients with dizziness, with pain intensity that may have a moderate to severe interference with daily functioning. Pain in the neck and shoulder is well documented, but there are few studies addressing musculoskeletal pain in additional parts of the body. More research is needed to understand the relations between dizziness and musculoskeletal pain.
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Affiliation(s)
- Unni Moen
- Western Norway University of Applied SciencesBergenNorway
| | | | | | - Frederik Kragerud Goplen
- Norwegian National Advisory Unit on Vestibular DisordersHaukeland University HospitalBergenNorway
- Department of Otorhinolaryngology & Head and Neck SurgeryHaukeland University HospitalBergenNorway
| | - Stein Helge Glad Nordahl
- Department of Otorhinolaryngology & Head and Neck SurgeryHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Dara Meldrum
- The School of Medicine Trinity College DublinThe University of DublinDublinIreland
| | - Mari Kalland Knapstad
- Western Norway University of Applied SciencesBergenNorway
- Norwegian National Advisory Unit on Vestibular DisordersHaukeland University HospitalBergenNorway
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Shen Y, Qi X. Update on diagnosis and differential diagnosis of vestibular migraine. Neurol Sci 2022; 43:1659-1666. [PMID: 35015204 DOI: 10.1007/s10072-022-05872-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/05/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Vestibular migraine (VM) is considered the most common cause of spontaneous episodic vertigo and the second most common cause of vertigo. However, without a biomarker or a complete understanding of the pathophysiology, VM remains underrecognized and underdiagnosed. Therefore, definite diagnostic criteria are urgently needed. Meanwhile, VM should be clearly differentiated from other similar diseases. This paper may help clinicians improve the diagnostic rate of VM and reduce the rate of misdiagnosis. A PubMed search was performed using the following terms: vestibular migraine, migraine-associated vertigo/dizziness, migraine-related vertigo, migraine-related vestibulopathy, benign recurrent vertigo, vertiginous migraine, migraine, headache, vertigo, dizziness, and diagnosis. This paper also summarizes the diagnostic criteria and differential diagnoses of VM. The diagnosis of VM is based on the symptoms, degree, frequency, and duration of the vestibular episodes, a history of migraine, and the temporal association of migraine symptoms with vestibular episodes in at least 50% of cases, while ruling out what may be due to other reasons. In addition to vestibular symptoms and migraine, transient auditory symptoms, nausea, vomiting, and susceptibility to motion sickness may also be associated with VM. Thus, VM should be differentiated from other diseases such as Meniere's disease, benign paroxysmal positional vertigo, migraine with brainstem aura, vestibular neuritis, posterior circulation ischemia, multiple lacunar infarction, vestibular paroxysmia, motion sickness, and episodic ataxia type 2. CONCLUSION Only if the diagnostic criteria of VM and differential diagnosis can be mastered clearly, we can make a definite diagnosis and treat patients properly.
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Affiliation(s)
- Youjin Shen
- Zhujiang Hospital (The Second School of Clinical Medicine), Southern Medical University, Guangzhou, 510515, Guangdong, China. .,Department of Neurology, Deqing County People's Hospital, Zhaoqing, 526600, Guangdong, China.
| | - Xiaokun Qi
- Zhujiang Hospital (The Second School of Clinical Medicine), Southern Medical University, Guangzhou, 510515, Guangdong, China.,Department of Neurology, The Sixth Medical Center of PLA of Chinese General Hospital, Beijing, 100048, China
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Association between dietary acid load and clinical features of migraine headaches among Iranian individuals. Sci Rep 2022; 12:2460. [PMID: 35165363 PMCID: PMC8844046 DOI: 10.1038/s41598-022-06515-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/24/2022] [Indexed: 11/09/2022] Open
Abstract
There is limited evidence regarding the possible role of dietary acid load (DAL) in the pathophysiology of migraine headaches. Therefore, we sought to examine DAL in relation to the clinical features of migraine including headache frequency, severity and duration, headache impact test-6 (HIT-6), and serum levels of nitric oxide (NO). In the present cross-sectional study, 262 patients (38 men and 224 women aged 20–50 years) were recruited through a simple random sampling method. Dietary intakes were obtained by using a validated 168-item semi-quantitative food frequency questionnaire (FFQ). DAL was then calculated by two different methods; potential renal acid load (PRAL) and net endogenous acid production (NEAP). In total, 262 patients with a mean (SE) age of 36.1 (0.53) and a BMI of 25.55 (0.21) were included in the current study. After controlling for potential confounders, a higher DAL was positively associated with headache frequency in those with the highest DAL score compared to the lowest (PRAL; β = 2.33; 95% CI 0.78, 3.88; NEAP; β = 1.74; 95% CI 0.13, 3.34). Increasing NEAP from 28.96 to 35.89 resulted in a 3.43 and 2.74 increment in HIT-6 scores in the crude (95% CI 1.35, 5.52) and fully-adjusted models (95% CI 0.40, 5.07), respectively. Moreover, a higher dietary PRAL was significantly associated with migraine-related disability, as shown by HIT-6, in subjects of the third tertile compared to those in the first tertile after controlling for confounders (β = 2.42; 95% CI 0.13, 4.70). In conclusion, our study highlighted the importance of the acid–base properties of a diet in the pathophysiology of migraine headaches. However, further well-designed studies are needed to confirm our findings.
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Hoskin JL, Fife TD. New Anti-CGRP Medications in the Treatment of Vestibular Migraine. Front Neurol 2022; 12:799002. [PMID: 35153979 PMCID: PMC8828914 DOI: 10.3389/fneur.2021.799002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background Vestibular migraine (VM) is a condition associated with migraine headache, vertigo, dizziness, and balance disturbances. Treatment options are limited. It is unknown if new calcitonin gene-related peptide (CGRP) migraine medications have efficacy in treating VM. Methods We retrospectively reviewed all patients with VM who were prescribed one of the new CGRP medications between January 2016 and July 2020. In total, 28 patients met the inclusion criteria. We specifically evaluated the “older” CGRP medications including erenumab, galcanezumab, fremanezumab, and ubrogepant. Medical records for subsequent visits were assessed to monitor improvement described by patients. Results Of the 28 patients identified, three were lost to follow up. For the remaining 25 patients, we divided the patients based on a scale of “significant improvement,” “moderate improvement,” “mild improvement,” or “no improvement.” In total 21 of 25 patients demonstrated some level of improvement in their VM symptoms with 15 having moderate to significant improvement. Conclusion Results demonstrated a trend toward improvement, suggesting that the CGRP medications appear to be a decent treatment option for VM. A prospective study evaluating CGRP medications in patients with VM would provide further information about this treatment option.
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