The Spectrum of Vestibular Migraine: Clinical Features, Triggers, and Examination Findings.

Published on May 1, 2019in Headache4.041
· DOI :10.1111/HEAD.13484
Shin C. Beh13
Estimated H-index: 13
(UTSW: University of Texas Southwestern Medical Center),
Shamin Masrour2
Estimated H-index: 2
(UTSW: University of Texas Southwestern Medical Center)
+ 1 AuthorsDeborah I. Friedman34
Estimated H-index: 34
(UTSW: University of Texas Southwestern Medical Center)
OBJECTIVE: To assess the ictal symptoms, interictal symptoms, psychiatric comorbidities, and interictal neuro-otologic examination findings in vestibular migraine (VM). METHODS: Retrospective chart review of 491 patients seen from August 2014 until March 2018 at a tertiary neurology referral center for vestibular disorders to identify patients fulfilling the 2012 VM criteria. RESULTS: One hundred and thirty-one patients (105 women) were identified. Mean age of VM onset was 44.3 (±13.7) years. Preceding the onset of vestibular symptoms, most had migraine (57.3%) and motion sickness (61.1%). It was common to have a family history of migraine (50.8%) and episodic vestibular symptoms (28.1%). Common ictal symptoms were triggered (visually induced and head-motion) and spontaneous vertigo, accompanied by photophobia and phonophobia (118/131 [90.1%] patients), nausea (105/131 [80.2%] patients), aural symptoms (79/131 [60.3%] patients), and headache (65/131 [49.6%] patients). Interictally, many experienced visually induced (116/131 [88.6%] patients), head-motion (86/131 [65.6%] patients), and persistent (67/131 [51.1%] patients) dizziness. Psychiatric comorbidities include anxiety (92/131 [70.2%] patients), depression (53/131 [40.5%] patients), insomnia (38/131 [29.0%] patients), phobic disorders (15/131 [11.5%] patients), and psychogenic disorders (11/131 [8.4%] patients). Common triggers were stress (52/131 [39.7%] patients), bright lights (35/131 [26.7%] patients), weather changes (34/131 [26.0%] patients), and sleep deprivation (34/131 [26.0%] patients). Interictal neuro-otologic examination was abnormal in 56/131 (42.7%), usually hyperventilation-induced, head-shaking-induced, vibration-induced, and positional nystagmus. The most common balance-test finding was impaired sharpened Romberg's test (22/130 [16.9%] patients). CONCLUSIONS: In this single center study, we found that VM typically affects women in their 40s, with a personal and family history of migraine. Typical ictal symptoms were triggered and spontaneous vertigo, associated with photophobia and phonophobia, nausea, aural symptoms, and headache. Interictal vestibular symptoms, comorbid psychiatric disorders, and non-specific interictal neuro-otologic findings were common.
📖 Papers frequently viewed together
2 Citations
482 Citations
28 Citations
#1Shin C. BehH-Index: 13
#2Shamin MasrourH-Index: 2
Last. Deborah I. FriedmanH-Index: 34
view all 4 authors...
Background Alice in Wonderland syndrome (AIWS) is a rare sensory perception disorder, most often caused by migraine in adults. We aimed to characterize the clinical characteristics of AIWS in a cohort of vestibular migraine (VM) patients. Methods Retrospective chart review of patients diagnosed with VM seen between August 2014 and January 2018. Results Seventeen patients were identified (10 women) with a median age at onset of 45 years (range 15–61 years), and median age at presentation of 49 ye...
10 CitationsSource
#1Eric J. Formeister (UCSF: University of California, San Francisco)H-Index: 10
#2Habib G. Rizk (MUSC: Medical University of South Carolina)H-Index: 12
Last. Jeffrey D. Sharon (UCSF: University of California, San Francisco)H-Index: 13
view all 4 authors...
Objectives:1. Describe the epidemiology of vestibular migraine (VM) in the United States, using data from the 2008 National Health Interview Survey (NHIS). 2. Characterize the sociodemographic and clinical attributes of people with VM.Study Design:Population-based nationwide survey study of US adult
43 CitationsSource
#1Roberto TeggiH-Index: 19
#2Bruno ColomboH-Index: 23
Last. Mario BussiH-Index: 23
view all 23 authors...
OBJECTIVE: The aim of this work was to assess through a questionnaire the features of vertiginous episodes, accompanying symptoms, familial history, and migraine precursors in a sample of 252 subjects with a diagnosis of definite vestibular migraine. BACKGROUND: Migraine is a common neurological disorder characterized by episodic headaches with specific features. About two-thirds of cases run in families, and patients may refer symptoms occurring in infancy and childhood, defined as episodic syn...
