Vestibular Migraine
Vestibular migraine presents with attacks of spontaneous or positional vertigo, head motion-induced vertigo, and visual vertigo lasting 5 minutes to 3 days. The recent classification of vestibular migraine, jointly proposed by the Bárány Society and the International Headache Society, allows identification of vestibular migraine and probable vestibular migraine based on explicit criteria. The diagnosis is based on symptom type, severity and duration, a history of migraine, temporal association of migraine symptoms with vertigo attacks, and exclusion of other causes. Because headache is often absent during acute attacks, other migraine features such as photophobia or auras have to be specifically inquired about. During acute attacks, one may find central spontaneous or positional nystagmus, and less commonly, unilateral vestibular hypofunction. In the symptom-free interval, vestibular testing adds little to the diagnosis as findings are mostly minor and nonspecific. The pathophysiology of vestibular migraine is unknown, but several mechanisms link the trigeminal system, which is activated during migraine attacks, and the vestibular system. Treatment includes antiemetics for severe acute attacks, pharmacological migraine prophylaxis, and lifestyle changes.
When a new disorder enters the medical world, it is usually invented by the pharmaceutical industry trying to expand their markets. The field of neuro-otology may be an exception to this rule, as the last three decades have seen the emergence of new vestibular syndromes on the basis of clinical, epidemiological, and pathophysiological findings, including various subtypes of benign paroxysmal positional vertigo, superior canal dehiscence and—of particular interest here—vestibular migraine.
That migraine may present with attacks of vertigo has been repeatedly documented from the early days of neurology. Starting with Kayan and Hood's classical article, the clinical features of vestibular migraine have been well elucidated in several large case series. Various terms have been used to designate vertigo caused by a migraine mechanism including migraine-associated vertigo, migraine-associated dizziness, migraine-related vestibulopathy, migrainous vertigo, benign recurrent vertigo, and basilar migraine. The term vestibular migraine has been convincingly advocated as a condition that stresses the particular vestibular manifestation of migraine and thus best avoids confounding with nonvestibular dizziness associated with migraine. Therefore, the Bárány Society and the International Headache Society (IHS) have opted for vestibular migraine in their recent joint article on the classification of the disorder. The term basilar-type migraine should be restricted to patients who fulfill the respective diagnostic criteria of the International Classification of Headache Disorders (ICHD).
Abstract and Introduction
Abstract
Vestibular migraine presents with attacks of spontaneous or positional vertigo, head motion-induced vertigo, and visual vertigo lasting 5 minutes to 3 days. The recent classification of vestibular migraine, jointly proposed by the Bárány Society and the International Headache Society, allows identification of vestibular migraine and probable vestibular migraine based on explicit criteria. The diagnosis is based on symptom type, severity and duration, a history of migraine, temporal association of migraine symptoms with vertigo attacks, and exclusion of other causes. Because headache is often absent during acute attacks, other migraine features such as photophobia or auras have to be specifically inquired about. During acute attacks, one may find central spontaneous or positional nystagmus, and less commonly, unilateral vestibular hypofunction. In the symptom-free interval, vestibular testing adds little to the diagnosis as findings are mostly minor and nonspecific. The pathophysiology of vestibular migraine is unknown, but several mechanisms link the trigeminal system, which is activated during migraine attacks, and the vestibular system. Treatment includes antiemetics for severe acute attacks, pharmacological migraine prophylaxis, and lifestyle changes.
Introduction
When a new disorder enters the medical world, it is usually invented by the pharmaceutical industry trying to expand their markets. The field of neuro-otology may be an exception to this rule, as the last three decades have seen the emergence of new vestibular syndromes on the basis of clinical, epidemiological, and pathophysiological findings, including various subtypes of benign paroxysmal positional vertigo, superior canal dehiscence and—of particular interest here—vestibular migraine.
That migraine may present with attacks of vertigo has been repeatedly documented from the early days of neurology. Starting with Kayan and Hood's classical article, the clinical features of vestibular migraine have been well elucidated in several large case series. Various terms have been used to designate vertigo caused by a migraine mechanism including migraine-associated vertigo, migraine-associated dizziness, migraine-related vestibulopathy, migrainous vertigo, benign recurrent vertigo, and basilar migraine. The term vestibular migraine has been convincingly advocated as a condition that stresses the particular vestibular manifestation of migraine and thus best avoids confounding with nonvestibular dizziness associated with migraine. Therefore, the Bárány Society and the International Headache Society (IHS) have opted for vestibular migraine in their recent joint article on the classification of the disorder. The term basilar-type migraine should be restricted to patients who fulfill the respective diagnostic criteria of the International Classification of Headache Disorders (ICHD).
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