Association between Ménière’s disease and vestibular migraine

Pyykkö, Ilmari; Manchaiah, Vinaya; Färkkilä, Markus; Kentala, Erna; Zou, Jing

doi:10.1016/j.anl.2019.02.002

Cited by 35 publications

(23 citation statements)

References 57 publications

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“…27 However, with the current clinical criteria, it remains difficult to distinguish MD from vestibular migraine. This difficulty is in concordance with previously published studies suggesting that they share similar pathophysiological mechanisms 3 or that describe a group of patients who fulfill both diagnostic criteria. 28 Bernaerts et al 14 demonstrated that the 2 most distinctive characteristics to distinguish MD ears from asymptomatic ears are cochlear PE and vestibular EH.…”

Section: Discussionsupporting

confidence: 92%

“…1 Because key clinical symptoms overlap other clinical entities such as vestibular migraine, it remains difficult to distinguish MD from other vertigo-associated inner ear pathologies. [2][3][4] Although the etiology of MD remains unclear, endolymphatic hydrops (EH) is generally accepted as the pathologic hallmark of the disease. 5 3T MR imaging after delayed intravenous gadolinium allows visualization of the endolymphatic space, with EH findings similar to histopathologic findings.…”

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confidence: 99%

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Value of Endolymphatic Hydrops and Perilymph Signal Intensity in Suspected Ménière Disease

Steekelenburg

Weijnen

Pont

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Ménière disease is characterized by endolymphatic hydrops, whereas perilymphatic enhancement on MR imaging has been suggested to be of additional value in diagnosing Ménière disease. This study evaluates the presence of endolymphatic hydrops and perilymphatic enhancement in patients with Ménière disease and with other vertigo-associated inner ear pathology. MATERIALS AND METHODS: A 3D-FLAIR sequence 4 hours after intravenous gadolinium injection was performed to visualize the endolymph and perilymph in 220 patients suspected of having Ménière disease. Patients' ears were retrospectively categorized as having Ménière disease (probable or definite) or other vertigo-associated inner ear pathology not attributable to Ménière disease. Endolymphatic hydrops was evaluated using a visual classification system, and perilymphatic enhancement was scored both visually and quantitatively. RESULTS: Endolymphatic hydrops was present in 137 (91.9%) of the definite Ménière disease ears and in 9 (7.0%) of the ears with other vertigo-associated inner ear pathology (P , .001). The combination of endolymphatic hydrops and visually increased perilymphatic enhancement was present in 122 (81.9%) definite Ménière disease ears compared with 4 (3.1%) ears with other vertigo-associated inner ear pathology (P , .001). This combination increases the positive predictive value from 0.94 for endolymphatic hydrops and 0.91 for perilymphatic enhancement to 0.97. The addition of measured perilymphatic enhancement leads to a moderate decrease in sensitivity from 0.92 for endolymphatic hydrops to 0.86. CONCLUSIONS: The combination of perilymphatic enhancement and endolymphatic hydrops in patients suspected of having Ménière disease increases the positive predictive value in the diagnosis of definite Ménière disease. ABBREVIATIONS: EH ¼ endolymphatic hydrops; MD ¼ Ménière disease; PE ¼ perilymphatic enhancement; SIR ¼ signal intensity ratio; VAIEP ¼ vertigoassociated inner ear pathology M énière disease (MD) is characterized by attacks of vertigo, low-frequency hearing loss, and tinnitus. In the absence of a diagnostic standard, clinical diagnostic criteria were defined by the American Academy of Otolaryngology-Head and Neck Surgery and updated into a consensus of diagnostic guidelines by

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Section: Discussionsupporting

confidence: 92%

mentioning

confidence: 99%

Value of Endolymphatic Hydrops and Perilymph Signal Intensity in Suspected Ménière Disease

Steekelenburg

Weijnen

Pont

et al. 2020

AJNR Am J Neuroradiol

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“…Radtke et al [52] reported that the lifetime prevalence of migraine was higher in the MD group (56%) than controls (25%, p < 0.001); they concluded that migraine and MD might share a similar pathophysiology. In a very large group of 911 MD patients, Pyykkö et al [53] found migraine in 20.9% of subjects while headache was reported by 42.9%. Notably, migraine patients complained of more severe MD symptoms than non-migraineur patients with MD.…”

Section: Differential Diagnosismentioning

confidence: 98%

Vestibular migraine — an underdiagnosed cause of vertigo. Diagnosis and treatment

Nowaczewska

2020

Neurol Neurochir Pol.

