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LETTER TO THE EDITOR
Year : 2020  |  Volume : 13  |  Issue : 5  |  Page : 567  

Vestibular migraine


Department of ENT, School of Medicine, Alanya Alaaddin Keykubat University, Alanya, Antalya, Turkey

Date of Submission24-Dec-2019
Date of Decision04-Jan-2020
Date of Acceptance11-Mar-2020
Date of Web Publication7-Sep-2020

Correspondence Address:
Caner Sahin
Department of ENT, School of Medicine, Alanya Alaaddin Keykubat University, Alanya, Antalya
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_355_19

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How to cite this article:
Sahin C, Kubat GO. Vestibular migraine. Med J DY Patil Vidyapeeth 2020;13:567

How to cite this URL:
Sahin C, Kubat GO. Vestibular migraine. Med J DY Patil Vidyapeeth [serial online] 2020 [cited 2020 Sep 20];13:567. Available from: http://www.mjdrdypv.org/text.asp?2020/13/5/567/294366



Vestibular migraine (VM) is consisted of episodic vertigo in patients who describe clinical complaints such as photophobia, visual aura, phonophobia similar to migraine.[1] The disease is also named as migraine-associated vertigo, migraine-associated dizziness, migraine-related vestibulopaty, and migraineous vertigo in the literature.[2]

The general incidence of VM in the general population is reported as 1% in the literature. VM is more common in women than in men (60%–83%).[3] VM is more common in children than in adults.[4] The risk of developing migraine is observed more frequently in patients with episodic vertigo later in lifetime.[5]

Clinically, the patient should have migraine headache, episodic vestibular symptoms, and no accompanying neurological symptoms for the diagnosis of the disease. In the migraine with brainstem aura focal neurological auras are observed 5–60 min before migraine headache.[3] Meniere's disease, benign positional vertigo, vestibular proxemia, persistent postural perceptual dizziness, brainstem ischemia should be thought in the differential diagnosis of the disease.[2]

Diagnosis of the disease is made according to the International Classification of Headache Disorder: History of migraine with or without aura, at least 50% of vestibular attacks include at least one of the three migraine criteria: (1) Unilateral, pulsatile, headache aggregated by routine physical activity; (2) photophobia and phonophobia; (3) visual aura and absence of any other concomitant disease.[6] Audiometry, magnetic resonance imaging for vascular/brainstem diseases, and positional maneuvers can be done for differential diagnosis.

In the treatment of the disease, first, the disease should be suspected. The treatment VM is equivalent to the treatment of migraine. For acute treatment for attacks vestibular suppressants (benzodiazepines, promethazine, and antihistamines) can be used. In preventive treatment avoiding from triggers and migraine prophylactic medication (beta-blockers, tricyclic antidepressants, norepinephrine reuptake inhibitors, and calcium channel blockers, etc.,) can be used.[7] In a study including a follow-up of 61 patients for at least 9 years, it was found that although the frequency of the cases decreased, the attacks continued in 87% of the cases.[8]

Vestibular diseases and migraine are common diseases seen in the society separately. VM is a common disease, in which these two diseases are observed together and can be diagnosed clinically with suspicion. Ear, nose, throat, neurology, and internal medicine are multidisciplinary branches dealing with episodic vertigo and headache.



 
  References Top

1.
Lempert T, Olesen J, Furman J, Waterston J, Seemungal B, Carey J, et al. Vestibular migraine: Diagnostic criteria. J Vestib Res 2012;22:167-72.  Back to cited text no. 1
    
2.
Neuhauser HK, Radtke A, von Brevern M, Feldmann M, Lezius F, Ziese T, et al. Migrainous vertigo: Prevalence and impact on quality of life. Neurology 2006;67:1028-33.  Back to cited text no. 2
    
3.
Dieterich M, Brandt T. Episodic vertigo related to migraine (90 cases): Vestibular migraine? J Neurol 1999;246:883-92.  Back to cited text no. 3
    
4.
Furman JM, Marcus DA, Balaban CD. Migrainous vertigo: Development of a pathogenetic model and structured diagnostic interview. Curr Opin Neurol 2003;16:5-13.  Back to cited text no. 4
    
5.
Cha YH, Lee H, Santell LS, Baloh RW. Association of benign recurrent vertigo and migraine in 208 patients. Cephalalgia 2009;29:550-5.  Back to cited text no. 5
    
6.
Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018;38:1-211.  Back to cited text no. 6
    
7.
Reploeg MD, Goebel JA. Migraine-associated dizziness: Patient characteristics and management options. Otol Neurotol 2002;23:364-71.  Back to cited text no. 7
    
8.
Radtke A, von Brevern M, Neuhauser H, Hottenrott T, Lempert T. Vestibular migraine: Long-term follow-up of clinical symptoms and vestibulo-cochlear findings. Neurology 2012;79:1607-14.  Back to cited text no. 8
    




 

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