Episodic vertigo related to migraine (90 cases): vestibular migraine?

Abstract

A retrospective study was conducted on 90 patients with episodic vertigo that could be related to migraine as the most probable pathomechanism. Since the majority of the patients did not fulfill the criteria of the International Headache Society (IHS) for basilar migraine, the diagnosis was substantiated by disease course, medical efficacy in treating (ergotamines) and preventing (metoprolol, flunarizine) attacks, ocular motor abnormalities in the symptom-free interval, and careful exclusion of the most relevant differential diagnoses, such as transient ischemic attacks, Menière's disease, and vestibular paroxysmia. The following clinical features were elaborated. The initial manifestation could occur at any time throughout life, with a peak in the fourth decade in men and a "plateau" between the third and fifth decades in women. The duration of rotational (78%) and/or to-and-fro vertigo (38%) could last from a few seconds to several hours or, less frequently, even days; duration of a few minutes or of several hours was most frequent. Monosymptomatic audiovestibular attacks (78%) occurred as vertigo associated with auditory symptoms in only 16%. Vertigo was not associated with headache in 32% of the patients. In the symptom-free interval 66% of the patients showed mild central ocular motor signs such as vertical (48%) and/or horizontal (22%) saccadic pursuit, gaze-evoked nystagmus (27%), moderate positional nystagmus (11%), and spontaneous nystagmus (11%). Combinations with other forms of migraine were found in 52%. Thus, migraine is a relevant differential diagnosis for episodic vertigo. According to the criteria of the IHS, only 7.8% of these patients would be diagnosed as having basilar migraine. However, to ensure that at least those presenting with monosymptomatic episodic vertigo (78% in our study) receive effective treatment, we propose the use of the more appropriate term "vestibular migraine."

Epidemiology of vertigo, migraine and vestibular migraine

“…VM may occur at any age [ 16,14,30 ] with a reported female to male ratio between 1.5 and 5 to 1 [ 14,30,18,41 ]. Familial occurrence is not uncommon, probably based on an autosomal dominant pattern of inheritance with decreased penetrance in men [ 47 ].…”

“…Familial occurrence is not uncommon, probably based on an autosomal dominant pattern of inheritance with decreased penetrance in men [ 47 ]. In most patients, migraine headaches begin earlier in life than VM [ 18,41 ]. Some patients are headache-free for years before VM manifests itself [ 18 ].…”

“…In most patients, migraine headaches begin earlier in life than VM [ 18,41 ]. Some patients are headache-free for years before VM manifests itself [ 18 ]. Benign paroxysmal vertigo of childhood is probably an early manifestation of VM and affects about 2.8 % of unselected children between the ages of 6 and 12 years [ 1 ].…”

“…The clinical characteristics of VM have been elucidated by several large case series from specialized dizziness clinics [ 14,16,18,26,30,31,41 Head motion intolerance, íe imbalance, illusory motion and nausea aggravated or provoked by head movements, is a frequent additional symptom [ 14,30 ]. Visual vertigo, which is vertigo provoked by moving visual scenes [traffic, cinema] can be another prominent feature of VM [ 14,61 ].…”

Vestibular Evoked Myogenic Potentials in a Female Population with Migraine

“…Vestibular migraine is an association between migraine and spontaneous course of vertigo attacks of vestibular origin. Vertigo attacks are often separate from headaches and duration of vertigo often does not fall within the restrictions of aura [5][6][7]. Idiopathic paroxysmal vertigo of childhood has been defined as a migraine's equivalent syndrome in which the attacks are brief and have a benign prognosis [8].…”