28 CitationsSource
#1Michael Strupp (LMU: Ludwig Maximilian University of Munich)H-Index: 76
#2Thomas Brandt (LMU: Ludwig Maximilian University of Munich)H-Index: 93
Last. Eva Grill (LMU: Ludwig Maximilian University of Munich)H-Index: 36
view all 4 authors...
8 CitationsSource
#1Jeffrey P. Staab (Mayo Clinic)H-Index: 32
Last. Adolfo M. Bronstein (Imperial College London)H-Index: 73
view all 7 authors...
This paper presents diagnostic criteria for persistent postural-perceptual dizziness (PPPD) to be included in the International Classification of Vestibular Disorders (ICVD). The term PPPD is new, but the disorder is not. Its diagnostic criteria were derived by expert consensus from an exhaustive review of 30 years of research on phobic postural vertigo, space-motion discomfort, visual vertigo, and chronic subjective dizziness. PPPD manifests with one or more symptoms of dizziness, unsteadiness,...
198 CitationsSource
#1Marianne Dieterich (LMU: Ludwig Maximilian University of Munich)H-Index: 87
#2Mark Obermann (University of Duisburg-Essen)H-Index: 38
Last. Neşe Çelebisoy (Ege University)H-Index: 17
view all 3 authors...
Vestibular migraine (VM) is the most common cause of episodic vertigo in adults as well as in children. The diagnostic criteria of the consensus document of the International Barany Society for Neuro-Otology and the International Headache Society (2012) combine the typical signs and symptoms of migraine with the vestibular symptoms lasting 5 min to 72 h and exclusion criteria. Although VM accounts for 7 % of patients seen in dizziness clinics and 9 % of patients seen in headache clinics it is st...
85 CitationsSource
#1Soo-Jin Cho (Sacred Heart Hospital)H-Index: 19
#2Byung Kun Kim (Eulji University)H-Index: 10
Last. Jong Hee Sohn (Hallym University)H-Index: 8
view all 10 authors...
BackgroundVestibular migraine (VM), the common term for recurrent vestibular symptoms with migraine features, has been recognized in the appendix criteria of the third beta edition of the International Classification of Headache Disorders (ICHD-3β). We applied the criteria for VM in a prospective, multicenter headache registry study.MethodsNine neurologists enrolled consecutive patients visiting outpatient clinics for headache. The presenting headache disorder and additional VM diagnoses were cl...
34 CitationsSource
#1Louisa Murdin (UCLH: University College London Hospitals NHS Foundation Trust)H-Index: 10
#2Florence Chamberlain (Imperial College London)H-Index: 1
Last. Adolfo M. Bronstein (Imperial College London)H-Index: 73
view all 7 authors...
Motion sickness is a syndrome provoked by sensory conflict that involves the vestibular system with symptoms resembling those of common neuro-otological disorders including vestibular neuritis (VN) and vestibular migraine (VM). By contrast, it is generally believed that bilateral vestibular failure (BVF) causes reduced motion sickness susceptibility. We investigate differences between these conditions with a single protocol using validated objective experimental (off-vertical axis rotation, OVAR...
43 CitationsSource
#1Raquel Gil-Gouveia (University of Lisbon)H-Index: 12
#2Antonio Gouveia Oliveira (UFRN: Federal University of Rio Grande do Norte)H-Index: 30
Last. Isabel Pavão Martins (University of Lisbon)H-Index: 26
view all 3 authors...
Patients consistently report cognitive impairment during migraine attacks, yet the documentation of such dysfunction by neuropsychological evaluation has lacked similar consistency. This incongruence may be due to discrepant study designs, assessment tools and small samples sizes. To search for evidence of decline in cognitive functions during a migraine attack, compared to headache-free performance. The secondary objective was to determine if the eventual decline had a consistent neuropsycholog...
31 CitationsSource
#1Claas Lahmann (LMU: Ludwig Maximilian University of Munich)H-Index: 27
#2Peter Henningsen (LMU: Ludwig Maximilian University of Munich)H-Index: 42
Last. Gabriele Schmid (LMU: Ludwig Maximilian University of Munich)H-Index: 11
view all 10 authors...
Background Vertigo and dizziness are often not fully explained by an organic illness, but instead are related to psychiatric disorders. This study aimed to evaluate psychiatric comorbidity and assess psychosocial impairment in a large sample of patients with a wide range of unselected organic and non-organic (ie, medically unexplained) vertigo/dizziness syndromes. Methods This cross-sectional study involved a sample of 547 patients recruited from a specialised interdisciplinary treatment centre ...
