Enxaqueca associada a disfunção auditivo-vestibular

Abstract

The association between hearing and balance disorders with migraine is known since the times of the ancient Greeks, when Aretaeus from Cappadocia in 131 B.C, made an accurate and detailed description of this occurrence during a migraine episode. We present a broad review of migraine neurotological manifestations, using the most recent publications associated with epidemiology, clinical presentation, pathophysiology, diagnostic methods and treatment for this syndrome. Aim: to describe the clinical entity: "Migraine associated with auditoryvestibular dysfunction" in order to help otorhinolaryngologists and neurologists in the diagnosis and management of such disorder. Final Remarks: There is a strong association between neurotological symptoms and migraine, and the auditory-vestibular dysfunction-associated migraine is the most common cause of spontaneous episodic vertigo (nonpositional). Symptoms may vary broadly among patients, making it a diagnostic challenge to the otorhinolaryngologist. This entity usually presents with positional or spontaneous vertigo spells, lasting for seconds or days, associated with migraine symptoms. A better understanding of the relationship between central vestibular mechanisms and migraine mechanisms, besides the discovery of ionic channel disorders in some cases of migraine, ataxia and vertigo, may lead to a better understanding of migraine pathophysiology associated with audio-vestibular disorder.

Triagem otoneurológica em operários da construção civil que executam trabalho em altura

“…Such finding corroborates another study found in the literature that mentions cardiovascular disorders as the main causes of vertigo or dizziness 20 . The occurrence of cervical alteration was noticed in eight (24,2%) workers.…”

“…Studies that investigate the consumption of those substances in civil construction workers were not found, however, one study confirms the association between the presence of vestibular symptoms and regular caffeine ingestion 27 . The prevalence of 50% of the individuals with headache or migraine corroborates other studies, which confirm the report of headache crisis in individuals with balance disorders, mainly during the most productive phase of life, between the ages of 30 and 39 20 . Due to the fact that this situation is dealing with a young population that is entering the job market prematurely, it is very important to implement screening programs to detect individuals with balance disorders and, when necessary, to establish a diagnosis in order to refer individuals with complaints and altered results in their exams to an efficient treatment, decreasing the risks of serious accidents in civil construction.…”

“…However, in other studies headaches and/or migraines were prevailing symptoms, mainly in the condition in which dizziness and vertigo are associated 20 . Therefore, it is extremely important to distinguish if a worker presents complaints about headache and/or migraine associated with a condition of auditory-vestibular dysfunction, because if such situation is confirmed, it is possible that this individual feels loss of balance and nausea, mainly jeopardizing the professional who needs to work at height.…”

O impacto da tontura na qualidade de vida de indivíduos com migrânea

“…Neste estudo, o segundo aspecto mais afetado foi o físico. Indivíduos que apresentam migrânea associada à disfunção vestibular geralmente apresentam vertigem espontânea ou de posição, e ainda, ela pode começar como espontânea e transformar-se em posicional (18) . Uma característica marcante desse tipo de migrânea é a intolerância a movimentos do próprio corpo ou do ambiente (19) , isso justifica as queixas dos pacientes nas quais as funções mais prejudicadas foram movimentos rápidos de cabeça, inclinar-se e olhar para cima.…”

O efeito da cafeína na função vestibular : ensaio clínico randomizado, triplo cego, placebo controlado

“…O labirinto posterior é um órgão altamente sensível a alterações em outros órgãos e sistemas, sendo que muitos dessas alterações manifestam-se primeiramente com sintomas vestibulares. Problemas cervicais (devido à compressão da artéria basilar e redução do fluxo sanguíneo no sistema vestibular), problemas cardiovasculares (mesmo quando compensados, devido à redução no fluxo sanguíneo periférico), migrânea (devido à vasoconstricção transitória), alterações metabólicas (como Diabetes Mellitus, hiperinsulinemia ou hipoglicemia, hipertrigliceridemia, hiperlipidemias e alterações metabólicas decorrentes da insuficiência renal crônica), alterações hormonais (dos esteroides responsáveis pelo ciclo ovariano ou dos hormônios tireoidianos), distúrbios psíquicos (como ansiedade, fobia e Síndrome do Pânico, devido ao rebaixamento da integração dos sinais sensoriais centrais), doenças neurológicas (como Esclerose Múltipla, tumores, Epilepsia, ataques isquêmicos ou na intoxicação por drogas) e o uso de medicamentos como antibióticos, antiinflamatórios, diuréticos e psicotrópicos podem afetar o labirinto desencadeando sintomas como a vertigem (3)(4)(5)(6)(7).…”