Migraine Features in Patients With Recurrent Benign Paroxysmal Positional Vertigo

Bruss, David M.; Abouzari, Mehdi; Sarna, Brooke; Goshtasbi, Khodayar; Lee, Ariel; Birkenbeuel, Jack; Djalilian, Hamid R.

doi:10.1097/mao.0000000000002976

Cited by 21 publications

(23 citation statements)

References 29 publications

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“…Notably, all groups had a high prevalence of migraine, which is consistent with large epidemiological studies demonstrating that migraine is associated with an increased risk for BPPV [15]. Patients with migraine are also at an increased risk of developing recurrent BPPV symptoms [16]. To explain the comorbidity of migraine and BPPV, Ishiyama et al have proposed that vasospasm in migraine causes repeated damage to the vasculature of the inner ear, which predisposes to the displacement of otoconia [17].…”

Section: Discussionsupporting

confidence: 66%

Vestibular Test Results in Patients With Horizontal Canal Benign Paroxysmal Positional Vertigo

Kim¹,

Pasquesi²,

Steenerson³

et al. 2022

Cureus

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IntroductionWhile the mechanism of posterior canal benign paroxysmal positional vertigo (BPPV) is widely accepted as canalolithiasis, the pathophysiology of horizontal canal BPPV remains controversial. We seek to analyze vestibular test results of patients with horizontal canal BPPV with ageotropic nystagmus (AHC) and geotropic nystagmus (GHC) in comparison to patients with posterior canal BPPV (PC) to better understand its pathophysiology. MethodsIn a retrospective chart review of adults with BPPV at a tertiary referral balance center, we reviewed the clinical characteristics and compared videonystagmography, caloric, rotary chair, subjective visual vertical (SVV)/ subjective visual horizontal (SVH), and vestibular evoked myogenic potential (VEMP) results between groups. ResultsWe included 11 AHC and seven GHC patients and randomly selected 20 PC patients as the comparison group. All groups had a high rate of migraine and low rates of diabetes and head trauma, but no difference between groups. Ipsilateral caloric weakness was more prevalent in the GHC group compared to the PC group (p=0.02). One of two AHC patients and both GHC patients who had SVV/SVH testing had abnormal findings. The only AHC patient who had ocular VEMP testing had abnormal results. Additionally, we observed a significant downbeating component to nystagmus (4 deg/sec or greater) exclusively in the AHC group (5/10 patients, p=0.001). ConclusionsPatients with AHC and GHC have unique vestibular testing results. In particular, only AHC patients showed a downbeating component to their nystagmus, which may suggest utricular dysfunction in the pathophysiology of AHC.

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Section: Discussionsupporting

confidence: 66%

Vestibular Test Results in Patients With Horizontal Canal Benign Paroxysmal Positional Vertigo

Kim¹,

Pasquesi²,

Steenerson³

et al. 2022

Cureus

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“…There are suggestions that migraine mechanisms can affect the inner ear, that BPPV and MD can be complications of a migraine process, and that these conditions are potentially in pathophysiologic continuum with VM in which some patients manifest pure central disease, others manifest pure peripheral disease, and others have manifestations of both ( 26 , 27 ). Patients with VM may exhibit tinnitus, aural pressure, and fluctuations in hearing.…”

Section: Care Gap 2: Vm Is Currently Underdiagnosed In the General Population And Multiple Associated Co-morbidities Are Underrecognizedmentioning

confidence: 99%

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

et al. 2022

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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.

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“…Migraine has long been associated with vertigo, with studies suggesting that patients suffering from migraine are two to three times more likely to suffer from vertigo, compared to the headache-free controls [ 55 , 56 , 57 ]. Moreover, migraine was found to be three times more common in patients with BPPV of an unknown cause than in those with BPPV secondary to trauma or surgical procedures [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…Recurrent vasospasm is also associated with the oxidative stress of endothelial cells, which is a possible pathogenetic mechanism common to both migraine and BPPV [58,59]. Therefore, it is speculated that patients with migraines have a recurrent vascular damage in the inner ear that disposes to recurrent BPPV [30,55]. In addition, trigeminal nerve stimulation, an underlying pathophysiologic mechanism of migraine, induces fluid extravasation in the cochlea leading to the detachment of otoconia from the otolith organs [60].…”

Section: Migrainementioning

confidence: 99%

Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo. A Clinical Review

Sfakianaki

Binos

Karkos

et al. 2021

JCM

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Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular dysfunctions encountered in clinical practice. Although the treatment of BPPV is relatively successful, many patients develop recurrence after treatment. Our purpose is to evaluate the mean recurrence rate and risk factors of BPPV after treatment. A review of the literature on the risk factors of BPPV recurrence was performed. A thorough search was conducted using electronic databases, namely Pubmed, CINAHL, Academic Search Complete and Scopus for studies published from 2000 to 2020. Thirty studies were included in this review with 13,358 participants. The recurrence rate of BPPV ranged from 13.7% to 48% for studies with follow-up <1 year, and from 13.3% to 65% for studies with follow-up ≥2 years. Pathophysiologic mechanisms and implication of each of the following risk factors in the recurrence of BPPV were described: advanced age, female gender, Meniere’s disease, trauma, osteopenia or osteoporosis, vitamin D deficiency, diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, migraine, bilateral/multicanal BPPV, cervical osteoarthrosis and sleep disorders. Patients with hyperlipidemia and hypertension had the highest recurrence rates of BPPV, 67.80% and 55.89%, respectively, indicating that vascular comorbidities increase the risk of BPPV recurrence. In addition, more than half of patients (53.48%) with diabetes mellitus and BPPV experienced recurrence of BPPV. Knowledge and awareness of risk factors for recurrence of BPPV are essential for the assessment and long-term prognosis of patients. Identification of these relapse risk factors may enhance the ability of clinicians to accurately counsel patients regarding BPPV and associated comorbidities.

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Migraine Features in Patients With Recurrent Benign Paroxysmal Positional Vertigo

Cited by 21 publications

References 29 publications

Vestibular Test Results in Patients With Horizontal Canal Benign Paroxysmal Positional Vertigo

Vestibular Test Results in Patients With Horizontal Canal Benign Paroxysmal Positional Vertigo

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

Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo. A Clinical Review

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