Epidemiology of vertigo, migraine and vestibular migraine

Abstract

Both migraine and vertigo are common in the general population with lifetime prevalences of about 16% for migraine and 7% for vertigo. Therefore, a concurrence of the two conditions can be expected in about 1.1% percent of the general population by chance alone. However, recent epidemiological evidence suggests that the actual comorbidity is higher, namely 3.2 %. This can be explained by the fact that several dizziness and vertigo syndromes occur more frequently in migraineurs than in controls including benign paroxysmal positional vertigo, Meniere's disease, motion sickness, cerebellar disorders and anxiety syndromes which may present with dizziness. In addition, there is increasing recognition of a syndrome called vestibular migraine (VM), which is vertigo directly caused by migraine. VM affects more than 1% of the general population, about 10% of patients in dizziness clinics and at least 9% of patients in migraine clinics.Clinically, VM presents with attacks of spontaneous or positional vertigo lasting seconds to days. Migrainous accompaniments such as headache, phonophobia, photophobia or auras are common but not mandatory. Cochlear symptoms may be associated but are mostly mild and non-progressive. 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 non-specific. In the absence of controlled studies, treatment of VM is adopted from the migraine sphere comprising avoidance of triggers, stress management as well as pharmacotherapy for acute attacks and prophylaxis.

Vestibular migraine: diagnosis challenges and need for targeted treatment

“…Auditory symptoms, including hearing loss, tinnitus, and aural pressure have been reported in up to 38% patients with vestibular migraine. Hearing loss is usually mild and transient, without or with only minor progression in the course of the disease 2,34,35 . Radtke et al reassessed 61 patients with definitive VM according to validated diagnostic criteria after a follow-up time of 9 years and their findings are shown on Table 2 36 .…”

Migraine and motion sickness: What is the link?

“…The presence of these otoneurologic symptoms indicates activation of vestibular pathways. Dizziness and vertigo often accompany migraine attacks (von Brevern, Zeise, Neuhauser, Clarke and Lempert, 2005;Cutrer and Baloh, 1992;Lance, 2000) and are frequently reported during the headache-free interval (Kuritzy, Ziegler and Hassanein, 1981;Lempert and Neuhauser, 2009;Cha et al, 2009). Indeed, around 25% of migraine sufferers experience episodes of vertigo (Baloh, 1997).…”

Vestibular Evoked Myogenic Potentials in a Female Population with Migraine

“…Epidemiological studies suggest that co morbidity of migraine and vertigo is 4.5 % for women and 1.5 % for men [3]. In an analysis of 200 patients from a dizziness clinic, it has been shown that 38 % of patients with dizziness may actually fit into the clinical criteria for migraine [4].…”

“…The type of dizziness can be peripheral and central in patients with migraine. Benign paroxysmal positional vertigo (BPPV), Meniere's disease, motion sickness, cerebellar disorders and anxiety syndromes are more frequent in migraineurs than in controls [3].…”