Presentation
Case presentation History: A 31-year-old woman presented with complaints of persistent postural imbalance for two weeks. [irispublishers.com]
Objective: The aim of this study is to characterize eye movements of patients presenting with nystagmus during attacks of migrainous vertigo. [karger.com]
With Hallpike-Dix positional testing (unless true BPPV presents), no rotational component nystagmus is usually evident. However in acute migraine event, bilateral torsional nystagmus may present with positional testing and gaze added. [vestibular.org]
For example, babies may present with migraine in the form of “cyclical vomiting”. [menieres.org.uk]
Patients with VM also have high rates of chronic subjective dizziness, which may be associated with anxious, introverted temperaments that can affect clinical presentation and treatment response. [mayoclinic.pure.elsevier.com]
Entire Body System
- Disability
The severity, frequency, and number of attacks and disability scores were reduced, and the quality of life was improved in patients with vestibular migraine with propranolol treatment. [advancedotology.org]
Please enable JS and disable any ad blocker [neurologytimes.com]
The association of vestibular aura/dysfunction with migraine is often under-recognised leading to delayed treatment, adding further to the burden of disability migraineurs suffer. [acnr.co.uk]
If you have frequent or disabling vestibular migraines, your doctor may try drugs similar to traditional migraine meds. [webmd.com]
I am often too preoccupied with my own disability to write reviews, but this book is so important to me. I have lived with vestibular migraines for 7 years. [amazon.com]
- Unconsciousness
Some patients become dysarthric during attacks, slur their speech, and even become unconscious. This is extremely impairing. Patients usually respond to the usual migraine prophylactic drugs. [dizziness-and-balance.com]
Ears
- Hearing Problem
Basic audiological examination ( table 2 ) revealed that few patients had evidence suggesting conduction hearing problems. Normal middle ear status was confirmed by otoscopy and standard aural immittance procedures. [jneuro.com]
Neurologic
- Vertigo
Overview Vestibular migraine presents with attacks of spontaneous or positional vertigo, head motion–induced vertigo, and visual vertigo lasting 5 minutes to 3 days. [medlink.com]
[…] description of vertigo. [reliasmedia.com]
The interrelations of migraine, vertigo, and migrainous vertigo. Neurology 2001;56:436-441. Murdin L, Davies RA, Bronstein AM. Vertigo as a migraine trigger. Neurology 2009;73:638-642. Baloh RW. Neurotology of migraine. Headache 1997;37:615-621. [acnr.co.uk]
[…] or Migrainous Vertigo. [irispublishers.com]
The mean vertigo intensity before nVNS was 5.2 (±1.6; median 6), and 3.1 (±2.2; median 3) following stimulation; mean reduction in vertigo intensity was 46.9% (±31.5; median 45%). [n.neurology.org]
- Nystagmus
Spontaneous nystagmus was seen in 19% of patients and nystagmus provoked by horizontal headshaking was seen in 35%. Nystagmus could be provoked with positional testing in 100% of symptomatic patients with fixation blocked. [karger.com]
For ENG test, we analyzed various nystagmus types as spontaneous nystagmus, gaze nystagmus, positional and positioning nystagmus with headshaking and head-thrust (Halmagyi) tests, optokinetic, and postcaloric (in Bruning’s proof, using Jongkees’ formula [jneuro.com]
Abnormal neuro-otologic examinations impacted 56 (42.7%) patients, including vibration-induced nystagmus, head-shaking induced nystagmus, hyperventilation-induced nystagmus, and positional nystagmus. [clinicalpainadvisor.com]
A low amplitude up-beating nystagmus on removal of fixation. 3. A left beating horizontal nystagmus on gaze testing without fixation (Figure 1). [irispublishers.com]
If one has the opportunity to observe a vertigo patient during an event, migraineurs seldom have spontaneous nystagmus or may have very little nystagmus. [tampabayhearing.com]
- Dysarthria
[…] controls). [4] Benign paroxysmal vertigo of childhood is an example of migraine-associated vertigo in which headache does not often occur. [5] Basilar artery migraine (BAM) consists of two or more symptoms (vertigo, tinnitus, decreased hearing, ataxia, dysarthria [en.wikipedia.org]
Symptoms Symptoms of migraine with brainstem aura include: significant speech disturbance (dysarthria) – this can mimic a stroke and should be investigated at the emergency department to be on the safe side vertigo (spinning sensation) ringing in the [balanceanddizziness.org]
Less than 10% of patients with VM simultaneously meet the diagnostic criteria for basilar-type migraine. 12,13 Diagnostic criteria for migraine with brainstem aura require at least two brainstem aura symptoms including dysarthria, vertigo, tinnitus, hypacusis [touchneurology.com]
However, a large portion of people with migraine often have no accompanying pain, their predominant symptom instead being vertigo (a spinning sensation) or dizziness/ disequilibrium (balance loss), mental confusion, disorientation, dysarthria, visual [vestibular.org]
