Can a Chronic BPPV With a History of Trauma be the Trigger of Symptoms in Vestibular Migraine, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and Whiplash Associated Disorders (WAD)? A Retrospective Cohort Study

Abstract

Background: In patients with chronic benign paroxysmal positional vertigo (BPPV), i.e., chronic vestibular multicanalicular canalithiasis (CVMCC), abnormal signals are transmitted from diseased labyrinths via the healthy vestibular nuclei complex to their end organs. The vestibulo-thalamo-cortical reflex as proposed in vestibular migraine is just one of these reflexes. In a group of patients diagnosed with CVMCC otolith repositioning maneuvers specific for each semicircular canal (SCC) ameliorated pain and other symptoms in 90%. Increased awareness of CVMCC may reduce suffering and continuous medication. Objective: To evaluate if CVMCC can be the trigger of symptoms in vestibular migraine, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and whiplash associated disorders (WAD). Study Design: Retrospective consecutive observational cohort study. Setting: Ambulatory at a private Otoneurology Centre. Patients: One hundred sixty-three patients with CVMCC and a history of trauma. Intervention: Based on the symptoms (structured symptom questionnaire), the patients are post hoc sub grouped according to the criteria of the different diagnoses. Main Outcome Measure: Frequency of patients with CVMCC who fulfill the criteria of the different diagnoses. Results: 98% of all patients with CVMCC fulfill the Barany Society criteria of a probable vestibular migraine; 17% fulfill the International Classification of Headache Disorders defined vestibular migraine criteria; 63% fulfill the Fukuda criteria of ME/CFS; 100% of the patients with WAD suffer from CVMCC. Conclusion: This survey supports the hypothesis that CVMCC can be the trigger of symptoms in vestibular migraine, ME/CFS, and WAD. The actual diagnosis the patient receives is often in accordance with the patient's dominant symptom.

Prevalence and distribution of musculoskeletal pain in patients with dizziness—A systematic review

“…Among 24 patients with Ménière's disease (Bjorne & Agerberg, 2003), 75% reported neck and shoulder pain, and 50% reported pain in the face or jaws. Similar results were found in two studies on BPPV (Iglebekk et al, 2013;Tjell et al, 2019) where 82%-87% reported neck pain, and 13% reported widespread/generalized pain. In the same studies, peri-/retroorbital pain was reported by 67%-74%, and temporomandibular pain by 59%.…”

“…In most cases dizziness passes quickly, but in 30%–50% of the cases the symptoms become persistent (Cousins et al., 2017 ; Godemann et al., 2005 ; Heinrichs et al., 2007 ; Kammerlind et al., 2005 ). Experiencing persistent dizziness can be exhausting and disabling with concomitant ailments such as musculoskeletal pain (Malmström et al., 2021 ), and psychological comorbidity (Lahmann et al., 2015 ), resulting in reduced quality of life and sick leave (Iglebekk et al., 2013 ; Neuhauser et al., 2008 ; Tjell et al., 2019 ). In some cases dizziness eventually results in long‐lasting conditions, such as persistent postural‐perceptual dizziness (PPPD) (Bittar & von Söhsten Lins, 2015 ).…”

Characterization of Post–exertional Malaise in Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

“…For instance, participants described fatigue as unpredictable in occurrence, intensity, and duration and feeling a loss of control of the body. Patients with whiplash-associated disorders suffer from fatigue, sleep disturbance, and cognitive deficits similar to ME/CFS patients (15). Chronic fatigue can be unpredictable and triggered by anxiety and emotional trauma (16).…”

Associations between Zygoma Fracture and Post-Traumatic Headache: A Study among Taiwanese Population

“…Another hypothesis is that PTH may result from abnormal signaling in any part of the trigeminal nerve system. A similar study suggests that minor trauma of the head, neck, and craniocervical junction could have a major impact on the vestibular system at variable sites, [24] which may explain the abnormal signals transmitting from a diseased labyrinth to the healthy, normally functioning vestibular nuclei complex in multiple chronic canal benign paroxysmal positional vertigo [25]. Because both ATN and ZTN are proximal to the vestibular nuclei complex, the mechanisms may be the closest analogy to PTH.…”