Recent Advances in the Understanding of Vestibular Migraine

Abstract

Approximately 1% of the general population and 10% of patients with migraine suffer from vestibular migraine (VM). However, this condition remains relatively unknown; therefore, it is often underdiagnosed despite the recent adoption of international diagnostic criteria for VM. The diagnosis of VM is based on the symptoms, degree, frequency, and duration of the vestibular episodes, a history of migraine, the temporal association of migraine symptoms with vestibular episodes in at least 50% of cases, and the exclusion of other causes. Physical examination and laboratory findings are usually normal in patients with VM but can be used to rule out other vestibular disorders with similar symptoms. The pathophysiology of VM remains incompletely understood; however, several mechanisms link the trigeminal system, which is activated during migraine attacks, and the vestibular system. Because few controlled trials have specifically investigated VM, the treatment options for this order are largely the same as those for migraine and include antiemetics for severe acute attacks, pharmacological migraine prophylaxis, and lifestyle changes.

Vestibular Migraine: A case report and review of the literature

“…The main hypothesis on the subject includes the pathophysiology of migraine and the role of reciprocal connections between vestibular nuclei in the brain and structures regulating the trigeminal nociceptive inputs. [1,8] In vestibular migraine, the onset of the symptoms is observed 5-10 years after the original onset of the migraine. [6,7] Episodic attacks characteristically include spontaneous, positional or movement-induced vertigo, dizziness, feeling of imbalance, and migrainous headache (may be aura or non-aura).…”

“…Ischemic attack is different to VM, with other accompanying neurological findings, risk factors, and a pathological doppler ultrasonography. [1] There is no consensus guideline for the treatment in VM, and the recommendations are based on randomized controlled studies, case reports, retrospective cohort studies and open label trials. In studies on tryptan use in acute attacks, almotryptan 12.5 mg orally was found to be highly effective in relieving the vertiginous symptoms, sumatryptan (variable doses) was found to be effective, and zolmitryptan 2.5 mg oral was found to be slightly effective.…”

“…Therefore, its prevalence is not clearly known, but is estimated to be 4.3-29.3%. [1] It was previously named migraine-related vertigo, migraine-associated vestibulopathy and migrainous vertigo as well, and was defined as vestibular migraine by the members of Barany Society and the International Headache Society (IHS) in 2012. In 2013, the diagnostic criteria of the disease were published in the appendix of the International Classification of Headache Disorders 3 (ICHD-3) beta.…”

Comparison of Audiological Findings in Patients with Vestibular Migraine and Migraine

“…The exact mechanism of VM is unknown. Vasospasm in internal auditory arteries, disruption of ion channels in the brain, and cortical spreading depression theory are the main theories on this issue (13). The most accepted theory is that migraine-induced vasospasm seen in the brain might also occur in the internal auditory arteries causing a decrease in blood flow to the inner ear.…”

Decoding vestibular migraine for easier diagnosis

“…Therefore Vestibular migraine remains underdiagnosed compared to other types of vertigo mainly due to the absence of a unified set of diagnostic criteria. 10 It is claimed that around 7% of the vertiginous population visiting the vertigo clinic are cases of vestibular migraine. 11 Yet the numbers diagnosed are very low which can be accounted for the fact that these patients are referred to the clinic by the referring physicians who diagnose less than 2 percent of their patients as vestibular migraine.…”