Care Gaps and Recommendations in Vestibular Migraine: An Expert Panel Summit

Abstract

Vestibular migraine (VM) is an increasingly recognized pathology yet remains as an underdiagnosed cause of vestibular disorders. While current diagnostic criteria are codified in the 2012 Barany Society document and included in the third edition of the international classification of headache disorders, the pathophysiology of this disorder is still elusive. The Association for Migraine Disorders hosted a multidisciplinary, international expert workshop in October 2020 and identified seven current care gaps that the scientific community needs to resolve, including a better understanding of the range of symptoms and phenotypes of VM, the lack of a diagnostic marker, a better understanding of pathophysiologic mechanisms, as well as the lack of clear recommendations for interventions (nonpharmacologic and pharmacologic) and finally, the need for specific outcome measures that will guide clinicians as well as research into the efficacy of interventions. The expert group issued several recommendations to address those areas including establishing a global VM registry, creating an improved diagnostic algorithm using available vestibular tests as well as others that are in development, conducting appropriate trials of high quality to validate current clinically available treatment and fostering collaborative efforts to elucidate the pathophysiologic mechanisms underlying VM, specifically the role of the trigemino-vascular pathways.

Development and Validation of the Predictive Model for the Differentiation between Vestibular Migraine and Meniere’s Disease

“…In terms of VM, the Bárány Society and the International Headache Society have established a consensus document, with diagnostic criteria, which was included in the appendix of the new International Classification of Headache Disorders (ICHD)-3 beta version, which means that VM can be deemed as an emerging entity needing further research [ 2 ]. The constantly revised diagnostic guideline and multidisciplinary international expert workshops [ 40 ] have contributed greatly to the assessment of MD and VM and their treatment.…”

Vestibular Function and Clinical Presentation of Dizziness: Are They Similar in Patients With Different Types of Migraine?

“…Experts recognize that the vestibular migraine (MV) classification leaves out many subtypes of the pathology, which avoids duplicate diagnoses (32). However, as already demonstrated, there is an overlap of several migraine and MV symptoms, not to mention that migraineurs can present different audiovestibular symptoms, making diagnosis difficult (17,32).…”

A Holistic Approach to a Dizzy Patient: A Practical Update

“…This has been described as "VM/MD overlapping syndrome." For differentiation, positional testing, which stimulates vertiginous attacks and elicits nystagmus, may be helpful, including the Dix-Hallpike maneuver or the supine roll test for the horizontal canal variant [36,37,39,40]. Other disorders that rarely mimic VM and should be taken into consideration during the differentiation process include central nervous system disorders such as vertebrobasilar transient ischemic attack and vascular compression of the eighth nerve [37].…”