Neuro-Otological Findings in Patients with Migraine- and Nonmigraine-Related Dizziness

Vitkovic, Jessica; Paine, Mark; Rance, Gary

doi:10.1159/000111783

Cited by 64 publications

(61 citation statements)

References 95 publications

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“…The high prevalence at follow-up agrees with previous findings [5], whereas the low prevalence at initial presentation is comparable to the results of recent studies that reported around 8 and 16.6% [8,9,10]. Thus, the clear-cut increase in central ocular motor findings at follow-up explains well the different results reported in earlier studies as being due to a time bias.…”

Section: Discussionsupporting

confidence: 90%

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Long-Term Changes of Central Ocular Motor Signs in Patients with Vestibular Migraine

Neugebauer¹,

Adrion

Glaser³

et al. 2012

Eur Neurol

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Background: A high percentage of patients with vestibular migraine (VM) were reported to have central ocular motor dysfunctions (COMD) in the symptom-free interval. Since VM is a chronic disorder, it is of interest if COMD worsen over time. Methods: Thirty VM patients and 11 control patients participated in an 8-year-long observational study with follow-up. All patients underwent standardized neuro-ophthalmological and neuro-otological examinations at the initial presentation and at follow-up. The primary outcome measure was change in COMD at follow-up. Results: In general, COMD in the symptom-free interval were subtle, consisting of a saccadic horizontal and/or vertical pursuit. At follow-up, significantly more patients with VM had COMD (p = 0.015). The prevalence of COMD increased from 20 to 63% in VM patients. Further, the presence of COMD at follow-up had a positive predictive value of 90.5% for the diagnosis of VM. Successful treatment with prophylactic migraine medication seems to prevent the development and worsening of COMD (p = 0.008). Conclusion: Mild COMD occur in a large percentage of VM patients during the course of the disease. The presence of COMD is predictive of VM in patients with recurrent attacks of vertigo. Prophylactic migraine medication seems to attenuate the development and progression of COMD.

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Section: Discussionsupporting

confidence: 90%

“…In contrast, current studies that included patients with migraine and vertigo according to the Neuhauser criteria showed different results. One study reported central ocular motor disturbances in 16.6%, while two other studies reported central ocular motor signs in only about 8% of patients with VM [8,9,10]. …”

Section: Introductionmentioning

confidence: 99%

Long-Term Changes of Central Ocular Motor Signs in Patients with Vestibular Migraine

Neugebauer¹,

Adrion

Glaser³

et al. 2012

Eur Neurol

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show abstract

“…Such findings, however, are not specific for vestibular migraine, because they can be found also in migraine patients without vestibular symptoms and in many other vestibular syndromes 37 . In one study, patients with vestibular migraine became nauseous after caloric testing four times more often than migraine patients and patients with other vestibular disorders 38 . A neuro-otologic study of 20 patients during the acute phase of vestibular migraine showed pathological nystagmus in 14 patients, mostly central spontaneous or positional nystagmus.…”

Section: Clinical Presentationmentioning

confidence: 97%

Vestibular migraine: diagnosis challenges and need for targeted treatment

Barbosa

Villa

2016

Arq. Neuro-Psiquiatr.

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Approximately 1% of the general population suffers from vestibular migraine. Despite the recently published diagnostic criteria, it is still underdiagnosed condition. The exact neural mechanisms of vestibular migraine are still unclear, but the variability of symptoms and clinical findings both during and between attacks suggests an important interaction between trigeminal and vestibular systems. Vestibular migraine often begins several years after typical migraine and has a variable clinical presentation. In vestibular migraine patients, the neurological and neurotological examination is mostly normal and the diagnosis will be based in the patient clinical history. Treatment trials that specialize on vestibular migraine are scarce and therapeutic recommendations are based on migraine guidelines. Controlled studies on the efficacy of pharmacologic interventions in the treatment of vestibular migraine should be performed.

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“…Oculographic studies may show evidence of central-vestibular dysfunction with acute migrainous vertigo [23]. No specific neurootologic abnormality has been linked to MAV although patients with MAV were 4 times more likely to develop nausea with caloric stimulation [24]. In the absence of a confirmatory diagnostic test, the diagnosis of MAV is based on clinical criteria [25].…”

Section: Diagnosticsmentioning

confidence: 99%

Potential solutions to several vestibular challenges facing clinicians

Merfeld

Priesol

Lee

et al. 2010

VES

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Among other problems, patients with vestibular problems suffer imbalance, spatial disorientation, and blurred vision. These problems lead to varying degrees of disability and can be debilitating. Unfortunately, a large number of patients with vestibular complaints cannot be diagnosed with the clinical tests available today. Nor do we have treatments for all patients that we can diagnose. These clinical problems provide challenges to and opportunities for the field of vestibular research. In this paper, we discuss some new diagnostic and treatment options that could become available for tomorrow’s patients. As a new diagnostic, we have begun measuring patient’s perceptual direction-detection thresholds. Preliminary results appear encouraging; patients diagnosed with bilateral loss have yaw rotation thresholds almost ten times greater than normals, while patients diagnosed with migraine associated vertigo have roll tilt thresholds well below normal at 0.1 Hz. As a new treatment, we have performed animal studies looking at responses evoked by electrical stimulation provided by a vestibular prosthesis. Results measuring the VOR demonstrate promise and preliminary studies of balance and perception are also encouraging. While electrical stimulation is a standard means of stimulation, optical stimulation is also being investigated as a way to improve prosthetic stimulation specificity.

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Neuro-Otological Findings in Patients with Migraine- and Nonmigraine-Related Dizziness

Cited by 64 publications

References 95 publications

Long-Term Changes of Central Ocular Motor Signs in Patients with Vestibular Migraine

Long-Term Changes of Central Ocular Motor Signs in Patients with Vestibular Migraine

Vestibular migraine: diagnosis challenges and need for targeted treatment

Potential solutions to several vestibular challenges facing clinicians

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