DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20171184

Vestibular migraine- a dilemma no more

Renu Rajguru, Inderdeep Singh, Abhishek Gupta

Abstract


Background: Vestibular migraine (VM) is an increasingly recognized cause of episodic vertigo. However, the pathophysiology of VM is still a matter of speculation and it is not known to what extent the dysfunction is located in the central or peripheral vestibular system. Though in its earlier version International Headache Society recognized only adult onset VM in the setting of basilar migraine, but in its latest 3rd edition beta version in consensus with Barany Society (2013), VM is included in the International Headache Society classification of migraine in appendix 1. It does not figure in the main list because it is yet to be validated by scientific research.

Methods: The purpose of this study is to record and describe the spectrum of clinical findings of VM patients, to study the vestibular system and find out the site of vestibular dysfunction. In this study we studied 20 patients with acute VM in the symptomatic and asymptomatic phase.  

Results: Abnormal findings in the vestibular work up were present in all 20 VM patients (100%). Central pathology in the vestibular system was seen in 10 patients (50%), 6 patients had peripheral vestibular pathology (30%), and in 4 patients (20%) the site of vestibular dysfunction was indeterminate as they had features of both central and peripheral dysfunction and the exact site of dysfunction could not be determined with certainty.

Conclusions: Acute VM should be considered in the differential diagnosis of vertigo. It can present both as a central and a peripheral vestibular disorder. However there are no definitive signs to pin-point the diagnosis. A careful clinical history combined with clinical findings and exclusion of other causes of vertigo, is fundamental for assessing the profile of patients with vestibular migraine.


Keywords


Vestibular migraine, Migraine, Clinical findings, Diagnosis

Full Text:

PDF

References


Neuhauser HK. Epidemiology of vertigo. Curr Opin Neurol. 2007;20(1):40-6.

Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd edition. Cephalalgia. 2004;24(1):9-160.

Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629–808.

Büttner U, Helmchen C, Brandt T. Diagnostic criteria for central versus peripheral positioning nystagmus and vertigo: a review. Acta Otolaryngol. 1999;119: 1-5.

Dieterich M, Brandt T. Episodic vertigo related to migraine (90 cases): vestibular migraine? J Neurol. 1999;246:883-92.

Kayan A, Hood JD. Neuro-otological manifestations of migraine. Brain. 1984;107:1123-42.

Neuhauser H, Leopold M, von Brevern M, Lempert T. The interrelations of migraine, vertigo and Vestibular migraine. Neurology. 2001;56:684-6.

Cutrer F, Baloh RW. Migraine-associated dizziness. Headache. 1992;32:300-4.

Neuhauser H, Lempert T. Vertigo and dizziness related to migraine: a diagnostic challenge. Cephalalgia. 2004;24:83-91.

Espinosa-Sanchez JM, Lopez-Escamez JA. New Insights into Pathophysiology of Vestibular Migraine. Front Neurol. 2015;6:12.

Bikhazi P, Jackson C, Ruckenstein MJ. Efficacy of antimigrainous therapy in the treatment of migraine-associated dizziness. Am J Otol. 1997;18:350-4.

Bisdorff AR. Treatment of migraine-related vertigo with lamotrigine: an observational study. Bull Soc Sci Med Grand Duche Luxemb. 2004;2:103-8

Carmona S, Settecase S. Use of topiramate (Topamax) in a subgroup of mirgraine-vertigo patients with auditory symptoms.Ann NY Acad Sci. 2005;1039:517–20.

Johnson GD (1998) Medical management of migraine-related dizziness and vertigo. Laryngoscope. 1998;108:1–28.

Maione A. Migraine-related vertigo: diagnostic criteria and prophylactic treatment. Laryngoscope. 2006; 116(10):1782-86.

Neuhauser H, Radtke A, Von Brevern M, Lempert T. Zolmitriptan for treatment of migrainous vertigo: a pilot randomized placebo-controlled trial. Neurology. 2003;60:882-3.