107 CitationsSource
Cited By25
#2Frank E. DiLiberto (RFUMS: Rosalind Franklin University of Medicine and Science)H-Index: 5
#4Sunit Das (U of T: University of Toronto)H-Index: 23
The idea of cervicogenic vertigo (CV) was proposed nearly a century ago, yet despite considerable scrutiny and research, little progress has been made in clarifying the underlying mechanism of the disease, developing a confirmatory diagnostic test, or devising an appropriately targeted treatment. Given the history of this idea, we offer a review geared towards understanding why so many attempts at clarifying it have failed, with specific comments regarding how CV fits into the broader landscape ...
Vestibular migraine (VM) is one of the most common neurologic causes of vertigo. Symptoms and International Classification of Headache Disorders criteria are used to diagnose VM because no objective tests, imaging or audiologic, have been shown to reliably diagnose this condition. Central auditory, peripheral, and central vestibular pathway involvement has been associated with VM. Although the interaction between migraine and other vestibular disorders can be a challenging scenario for diagnosis...
#1Habib G. Rizk (MUSC: Medical University of South Carolina)H-Index: 12
#2Yuan F. Liu (LLU: Loma Linda University)
When interviewing a patient presenting with dizziness, it is imperative to both diagnosis and treatment for the clinician to identify the impact dizziness has on the patient's productivity, general function level and cognition. and cognition. Psychiatric comorbidities and concurrent sleep disturbances are common in this patient population and identification of these additional factors is important in implementing a holistic, multidisciplinary treatment plan and ultimately improves the patient's ...
#1Shin C. Beh (UTSW: University of Texas Southwestern Medical Center)H-Index: 13
There is a reciprocal relationship between vestibular and neuropsychological disorders. People with vertigo and dizziness are at higher risk of various psychiatric disorders, particularly anxiety, depression, and panic disorder. On the other hand, people with mood disorders are at higher risk of experiencing vertigo and dizziness. Vestibular information plays a crucial role in cognitive processes, especially visuo-spatial abilities. Consequently, vestibular disorders (both peripheral and central...
#1Shin C. Beh (UTSW: University of Texas Southwestern Medical Center)H-Index: 13
#2Hsueh Sheng Chiang (UTSW: University of Texas Southwestern Medical Center)H-Index: 1
Last. Collin Sanderson (UTSW: University of Texas Southwestern Medical Center)H-Index: 1
view all 3 authors...
OBJECTIVES/HYPOTHESIS Mal de debarquement syndrome (MDDS) is characterized by a persistent rocking sensation, as though on a boat. It may occur following exposure to passive motion (motion-triggered MDDS [MT-MDDS]), or spontaneously (spontaneous-onset MDDS [SO-MDDS]). This study investigated the characteristics of MDDS patients with vestibular migraine (MDDS-VM) to those without (MDDS-O). STUDY DESIGN Retrospective review. METHODS Retrospective, single-center study of 62 patients with MDDS. Clin...
4 CitationsSource
view all 5 authors...
2 CitationsSource
#1Minping Li (SYSU: Sun Yat-sen University)
#2Xue Xu (SYSU: Sun Yat-sen University)H-Index: 2
Last. Haiwei Huang (SYSU: Sun Yat-sen University)H-Index: 5
view all 6 authors...
Vestibular migraine (VM) has been recently receiving increasing attention as an independent disease concept. It is a common cause of dizziness or headache; however, it was not clearly defined until 2018. Its diagnosis mainly relies on clinical history, including vertigo and migraine, as indicated by the appendix of the 3rd edition of the International Classification Diagnostic Criteria for Headache Diseases. There is often an overlap of vertigo and migraine across vestibular diseases; therefore,...
1 CitationsSource
#1Allison Nogi (JHUSOM: Johns Hopkins University School of Medicine)
#2Michael C. Schubert (Johns Hopkins University)H-Index: 33
Abstract A 73-year-old female presented to the emergency department with chief complaint of dizziness after sustaining a fall one month prior to dizziness onset. Although careful examination of eye movement patterns during positional testing was attempted at varying stages of her inpatient admission, her complex nystagmus patterns as a result of traumatic benign paroxysmal vertigo were difficult to manage. In particular, the nystagmus pattern from this case suggests the BPPV was variable and aff...
#1Wei Liu (Nanjing University of Chinese Medicine)
#2Hongli Dong (Nanjing University of Chinese Medicine)
Last. Yi Yang (Soochow University (Suzhou))H-Index: 2
view all 6 authors...
Objective: As a recently defined disease entity, vestibular migraine (VM) is a variant of migraine with broad spectrum of manifestations. We evaluated a prospective cohort of patients with VM in two centers to assess severity of VM attacks and investigate its contributing factors in patients with VM. Methods: Adult participants with the diagnosis of VM or probable VM were enrolled according to the 2012 International Headache Society-Barany Society Criteria. Every outpatient was followed up for 6...