Migrainous vertigo: development of a pathogenetic model and structured diagnostic interview (original) (raw)

Migraine-Associated Vertigo: A Review of the Pathophysiology and Differential Diagnosis

International Journal of Neuroscience, 2011

The clinical diagnosis of migraine-associated vertigo may be difficult because it shares features with some other clinical conditions. This communication presents a systematic review on the epidemiology and theories of pathophysiology of migraine-associated vertigo and its distinguishing features from peripheral vestibular disorders. We searched the Cochrane Library, MEDLINE, and Google scholar for all the studies on migraine-associated vertigo published in English language between 1966 and 2010. Their references were also reviewed for completion. Data from the studies were independently extracted and assessed by the three authors using standardized data forms. There was consensus between the authors on the studies in this review that met the criteria. Forty-five studies were identified and independently assessed based on the objectives of the study by the authors. All the studies discussed on the epidemiology of the migraine-associated vertigo, six discussed on the pathophysiology, while differential diagnosis were documented in thirty-two studies. In conclusion, migraine-associated vertigo is a global distinct disease entity that can be clinically distinguished from peripheral vestibular disorders. Abstinence from trigger factors remains imperative in the control, whereas some medications have been found useful in the management.

Comparison of Interictal Vestibular Function in Vestibular Migraine vs Migraine Without Vertigo

Headache: The Journal of Head and Face Pain, 2013

BackgroundPatients with vestibular migraine (VM) suffer attacks of vertigo that often occur in isolation from headache attacks. We aimed to assess and compare vestibular function interictally in patients with VM and patients with migraine without vertigo (M).MethodsThirty‐eight patients diagnosed with definite VM according to the Neuhauser criteria, and 32 patients diagnosed with M according to the International Headache Society criteria were examined between attacks using a broad battery of bedside vestibular tests, a caloric test, and videonystagmography.ResultsOverall, 70% of the VM patients and 34% of the M patients showed abnormalities on one or more of the 14 performed vestibular tests (P = .006). Abnormal findings were more frequent in VM than in M patients on Romberg's test, test for voluntary fixation suppression of the vestibular ocular reflex and test for static positional nystagmus (P = .03, .01 and .04, respectively). There were no differences in the distribution of...

Migraine, vertigo and migrainous vertigo: Links between vestibular and pain mechanisms

2011

This review develops the hypothesis that co-morbid balance disorders and migraine can be understood as additive effects of processing afferent vestibular and pain information in pre-parabrachial and pre-thalamic pathways, that have consequences on cortical mechanisms influencing perception, interoception and affect. There are remarkable parallel neurochemical phenotypes for inner ear and trigeminal ganglion cells and these afferent channels appear to converge in shared central pathways for vestibular and nociceptive information processing. These pathways share expression of receptors targeted by anti-migraine drugs. New evidence is also presented regarding the distribution of serotonin receptors in the planum semilunatum of the primate cristae ampullaris, which may indicate involvement of inner ear ionic homeostatic mechanisms in audiovestibular symptoms that can accompany migraine.

Migraine-Associated Vertigo: Diagnosis and Treatment

Seminars in Neurology, 2010

Migraine-associated vertigo has become a well-recognized disease entity diagnosed based on a clinical history of recurrent vertigo attacks unexplained by other central or peripheral otologic abnormalities, which occurs in the patient with a history of migraine headaches. There is no international agreement on what spectrum of symptoms should be covered under this diagnosis, or what terminology should be used. The headaches and vestibular symptoms of migraine-associated vertigo may not be temporally associated, which often obscures the association. Diagnostic tests usually show nonspecific abnormalities that are also seen in patients with migraine who do not experience vestibular symptoms. Management generally follows the recommended treatment of migraine headaches, and includes dietary and lifestyle modifications and medical treatment with β blockers, calcium channel blockers, and tricyclic amines. Small case series show that acetazolamide and lamotrigine appear to be more effective for the vertigo attacks than headaches. Vestibular rehabilitation has also been shown to be helpful in several studies. In this review, the epidemiologic and clinical features of the disorder, as well as the current state of knowledge on pathophysiology, diagnostic testing, and treatment are described.

Vestibular dysfunction in migraine: effects of associated vertigo and motion sickness

Journal of Neurology, 2010

The mechanisms of vestibular migraine and motion sickness remain unknown. The aims of this study were to determine interictal vestibular dysfunction in migraineurs according to associated dizziness/vertigo and motion sickness, and to find out whether impaired uvulonodular inhibition over the vestibular system underlies the vestibular symptoms and signs by measuring tilt suppression of the vestibulo-ocular reflex (VOR). One hundred and thirty-one patients with migraine [65 with vestibular migraine (MV), 41 with migrainous dizziness (MD), and 25 with migraine only (MO)] and 50 normal controls underwent evaluation of vestibular function. Motion sickness was assessed using the motion sickness susceptibility questionnaire (MSSQ) and subjective scale. Compared with normal controls and MO group, patients with MV/MD showed increased VOR time constant (TC) and greater suppression of the post-rotatory nystagmus with forward head tilt. The mean MSSQ score and subjective scale were highest in MV group, followed by MD, MO, and controls (p = 0.002, p \ 0.001). Multiple linear regression model analyses revealed that motion sickness is an independent factor of TC prolongation (p = 0.024). Twenty-eight (21.4%) patients with migraine also showed perverted head shaking nystagmus and 12 (9.2%) had positional nystagmus. In view of the increased tilt suppression of the VOR, we speculate that dysfunction of the nodulus/uvula may not account for the prolonged TCs in MD/MV. Instead, innate hypersensitivity of the vestibular system may be an underlying mechanism of motion sickness and increased TC in MD/MV. The increased tilt suppression may be an adaptive cerebellar mechanism to suppress the hyperactive vestibular system in migraineurs.