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Introduction. Migraine and vertigo are two common conditions. The main disorder connecting both these entities is vestibular migraine (VM). State of the art. VM may affect 1-3% of the general population. It is a disabling disease of recurrent attacks of vestibular symptoms accompanied by migraine features which occur in patients with a current or previous history of migraine. The episodes can last minutes, hours or even days, and may occur without any concurrent headache, which can prompt misdiagnosis. VM often begins several years after a typical migraine, and the delay between onset of headache and vertigo may be long. The diagnosis is based on the patient's clinical history and can be challenging due to the lack of an established confirmatory diagnostic test or biomarkers. The mechanism of vestibular migraine remains unclear and is still under investigation, but it seems to be an interaction between trigeminal and vestibular systems. Due to the lack of specific trials, treatment recommendations are based on migraine guidelines. Several drugs seem to be effective, although there have been few randomised controlled trials in this area. Regardless of the published strict and detailed diagnostic criteria, this condition remains little known, and as a consequence is underdiagnosed and undertreated. Clinical implications. Efforts should be made to educate medical communities and patients about this disease and to encourage neurologists and ENT specialists to cooperate. Every patient with vertigo of unknown origin should be directly asked about a past or present history of migraine, or migraine symptoms experienced during their vertigo episodes. Future directions. There is a growing need for studies regarding the pathophysiology of VM as well as randomised trials to establish clear treatment recommendations and to improve management of this surprisingly common disorder.

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“…Some reports have recently found that there exists much overlap between Ménière's disease (MD) and VM [Ghacami et al, 2016;Wang et al, 2018;Abouzari et al, 2019;Pyykkö et al, 2019;Shin et al, 2019]. Murofushi et al [2018] proposed that these patients presented with simultaneous MD and VM signs/symptoms -a new clinical syndrome -"VM/MD overlapping syndrome (VM/ MD-OS)".…”

Section: Introductionmentioning

confidence: 99%

Audiological Findings in Patients with Vestibular Migraine and Migraine: History of Migraine May Be a Cause of Low-Tone Sudden Sensorineural Hearing Loss

Xue

Lin

et al. 2020

Audiol Neurotol

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Introduction: The aim of this study was to investigate and compare the auditory findings in migraine, vestibular migraine (VM), and healthy controls. Methods: Twenty-eight migraine patients (56 ears), 18 VM (36 ears), and 25 healthy controls (50 ears) were included. Audiometry, speech discrimination scores, distortion product optoacoustic emission (DPOAE), and auditory brainstem response were tested. Results: The pure tone in the VM group showed higher thresholds at lower frequencies (250, 500, 1,000, 2,000 Hz) than the control group, with statistical differences observed (P_{250 Hz} = 0.001, P_{500 Hz} = 0.003, P_{1,000 Hz} = 0.016, P_{2,000 Hz} = 0.002). Compared with the healthy controls, the patients with VM had significantly lower amplitudes of DPOAE at 1 kHz (p < 0.001) and 2 kHz (p = 0.020), and the patients with migraine had lower amplitudes at 2 kHz (p = 0.042). Compared with the control group, the patients with migraine reported prolonged latency of wave V (p = 0.016) and IPL I–V (p = 0.003). The patients with VM had significant prolongation of IPL I–V (p = 0.024). Conclusion: Not only the peripheral, but also the central auditory system was involved in patients with migraine and VM. In particular, lower frequencies of the auditory system were more likely to be involved in VM. The history of migraine may be a cause of low-tone sudden sensorineural hearing loss.

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Association between Ménière’s disease and vestibular migraine

Cited by 35 publications

References 57 publications

Value of Endolymphatic Hydrops and Perilymph Signal Intensity in Suspected Ménière Disease

Value of Endolymphatic Hydrops and Perilymph Signal Intensity in Suspected Ménière Disease

Vestibular migraine — an underdiagnosed cause of vertigo. Diagnosis and treatment

Audiological Findings in Patients with Vestibular Migraine and Migraine: History of Migraine May Be a Cause of Low-Tone Sudden Sensorineural Hearing Loss

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