Migrainous Vertigo: Results of Caloric Testing and Stabilometric Findings

Teggi, Roberto; Colombo, Bruno; Bernasconi, Luca; Bellini, Chiara; Comı, Gıancarlo; Bussi, Mario

doi:10.1111/j.1526-4610.2009.01338.x

Cited by 85 publications

(101 citation statements)

References 38 publications

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“…The high prevalence at follow-up agrees with previous findings [5], whereas the low prevalence at initial presentation is comparable to the results of recent studies that reported around 8 and 16.6% [8,9,10]. Thus, the clear-cut increase in central ocular motor findings at follow-up explains well the different results reported in earlier studies as being due to a time bias.…”

Section: Discussionsupporting

confidence: 81%

“…Furthermore, the comparable distribution of findings in our study and in other studies is indirect proof that the populations of patients were similar (e.g. percentage of peripheral vestibular deficit in our study 11 vs. 8.3–28.8% in previous studies) [5,6,8,9,12]. …”

Section: Discussionsupporting

confidence: 69%

“…In contrast, current studies that included patients with migraine and vertigo according to the Neuhauser criteria showed different results. One study reported central ocular motor disturbances in 16.6%, while two other studies reported central ocular motor signs in only about 8% of patients with VM [8,9,10]. …”

Section: Introductionmentioning

confidence: 99%

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Long-Term Changes of Central Ocular Motor Signs in Patients with Vestibular Migraine

Neugebauer¹,

Adrion

Glaser³

et al. 2012

Eur Neurol

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Background: A high percentage of patients with vestibular migraine (VM) were reported to have central ocular motor dysfunctions (COMD) in the symptom-free interval. Since VM is a chronic disorder, it is of interest if COMD worsen over time. Methods: Thirty VM patients and 11 control patients participated in an 8-year-long observational study with follow-up. All patients underwent standardized neuro-ophthalmological and neuro-otological examinations at the initial presentation and at follow-up. The primary outcome measure was change in COMD at follow-up. Results: In general, COMD in the symptom-free interval were subtle, consisting of a saccadic horizontal and/or vertical pursuit. At follow-up, significantly more patients with VM had COMD (p = 0.015). The prevalence of COMD increased from 20 to 63% in VM patients. Further, the presence of COMD at follow-up had a positive predictive value of 90.5% for the diagnosis of VM. Successful treatment with prophylactic migraine medication seems to prevent the development and worsening of COMD (p = 0.008). Conclusion: Mild COMD occur in a large percentage of VM patients during the course of the disease. The presence of COMD is predictive of VM in patients with recurrent attacks of vertigo. Prophylactic migraine medication seems to attenuate the development and progression of COMD.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 69%

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Long-Term Changes of Central Ocular Motor Signs in Patients with Vestibular Migraine

Neugebauer¹,

Adrion

Glaser³

et al. 2012

Eur Neurol

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“…It may present at any age with attacks of vertigo or imbalance lasting from minutes to days, sometimes associated with migrainous headache, more often with migrainous features as phono or photophobia [3]; in most patients, the neurotological examination outside attacks is normal or inconclusive, so diagnosis mainly relies on clinical history [4,5]. Diagnostic criteria for definite VM have been recently proposed jointly by the Barany Society and the International Headache Society [6], and include:…”

Section: Introductionmentioning

confidence: 99%

Fixed combination of cinnarizine and dimenhydrinate in the prophylactic therapy of vestibular migraine: an observational study

et al. 2015

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Vestibular migraine (VM) is one of the most frequent causes of episodic vertigo, with a lifetime prevalence of 0.98%. Prophylactic therapy includes calcium channel blockers, beta-blockers, antiepileptic drugs and antidepressants. We studied the association of cinnarizine 20 mg and dimenhydrinate 40 mg (Arlevertan) in a group of 22 patients affected by definite VM. Proposed therapy included one tablet twice a day for 1 month, which was repeated three times with 1 month of interval between drug intake; results were compared with those of a control group of 11 VM patients who asked to observe only lifestyle measures for migraine. The main outcome was the number of vertigo and headache crises in the 6 months before therapy and in the 6 months of follow-up. Subjects performing Arlevertan presented during the 6 months of therapy a decrease of vertigo attacks from 5.3 to 2.1 and of headaches from 4.3 to 1.7 (p < 0.0001); 68% of these subjects reported a decrease of at least 50% of vertigo attacks, while 63% of headaches. Conversely, vertigo attacks decreased from 3.5 to 2.2 and headaches from 2.6 to 2 in patients observing only lifestyle; 18% of these subjects reported a decrease of at least 50% of vertigo crises and 27% of headaches. Our data do not differ from those of previous works assessing efficacy of different prophylactic therapies for VM and reporting consistent reduction of vertigo spells in a rate of patients ranging from 60 and 80%.

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“…In BPPV patients, the positioning vertigo and typical nystagmus usually disappear after repositioning maneuver, but residual dizziness and postural instability measured by posturography may continue even up to days [11] or event months [12] even if the tendency to falls disappears [12]. Being aware that successful treatment may not stop dizziness or further balance problems, we did not exclude BPPV patients from the study, similarly as we did not exclude migraine patients, who may develop dizziness, vertigo spells and postural and VNG abnormalities [13]. From tests used to examine the problem of spinal tract, we chose the Romberg test with eyes open/closed and Unterberger tests as the most popular and recommended by legal requirements.…”

Section: Stepping Testmentioning

confidence: 99%

Bedside examination for vestibular screening in occupational medicine

Zamysłowska-Szmytke

Szostek-Rogula²,

Śliwińska-Kowalska

2015

Int J Occup Med Environ Health

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Objectives: The aim of the study was to assess the usefulness of bedside examination for screening of vestibular and balance system for occupational medicine purposes. Study group comprised 165 patients referred to Audiology and Phoniatric Clinic due to vestibular and/or balance problems. Caloric canal paresis of 19% was the cut off value to divide patients into 43 caloric-positive vestibular subjects and 122 caloric-negative patients. The latter group comprised 79 subjects revealing abnormalities of videonystagmographic (VNG) oculomotor tests (central group) and 43 subjects with normal VNG. Material and Methods: Vestibular and balance symptoms were collected. Five tests were included to bedside examination: Romberg and Unterberger tests, Head Impulse Test (HIT), Dynamic Visual Acuity (DVA) and gaze nystagmus assessment. Results: Vestibular and balance symptoms were reported by 82% of vestibular, 73% of central and 40% of VNG-normal patients. Thirteen out of 18 VNG-normal but symptomatic subjects (73%) had abnormal tests in clinical assessment. The sensitivity of bedside test set for vestibular pathology was 88% as compared to caloric test and 68% for central pathology as compared to VNG oculomotor tests. Conclusions: The combination of 5 bedside tests reveal satisfactory sensitivity to detect vestibular abnormalities. Bedside examination abnormalities are highly correlated with vestibular/balance symptoms, regardless the normal results of VNG. Thus, this method should be recommended for occupational medicine purposes.

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Migrainous Vertigo: Results of Caloric Testing and Stabilometric Findings

Cited by 85 publications

References 38 publications

Long-Term Changes of Central Ocular Motor Signs in Patients with Vestibular Migraine

Long-Term Changes of Central Ocular Motor Signs in Patients with Vestibular Migraine

Fixed combination of cinnarizine and dimenhydrinate in the prophylactic therapy of vestibular migraine: an observational study

Bedside examination for vestibular screening in occupational medicine

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