Migraine-Associated Vertigo: Diagnosis and Treatment

Seminars in Neurology 2010; 30(2): 167-174 DOI: 10.1055/s-0030-1249225 © Thieme Medical Publishers   Yoon-Hee Cha1 1 Department of Neurology, University of California Los Angeles, Los Angeles, California ABSTRACT 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.

Migraine-Associated Vertigo: Diagnosis and Treatment

Semin Neurol 2010; 30(2): 167-174
  Yoon-Hee Cha1
1 Department of Neurology, University of California Los Angeles, Los Angeles, California

ABSTRACT

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 Pathways Involvement in Children With Migraine: A Neuro-Otological Study

(Headache 2010;50:71-76)

Vincenzo Marcelli, MD, PhD; Teresa Furia, TTSA; Elio Marciano, MD
From the Audiology Unit, Department of Neuroscience And Behavioural Science, School of Medicine, "Federico II" University of Naples, Naples, Italy (V. Marcelli, T. Furia, and E. Marciano); Audiological and Vestibular Unit, ASL NA-1, DSB 50, Via del Cassano, Naples, Italy (V. Marcelli).
Correspondence to V. Marcelli, Via A. De Gasperi, 53, 84043 Agropoli, (SA) – Italy.
Conflict of Interest: None
 
ABSTRACT

Objective.—To assess, during symptom free intervals, the clinical, audiological, and vestibular findings in a cohort of child migraine sufferers, with or without vertigo or dizziness or both.

Background.—In adults and children, dizziness and vertigo are frequently associated with migraine.

Methods.—Twenty-two child migraine sufferers with vestibular symptoms, aged 7-13 years (group A), and 18 child migraine sufferers without vestibular symptoms, aged 8-13 (group B) entered our study between January 2007 and June 2007. The characteristics of auditory functions and vestibular symptoms and signs were assessed and reviewed by a blinded physician.

Results.—The whole sample was found audiologically normal. In group A, 6 subjects had normal vestibular test results, whereas vestibular testing disclosed either peripheral or central sufferance or both, in the remaining 16 patients (73%). Twelve subjects from group B had normal vestibular test results whereas positive vestibular test results were reported in the remaining 6 subjects (33%).

Conclusions.—This single-blind work outlines the brain stem abnormalities in children with migraine in the form of direct involvement of peripheral or central vestibular pathways or both. Interestingly, some children with migraine but without vestibular symptoms also had abnormal results at vestibular testing. This could demonstrate a subclinical involvement of vestibular pathways without clinical presentation. The subjects are still being followed up to evaluate the evolution of symptomatology.

Reduced head steadiness in whiplash compared with non-traumatic neck pain

Journal of Rehabilitation MedicineVol. 42/2010 > Iss. 1/January > pp. 35-41
Astrid Woodhouse, Pål Liljebäck, Ottar Vasseljen.
Original report
Abstract:
Objective: While sensorimotor alterations have been observed in patients with neck pain, it is uncertain whether such changes distinguish whiplash-associated disorders from chronic neck pain without trauma. The aim of this study was to investigate head steadiness during isometric neck flexion in subjects with chronic whiplash-associated disorders (WAD), those with chronic non-traumatic neck pain and healthy subjects. Associations with fatigue and effects of pain and dizziness were also investigated.
Methods: Head steadiness in terms of head motion velocity was compared in subjects with whiplash (n = 59), non-traumatic neck pain (n = 57) and healthy controls (n = 57) during 2 40-s isometric neck flexion tests; a high load test and a low load test. Increased velocity was expected to reflect decreased head steadiness.
Results: The whiplash group showed significantly decreased head steadiness in the low load task compared with the other 2 groups. The difference was explained largely by severe levels of neck pain and dizziness. No group differences in head steadiness were found in the high load task.

Conclusion: Reduced head steadiness during an isometric holding test was observed in a group of patients with whiplash-associated disorders. Decreased head steadiness was related to severe pain and dizziness.