Furthermore, in the case of migraine with brainstem aura, previously called basilar-type, there are other brainstem symptoms such dysarthria, tinnitus, hypacusis, diplopia, ataxia, or decreased level of consciousness. [frontiersin.org]
Treatment
“If these results can be confirmed with larger studies, not only could there finally be a treatment for vestibular migraine, such a treatment would also be easy to use,” said Beh. Reference Beh SC, Friedman DI. [ajmc.com]
“If these results can be confirmed with larger studies, not only could there finally be a treatment for vestibular migraine, such a treatment would also be easy to use.” [mdedge.com]
The questionnaires and scales that were applied to the patients before and after treatment were evaluated. [advancedotology.org]
Consequently, the treatment recommendations for the prophylactic treatment of vestibular migraine are mainly based on expert opinion and the treatments guidelines for migraine with and without aura. [touchneurology.com]
Prognosis
Prevalence, aetiologies and prognosis of the symptom dizziness in primary care – a systematic review. BMC Fam Pract 2018 ; 19: 33. DOI: 10.1186/s12875-017-0695-0. Google Scholar | Crossref | Medline 3. [journals.sagepub.com]
Etiology
Episodic Vertigo – Differentiating the Possible Etiologies There are significant challenges in diagnosing vestibular migraine. [canadianaudiologist.ca]
Both have in common a multiplicity of etiologic causes as well as the need for an adequate symptomatic examination in order to make the correct diagnosis. [mathewsopenaccess.com]
"Our study highlights the close pathophysiologic relationship between migraine headache and vestibular migraine and supports the migrainous etiology of vestibular symptoms in this disorder," Beh continued. [medpagetoday.com]
Beh et al noted that the varied and somewhat bizarre nature of the complaint in patients with VM may seem to point to a purely psychiatric etiology and that, “It is therefore vital for neurologists to recognize the clues that can help them correctly diagnose [reliasmedia.com]
[…] trial., Neuhauser H,Radtke A,von Brevern M,Lempert T,, Neurology, 2003 Mar 11 [PubMed PMID: 12629256] [26] Evaluation of the efficacy of caffeine cessation, nortriptyline, and topiramate therapy in vestibular migraine and complex dizziness of unknown etiology [statpearls.com]
Epidemiology
A growing body of clinical and epidemiological evidence supports a specific relationship between vestibular symptoms and migraine. [mayoclinic.pure.elsevier.com]
Epidemiology and comorbidity of headache. Lancet Neurol. 2008;7:354-61. [ Links ] 17. International Association for the Study of Pain 2011 Annual Report. Migraine and hormonal changes. [scielo.br]
Contributions of Epidemiology to Our Understanding of Migraine. Headache. 2013; 53 (2): 230-246. https://doi.org/10.1111/head.12038. 4. Neuhauser H. K. Epidemiology of vertigo. Curr. Opin. [epilepsia.su]
"Epidemiology of vertigo, migraine and vestibular migraine". J. Neurol. 256 (3): 333–8. doi : 10.1007/s00415-009-0149-2. PMID 19225823. ^ Cal R, Bahmad Jr F (2008). "Migraine associated with auditory-vestibular dysfunction" (PDF). [en.wikipedia.org]
Meniere's disease: a 30-year epidemiologic and clinical study in Rochester, MN, 1951-1980. [dizziness-and-balance.com]
Pathophysiology
Without a biomarker or complete understanding of pathophysiology, diagnosis of vestibular migraine (VM) currently depends upon symptoms in two dimensions: episodic vestibular symptoms temporally related to migraine symptoms. [mayoclinic.pure.elsevier.com]
Firstly, we will describe the mechanisms of migraine itself, since current hypotheses are mostly based on its pathophysiology. Pathophysiology of Migraine Migraine is a complex disorder with a controversial pathophysiology. [frontiersin.org]
Common vestibular disorders in migraine Recurrent vertigo is most common in migraineurs and although this is frequently migrainous in origin, the high prevalence of vestibular disorders raises the question of overlapping pathophysiology. [acnr.co.uk]
Self-motion perception is sensitized in vestibular migraine: pathophysiologic and clinical implications. Sci Rep. 2019;9(1):14323. [neurologyadvisor.com]
The pathophysiology of vestibular migraine is unknown, but several mechanisms link the trigeminal system, which is activated during migraine attacks, and the vestibular system. [medlink.com]
Prevention
Objectives: To assess the effects of pharmacological agents for the prevention of vestibular migraine. [cochrane.org]
Preventative medications may be prescribed and these need to be taken every day whether or not you feel unwell. Migraine episode treatments may also be prescribed, including pain relief medication and anti-nausea medication. [eyeandear.org.au]
Vestibular migraine treatment and prevention. [reliasmedia.com]
How to prevent Vestibular Migraine? In many VM patients, the attacks are severe, long and frequent enough to warrant a preventative migraine treatment. [migrainepal.com]
If you have frequent or disabling vestibular migraines, your doctor may try drugs similar to traditional migraine prevention meds. You take these regularly to reduce the severity or frequency of the headaches. [webmd.com]