Clinical criteria of positional vertical nystagmus in vestibular migraine

Elbadry, Mohamed; Samy, Hesham; Kabel, Abdel Mageed; Rafat, Fatma Mohamed; Talaat, Hossam Sanyelbhaa

doi:10.1080/00016489.2017.1318220

Cited by 23 publications

(14 citation statements)

References 15 publications

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“…Previous investigators also demonstrated a high prevalence of spontaneous ictal nystagmus (70%) comparable with our study (71.3%) (29). Persistent positional nystagmus while symptomatic was found in 100% of patients in two separate studies, comparable with our findings in 97.3% of patients (30,31). Occurrence of interictal spontaneous nystagmus in earlier reports of VM range between 2–11% (14.9% in our cohort) (21,32).…”

Section: Discussionsupporting

confidence: 92%

Clinical, oculographic, and vestibular test characteristics of vestibular migraine

et al. 2021

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Background We characterise the history, vestibular tests, ictal and interictal nystagmus in vestibular migraine. Method We present our observations on 101 adult-patients presenting to an outpatient facility with recurrent spontaneous and/or positional vertigo whose final diagnosis was vestibular migraine (n = 27) or probable vestibular migraine (n = 74). Ictal and interictal video-oculography, caloric and video head impulse tests, vestibular-evoked myogenic potentials and audiometry were performed. Results Common presenting symptoms were headache (81.2%), spinning vertigo (72.3%), Mal de Débarquement (58.4%), and motion sensitivity (30.7%). With fixation denied, ictal and interictal spontaneous nystagmus was observed in 71.3 and 14.9%, and purely positional nystagmus in 25.8 and 55.4%. Spontaneous ictal nystagmus was horizontal in 49.5%, and vertical in 21.8%. Ictal spontaneous and positional nystagmus velocities were 5.3 ± 9.0°/s (range 0.0–57.4), and 10.4 ± 5.8°/s (0.0–99.9). Interictal spontaneous and positional nystagmus velocities were <3°/s in 91.8 and 23.3%. Nystagmus velocities were significantly higher when ictal ( p < 0.001/confidence interval: 2.908‒6.733, p < 0.001/confidence interval: 5.308‒10.085). Normal lateral video head impulse test gains were found in 97.8% (mean gain 0.95 ± 0.12) and symmetric caloric results in 84.2% (mean canal paresis 7.0 ± 23.3%). Air- and bone-conducted cervical-vestibular-evoked myogenic potential amplitudes were symmetric in 88.4 and 93.4% (mean corrected amplitude 1.6 ± 0.7, 1.6 ± 0.8) with mean asymmetry ratios of 13.0 and 9.0%. Air- and bone-conducted ocular-vestibular-evoked myogenic potentials were symmetric in 67.7 and 97.2% (mean amplitude 9.2 ± 6.4 and 20.3 ± 12.8 µV) with mean asymmetry ratios of 15.7 and 9.9%. Audiometry was age consistent and symmetric in 85.5%. Conclusion Vestibular migraine is characterised by low velocity ictal spontaneous nystagmus, which can be horizontal, vertical, or torsional, and normal audiovestibular test results.

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Section: Discussionsupporting

confidence: 92%

Clinical, oculographic, and vestibular test characteristics of vestibular migraine

et al. 2021

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“…During VM episodes, most patients have a central spontaneous or positional nystagmus [48,49]. The nystagmus has no latency period, is usually persistent and non-fatigable, and is markedly reduced by visual fixation [50,51]. In addition, imbalance is a regular finding during acute attacks, including a positive Romberg test and gait ataxia [17,49].…”

Section: Neuro-otological Examinationmentioning

confidence: 99%

Vestibular migraine — an underdiagnosed cause of vertigo. Diagnosis and treatment

Nowaczewska

2020

Neurol Neurochir Pol.

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Introduction. Migraine and vertigo are two common conditions. The main disorder connecting both these entities is vestibular migraine (VM). State of the art. VM may affect 1-3% of the general population. It is a disabling disease of recurrent attacks of vestibular symptoms accompanied by migraine features which occur in patients with a current or previous history of migraine. The episodes can last minutes, hours or even days, and may occur without any concurrent headache, which can prompt misdiagnosis. VM often begins several years after a typical migraine, and the delay between onset of headache and vertigo may be long. The diagnosis is based on the patient's clinical history and can be challenging due to the lack of an established confirmatory diagnostic test or biomarkers. The mechanism of vestibular migraine remains unclear and is still under investigation, but it seems to be an interaction between trigeminal and vestibular systems. Due to the lack of specific trials, treatment recommendations are based on migraine guidelines. Several drugs seem to be effective, although there have been few randomised controlled trials in this area. Regardless of the published strict and detailed diagnostic criteria, this condition remains little known, and as a consequence is underdiagnosed and undertreated. Clinical implications. Efforts should be made to educate medical communities and patients about this disease and to encourage neurologists and ENT specialists to cooperate. Every patient with vertigo of unknown origin should be directly asked about a past or present history of migraine, or migraine symptoms experienced during their vertigo episodes. Future directions. There is a growing need for studies regarding the pathophysiology of VM as well as randomised trials to establish clear treatment recommendations and to improve management of this surprisingly common disorder.

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“…The relationships among BPPV, migraine, and stress or anxiety are complicated . Both BPPV and VM may present with positional nystagmus during positional testing, but positional nystagmus in VM patients is up‐ or down‐beating without latency or fatigue . In addition, BPPV is frequently associated with comorbidities such as migraine .…”

Section: Discussionmentioning

confidence: 99%

“…28 Both BPPV and VM may present with positional nystagmus during positional testing, but positional nystagmus in VM patients is up-or down-beating without latency or fatigue. 29 In addition, BPPV is frequently associated with comorbidities such as migraine. 30,31 In our patient, dizziness was triggered by stress and anxiety, provoked, for example, by school examinations, suggesting a possible comorbidity of BPPV and migraine.…”

Section: Discussionmentioning

confidence: 99%

Benign paroxysmal positional vertigo in children

Yao

Song

Wang

et al. 2018

Clinical Otolaryngology

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Clinical criteria of positional vertical nystagmus in vestibular migraine

Abstract: VM can induce characteristic form of vertical positional nystagmus and vertigo, which would be treated by medications used for controlling the VM.

Cited by 23 publications

References 15 publications

Clinical, oculographic, and vestibular test characteristics of vestibular migraine

Clinical, oculographic, and vestibular test characteristics of vestibular migraine

Vestibular migraine — an underdiagnosed cause of vertigo. Diagnosis and treatment

Benign paroxysmal positional vertigo in children

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