Vestibular Migraine I: Mechanisms, Diagnosis, and Clinical Features

Abstract

Vestibular migraine (VM), also known as migrainous vertigo or migraine-associated vertigo, is characterized by recurrent vestibular attacks often accompanied by migraine headaches and other migraine symptoms. It is one of the most common presenting complaints to physicians in primary care, otolaryngology, and neurology. Epidemiologic data suggest that VM may affect 1 to 3% of the general population and 10 to 30% of patients seeking treatment for dizziness. Attacks typically last minutes to hours and range from spontaneous and positional vertigo to extreme sensitivity to self and surround motion. As with headaches, nausea, and vomiting, phonophobia and photophobia are common accompanying symptoms. The clinical spectrum of VM and its underlying pathophysiological mechanisms are just being identified, with much debate about the causal relationship of vestibular symptoms and headache, no evidence-based guidelines for clinical management, limited characterization of its disease burden, and little information about its negative impact on health-related quality of life.

Vestibular migraine — an underdiagnosed cause of vertigo. Diagnosis and treatment

“…Interestingly, the time gap between migraine and vestibular symptoms onset may be long, as patients can be headache-free for years before the vestibular symptoms starts [21]. The mean delay between the onset of headache and vertigo is 8-14 years [21,22]. The majority of VM patients suffer from episodic migraine, and one in four of them have chronic migraine with medication overuse headache [15].…”

“…If a patient complains of nausea and vomiting during their typical migraine headaches, they tend to experience similar symptoms during VM attacks more frequently [8]. The higher prevalence of migraine with aura (MA) seen in VM patients may reflect an association of MA with vascular disease and posterior circulation [22]. We would like to underline that patients with vertigo should be directly asked about migraine symptoms during their episodes, as they often do not volunteer them [5].…”

Patients With Vestibular Migraine are More Likely to Have Occipital Headaches than those With Migraine Without Vestibular Symptoms

“…Vestibular migraine (VM) is a significantly under‐recognized disorder and needs better characterization to improve its diagnosis 1‐10 . VM is considered a type of migraine where patients suffer from headaches and vestibular symptoms such as vertigo or head motion‐induced dizziness 11,12 . VM diagnostic criteria were first established 2001 9 and it is currently diagnosed using the criteria of the International Classifications of Headache Disorders (ICHD‐3) 13 .…”

“…VM diagnostic criteria were first established 2001 9 and it is currently diagnosed using the criteria of the International Classifications of Headache Disorders (ICHD‐3) 13 . The reported incidence of VM in the United States is 1%‐3% of the adult population 9,14 and 10%‐30% of patients seen in headache and dizziness clinics 11,15 . Although it is one of the most common presenting conditions to primary care, otology, and neurology, 11 it remains significantly underdiagnosed, with VM ultimately diagnosed in 20.2% of the population studied based on specialist evaluations, although it was only suspected in 1.8% 5 .…”

“…The reported incidence of VM in the United States is 1%‐3% of the adult population 9,14 and 10%‐30% of patients seen in headache and dizziness clinics 11,15 . Although it is one of the most common presenting conditions to primary care, otology, and neurology, 11 it remains significantly underdiagnosed, with VM ultimately diagnosed in 20.2% of the population studied based on specialist evaluations, although it was only suspected in 1.8% 5 . It is estimated that 80% of VM patients do not carry the correct diagnosis 9 .…”