Vertigo and Dizziness Related to Migraine: A Diagnostic Challenge

Abstract

Vertigo and dizziness can be related to migraine in various ways: causally, statistically or, quite frequently, just by chance. Migrainous vertigo (MV) is a vestibular syndrome caused by migraine and presents with attacks of spontaneous or positional vertigo lasting seconds to days and migrainous symptoms during the attack. MV is the most common cause of spontaneous recurrent vertigo and is presently not included in the International Headache Society classification of migraine. Benign paroxysmal positional vertigo (BPPV) and Ménière's disease (MD) are statistically related to migraine, but the possible pathogenetic links have not been established. Moreover, migraineurs suffer from motion sickness more often than controls. Persistent cerebellar symptoms may develop in the course of familial hemiplegic migraine. Dizziness may also be due to orthostatic hypotension, anxiety disorders or major depression which all have an increased prevalence in patients with migraine.

Vestibular migraine: diagnosis challenges and need for targeted treatment

“…Hsu and colleagues reported a year prevalence of vestibular migraine in women aged 40-54 years of 5% 14 . Forty percent of patients with vestibular migraine reported missing work because of their symptoms, showing the impact of the disease on daily life 12 . Vestibular migraine can occur at any age, but the average age of onset of dizziness in migraine is about 40, and a first attack late age in 72 years has been reported.…”

“…Vestibular migraine can occur at any age, but the average age of onset of dizziness in migraine is about 40, and a first attack late age in 72 years has been reported. It has a female predominance, the female and male ratio of 5: 1 2,12,15 . In older patients, particularly post-menopausal women, typical migraine attacks are sometimes replaced by isolated episodes of vertigo, dizziness or transient feeling of imbalance 16 .…”

“…In another study in Germany, with 33 patients, two-thirds of patients diagnosed with VM had consulted a doctor because of vertigo, but only 20% were diagnosed with VM. The remaining patients were diagnosed with other diseases such as anemia, diabetes, hypovolemia 12 . Vestibular migraine has a year prevalence of 0.89% and represents about 10% of patients treated for either migraine and dizziness 13 .…”

Review: Current treatment of vestibular, ocular motor disorders and nystagmus

“…Characteristic features include recurrent attacks of various combinations of vertigo, ataxia of stance and gait, visual disorders, and other brainstem symptoms accompanied or followed by occipitally located head pressure, pain, nausea or vomiting [Neuhauser and Lempert, 2004;Furman et al 2003;Brandt and Dieterich, 1994]. There is, however, an ongoing debate as to whether it is a clinical entity.…”

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].…”