Population-based study of vestibular symptoms in migraineurs

Acta Oto-laryngologica, 2015

Conclusion: The differences between migraineurs with vertigo or motion sickness or both, and migraineurs with neither might reflect differences in migraine pathophysiology. Objective: To assess vestibular symptoms in 871 definite migraineurs. Methods: Data were gathered using a structured questionnaire. We considered responses to only 2/150 questions: (1) 'have you had vertigo with or apart from your headaches?' and (2) 'have you experienced motion sickness most of your life?'. The target groups were: (a) migraineurs with either vertigo or motion sickness, 'migraine with vestibular symptoms' (MwVS), their control group being migraineurs with neither vertigo nor motion sickness, 'migraine without vestibular symptoms' (MwoVS); (b) migraineurs who reported vertigo, 'migraine with vertigo' (MwV); their control group being migraineurs without vertigo (MwoV). Results: Among the 871 definite migraineurs, 534 had MwV, 337 had MwoV, 663 had MwVS, and 208 had MwoVS. The MwVS group had more headache, aura, nausea, vomiting, osmophobia, allergy, allodynia, headache increasing with head motion, noise as trigger for headache, days needing analgesics, and higher migraine disability scores than the MwoVS group. The pattern was the same in the MwV vertigo group as in the MwVS group, apart from migraine disability scores, which were no different.

Vestibular Migraine: from differential diagnosis and pathophysiology to treatment options

2018

Background: The occurrence of migraine and vertigo is common in the general population. Migraine vertigo is challenging and has several common symptoms with inner ear pathologies like Endolymphatic Hydropse. This paper presents a review of recent findings about symptoms, test results, pathophysiology and differential diagnosis. Methods: The present study is a review of 35 papers in the field of vestibular migraine. They were selected by searching the keywords vertigo, dizziness, migraine, treatment and rehabilitation in Pubmed, ScienceDirect, Scopus and Google Scholar search engines. Only human studies were included. Results: Recent findings have proposed several common pathophysiologies between vestibular system and migraine including spreading depression in the basilar artery, vasospasm in the internal auditory artery, involvement of the connection with locus coeruleus, dorsal raphe nucleus, disorder of multisensory integration and channelopathy. Conclusion: For the differential d...

Peripheral and central Vestibular function in patientswith migraine

Journal of Neurology and Neuroscience, 2012

This is a cross-sectional study evaluated vestibular function with migraine. Included were 58 patients [Migraine with aura (MA) = = 12; migraine without aura (MoA) = 46] (mean age = 31.60±9.17 and duration of illness = 8.33±4.47 years) and 40 healthy subjects. All underwent basic audiological evaluation, electronystagmography (ENG) and auditory-brainstem response (ABR). We reported frequent vestibular manifestations in between the headache attacks (MA>MoA) including: dizziness (44.82%), rotatory vertigo (20.69%), positional vertigo (10.34%) and sense of imbalance (13.79%). Abnormalities ≥ one ENG tests were reported in 74.14% including: post head shaking (31.03%) positioning/positional testing (20.67%), OKN (24.14%), unilateral caloric weakness (17.24%), pursuit (13.79%) and saccadic (8.62%) eye tracking, gaze nystagmus (10.34%), spontaneous nystagmus (5.17%) and directional preponderance (6.9%). Phonophobia and tinnitus were reported in 10.34% and 13.79%. None had manifest heari...

Vestibular function in patients with vestibular migraine

Auditory and Vestibular Research, 2016

Background and Aim: Vestibular migraine is a type of migraine that causes vertigo, dizziness, and imbalance in addition to typical migraine symptoms. In this study, we aimed to investigate vestibular system in these patients by videonystagmography (VNG), electrocochleography (ECochG), and vestibular evoked myogenic potential (VEMP) testing. Methods: This empirical study was conducted on 10 patients aged 18-45 years old (mean age: 29.7 years) with vestibular migraine and 10 normal subjects (mean age: 30.9 years). Immittance, audiometry, VNG, ECochG, and VEMP tests were performed in attack-free phase in both groups. Results: Mean value of spontaneous nystagmus was significantly higher in patients compared to the normal subjects (p 0.05). In positional test, pathologic nystagmus was detected in four patients with vestibular migraine, but there was not any significant difference between the two groups in this regard (p>0.05). Mean p13-n23 amplitude was significantly lower and mean p1...