Migrainous Vertigo, Tinnitus, and Ear Symptoms and Alternatives

Abouzari, Mehdi; Tawk, Karen; Lee, Darlene; Djalilian, Hamid R.

doi:10.1016/j.otc.2022.06.017

Cited by 6 publications

(4 citation statements)

References 84 publications

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“…In recent years, more research has been conducted studying both the association between migraine and vestibulocochlear disorders and the efficacy of migraine-prophylaxis (nortriptyline, verapamil, and/or topiramate) in treating these disorders. Additionally, due to patient suspicion regarding pharmacologic treatments for reasons including cost, fear of side effects, and the belief that they lack effectiveness or lack evidence, complementary and integrative medicine alternatives are often utilized by patients to help manage migraines [ 23 ]. Examples of these pharmacological and non-pharmacological therapies are listed in Table 1 .…”

Section: Previous and Current Managementmentioning

confidence: 99%

“…Definite VM is characterized by recurrent moderate-to-severe vestibular symptoms (spontaneous, positional, visually induced, or head-motion-induced vertigo or dizziness), lasting between 5 min and 72 h. At least half of these episodes should be associated with migraine headaches, photophobia and phonophobia, and/or visual aura [ 23 , 30 , 35 ]. Additionally, the Bárány Society has defined criteria for probable VM.…”

Section: Vestibular Migrainementioning

confidence: 99%

“…Additionally, the Bárány Society has defined criteria for probable VM. These patients have experienced at least five episodes of moderate-to-severe vestibular symptoms that last between 5 min and 72 h, either have a history of migraines or have had an episode with migraine features, and do not have a more appropriate vestibular or International Classification of Headache Disorders diagnosis [ 23 ]. However, these criteria have been demonstrated to be too strict, and by adhering to them, clinicians only acknowledge patients with probable and definite VM [ 4 , 36 ], thus leaving many subtypes of VM unidentified and undertreated.…”

Section: Vestibular Migrainementioning

confidence: 99%

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Management of Migraine-Associated Vestibulocochlear Disorders

et al. 2023

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Migraine is a chronic neurological disorder that frequently coexists with different vestibular and cochlear symptoms (sudden hearing loss, tinnitus, otalgia, aural fullness, hyperacusis, dizziness, imbalance, and vertigo) and disorders (recurrent benign positional vertigo, persistent postural perceptual dizziness, mal de debarquement, and Menière’s disease). Despite evidence of an epidemiological association and similar pathophysiology between migraine and these vestibulocochlear disorders, patients suffering from migraine-related symptoms are usually underdiagnosed and undertreated. Current migraine treatment options have shown success in treating vestibulocochlear symptoms. Lifestyle and dietary modifications (reducing stress, restful sleep, avoiding migraine dietary triggers, and avoiding starvation and dehydration) and supplements (vitamin B2 and magnesium) offer effective first-line treatments. Treatment with migraine prophylactic medications such as tricyclic antidepressants (e.g., nortriptyline), anticonvulsants (e.g., topiramate), and calcium channel blockers (e.g., verapamil) is implemented when lifestyle and dietary modifications are not sufficient in improving a patient’s symptoms. We have included an algorithm that outlines a suggested approach for addressing these symptoms, taking into account our clinical observations. Greater recognition and understanding of migraine and its related vestibular and cochlear symptoms are needed to ensure the appropriate diagnosis and treatment of affected patients.

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Section: Previous and Current Managementmentioning

confidence: 99%

Section: Vestibular Migrainementioning

confidence: 99%

Section: Vestibular Migrainementioning

confidence: 99%

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Management of Migraine-Associated Vestibulocochlear Disorders

et al. 2023

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“…Other keys to tinnitus management include dietary modifications such as having regular eating habits and avoiding migraine food triggers, maintaining a regular sleep schedule, gaining control over stress, and use of supplements such as magnesium and vitamin B2 (Figure 3 ). 131 , 132 …”

Section: Vestibular Migraine Treatmentmentioning

confidence: 99%

Migraine management for the otolaryngologist

Brooks

Tawk

Djalilian

et al. 2023

Laryngoscope Investig Oto

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ObjectiveTo characterize migraine pathophysiology, presentation, and current treatment strategies, specifically in regard to vestibulocochlear manifestations of migraine.MethodsNarrative review of available literature.ResultsMigraine disorder can be described as a spectrum of otologic manifestations, with vestibular migraine now recognized with fully‐fledged diagnostic criteria. Otologic manifestations are theorized to be due, in part, to trigeminal innervation of the inner ear structures and calcitonin gene‐related peptide (CGRP) expression within the labyrinth. Patients can experience vertigo, aural fullness, enhanced tinnitus, and hearing loss without the characteristic migraine headache, leading to under recognition of these symptoms as migraine‐related. Meniere's disease, mal de débarquement syndrome, persistent postural perceptual dizziness, and recurrent benign paroxysmal positional vertigo have close associations to migraine and may exist on the migraine spectrum. Migraine treatment consists of two goals: halting acute attacks (abortive therapy) and preventing attacks (prophylactic therapy). Abortive medications include triptans, corticosteroids, anti‐histamines, and anti‐emetics. Pharmacologic prophylaxis in conjunction with lifestyle modifications can decrease frequency and severity of symptoms and include tricyclic antidepressants, calcium channel blockers, anti‐epileptic medications, selective serotonin reuptake inhibitors, serotonin‐norepinephrine reuptake inhibitors, beta‐blockers, gepants, and monoclonal antibodies to CGRP. Promising evidence is emerging regarding the ability of migraine medications to positively treat the various otologic symptoms of migraine.ConclusionMigraine disorder manifesting with primarily cochleovestibular symptoms can be challenging to diagnose and manage for practicing clinicians. Patients with various vestibulopathies that are closely related to migraine may benefit from migraine treatment. Lifestyle choices and prophylactic medications are key to satisfactorily preventing acute migrainous attacks and improve function.

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Psychosomatic aspects in otorhinolaryngology—historical milestones

Marek

2023

HNO

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Migrainous Vertigo, Tinnitus, and Ear Symptoms and Alternatives

Cited by 6 publications

References 84 publications

Management of Migraine-Associated Vestibulocochlear Disorders

Management of Migraine-Associated Vestibulocochlear Disorders

Migraine management for the otolaryngologist

Psychosomatic aspects in otorhinolaryngology—historical milestones

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