Clinical characteristics and treatment choice in vestibular migraine

Power, Laura; Shute, W.; McOwan, Benjamin; Murray, Kate; Szmulewicz, David J.

doi:10.1016/j.jocn.2018.02.020

Cited by 50 publications

(49 citation statements)

References 33 publications

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“…VM is more prevalent in females, with a gender ratio of from 1.5 up to 5.1 [13][14][15]. The average age at onset of VM is 38-50 [15][16][17]. It is worth noting that migraine headache precedes the onset of vestibular attacks, where the age at onset of migraine is 23-32 years, while the average age at onset of vertigo is 34-38 years [15,18,19].…”

Section: Epidemiology and Demographic Factorsmentioning

confidence: 97%

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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Section: Epidemiology and Demographic Factorsmentioning

confidence: 97%

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

Nowaczewska

2020

Neurol Neurochir Pol.

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“…For example, although most head impulse testing is normal in patients with VM, patients with VM can have abnormal head impulse or abnormal caloric examination suggesting a peripheral cause [8]. Abnormal ocular motor function has been reported in VM suggesting a central cause yet as many as 35% of patients with VM are unable to be classified as either having a central or peripheral origin [8][9][10]. Finally, low velocity nystagmus that does not follow the expected characteristics of a peripheral etiology (i.e.…”

mentioning

confidence: 99%

The Bucket Test Differentiates Patients with MRI Confirmed Brainstem/Cerebellar Lesions from Patients Having Migraine and Dizziness Alone

Chang¹,

Winnick

Hsu

et al. 2019

Preprint

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Background: Among the most challenging diagnostic dilemmas managing patients with vestibular symptoms (i.e. vertigo, nausea, imbalance) is differentiating dangerous central vestibular disorders from benign causes. Migraine has long been recognized as one of the most common causes of vestibular symptoms, but the clinical hallmarks of vestibular migraine are notoriously inconsistent and thus the diagnosis is difficult to confirm. Here we conducted a prospective study investigating the sensitivity and specificity of combining standard vestibular and neurological examinations to determine how well central vestibular disorders (CVD) were distinguishable from vestibular migraine (VM). Method: Twenty-seven symptomatic patients diagnosed with CVD and 36 symptomatic patients with VM underwent brain imaging and clinical assessments including; 1) SVV bucket test, 2) ABCD2, 3) headache/vertigo history, 4) presence of focal neurological signs, 5) nystagmus, and 6) clinical head impulse testing. Results: Mean absolute SVV deviations measured by bucket testing in CVD and VM were 4.8±4.1° and 0.7±1.0°, respectively. The abnormal rate of SVV deviations (>2.3°) in CVD was significantly higher than VM (p<0.001). Using the bucket test alone to differentiate CVD from VM, sensitivity was 74.1%, specificity 91.7%, positive likelihood ratio (LR+) 8.9, and negative likelihood ratio (LR-) 0.3. However, when we combined the SVV results with the clinical exam assessing gaze stability (nystagmus) with an abnormal focal neurological exam, the sensitivity (92.6%) and specificity (88.9%) were optimized (LR+ (8.3), LR- (0.08)). Conclusion: The SVV bucket test is a useful clinical test to distinguish CVD from VM, particularly when interpreted along with the results of a focal neurological exam and clinical exam for nystagmus.

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“…According to our study result,the abnormal rateof caloric irrigation test was higher than vHIT.It suggests that low-frequencysemicircularcanal function is vulnerablein VM patients.And the results in our studyis also in accordance with the previous reports [23,24].Apart from vestibular function, oculomotorfunction is also a important sign in VM.In the symptomfree interval, nearly half of VM patientswere found abnormal oculomotor tests in our study. Such signsinclude spontaneous nystagmus, positional nystagmus, gaze-evoked nystagmus and smooth pursuit.In previous reports,oculomotorabnormalities were reported in 8 to 60% of VM patients [6,[25][26][27].…”

Section: Discussionmentioning

confidence: 83%

Assessment of Vestibular and Oculomotor Function in Patients with Vestibular Migraine: A Preliminary Study

Fu¹,

Han²,

He³

et al. 2020

Preprint

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Background: The purpose of the study is to assess the vestibular and oculomotor function in patients with vestibular migraine(VM).And we also investigate the relationship between test resultsandeffectiveness of prophylactic medication.Methods: We recruited 41 patientswith VM. They were examinedwith vestibular-evoked myogenic potentials(VEMP), video head impulse test(vHIT) and videonystagmography(VNG), including spontaneous or positional nystagmus, gaze-evoked nystagmus, smooth pursuit and caloric irrigation testing.All VM patients were treated withprophylactic medications. Theintensity of vertigo were evaluated with dizziness handicap inventory(DHI) before and after treatment. After 6 months, we evaluate the effectiveness of prophylactic medication. We analyzed the relationship between test resultsandeffectiveness of prophylactic medication.Results:In vestibular function test,71% of VM patients showed abnormal result. 20% showed abnormal air-conducted cVEMP and 42% showed abnormal air-conducted oVEMP. 32% showed abnormal vHIT and 56% showed abnormal caloric irrigation test.The abnormal rate of oVEMP was significantly higher than cVEMP (p<0.05). And the abnormal rate of caloric irrigation test was significantly higher than vHIT(p<0.05). In oculomotor function test, 42% showed pathological result. The abnormal rate of oculomotor function test was significantly lower than vestibular function test (p<0.05). After 6 months follow-up, rate of good effectiveness was significantly higher in normal vestibular function test group compared with the abnormal vestibular function test group (p<0.05). Rate of good effectiveness was no statistically significant difference between normal oculomotor function test group and abnormal oculomotor function test group (p>0.05).Conclusions: Abnormal vestibular and oculomotor function are commonly observed in VM patients. And VM patients with abnormal vestibular function have a weak effectiveness of prophylaxis medications.

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Clinical characteristics and treatment choice in vestibular migraine

Cited by 50 publications

References 33 publications

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

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

The Bucket Test Differentiates Patients with MRI Confirmed Brainstem/Cerebellar Lesions from Patients Having Migraine and Dizziness Alone

Assessment of Vestibular and Oculomotor Function in Patients with Vestibular Migraine: A Preliminary Study

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