Migraine Features in Patients with Persistent Postural-Perceptual Dizziness

Abstract

Objectives: To evaluate the presence of migraine features in patients with persistent postural-perceptual dizziness (PPPD). Methods: In a retrospective survey study, consecutive patients presenting to a tertiary care neurotology clinic during an 18-month period were given questionnaires about headache and dizziness symptoms. The survey responses plus history and examination of the patient were used to diagnose patients with PPPD. The prevalence of migraine headache, vestibular migraine (VM), and migraine characteristics was evaluated. Results: In total, 36 subjects with PPPD were included in the study. The mean age of the subjects was 56 ± 16 years with a female (72%) predominance. A total of 19 (53%) patients met the International Classification of Headache Disorders criteria for migraine headache, and 6 of those (17%) met the criteria for definite VM. Of the patients who did not meet full migraine headache criteria, 6 (17%) patients met 4 of 5 criteria, and 5 (14%) patients met 3 of 5 criteria. There was no significant difference between PPPD patients who fulfilled full migraine headache criteria and those who did not in sensitivity to light, sound, smells, weather changes, feelings of mental fog/confusion, and sinus pain/facial pressure. Conclusions: This study demonstrates that a majority of patients with PPPD fulfill the criteria for migraine headache. A large proportion of PPPD patients who do not meet the full criteria for migraine headache still meet a majority of the migraine headache criteria. This suggests an association between the 2 conditions. PPPD may be a part of the spectrum of otologic migraine, where migraine manifests as otologic symptoms.

Migraine Features in Patients With Isolated Aural Fullness and Proposal for a New Diagnosis

“…The results of the present study add further support to the hypothesis that prolonged aural fullness represents a symptom of “otologic migraine,” a term recently introduced to the literature to characterize a spectrum of disorders in which migraine manifests primarily with cochleovestibular complaints (26–31). We think that proper identification and treatment of these otologic symptoms with migraine therapies may avoid unnecessary surgical interventions and excess diagnostic work-up.…”

In Reference to The Interconnections of Mal de Débarquement Syndrome and Vestibular Migraine

“…Finally, we should raise the possibility that some of the spontaneous-onset MDDS patients in the authors' paper were suffering from another migraine-linked condition, persistent postural-perceptual dizziness (PPPD). 4 PPPD presents similarly to spontaneous-onset MDDS, and in our experience, also responds well to migraine therapy. Again, we commend the authors on their exceptional work.…”

Treatment of Stapedial Myoclonus as a Migraine-Related Phenomenon

“…For example, Hwang et al (24) described an association between cochlear disorders, most notably tinnitus, in patients with migraine. Previous reports have also discussed a connection between MH and conditions such as pulsatile tinnitus (25), benign paroxysmal positional vertigo (26), persistent postural perceptual dizziness (27), Menière's diseases) (28), aural fullness (29), hyperacusis (18), and mal de debarquement syndrome (30). Even more, treatment with migraine medications has been shown to provide relief of symptoms for Menière's disease and aural fullness patients.…”