The Epidemiology of Vestibular Migraine: A Population-based Survey Study

Formeister, Eric J.; Rizk, Habib G.; Kohn, Michael A.; Sharon, Jeffrey D.

doi:10.1097/mao.0000000000001900

Cited by 172 publications

(149 citation statements)

References 22 publications

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“…Other factors that should be considered were the contributions of motion sickness history and anxiety, which were more common in VM patients with concurrent vertigo and migraine. Anxiety was associated with significantly increased recurrence of VM (Formeister et al, 2018) and motion sickness could enhance motion intolerance (Wang and Lewis, 2016).…”

Section: Discussionmentioning

confidence: 97%

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Temporal Patterns of Vertigo and Migraine in Vestibular Migraine

et al. 2020

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Vestibular migraine (VM) is a multidisciplinary disease under exploration. Multiple temporal patterns of vertigo and migraine make it difficult to diagnose VM, and their effect on the clinical features of VM is still unclear. Here we investigated the clinical features of VM under three temporal patterns. 172 VM patients were enrolled in this study and divided into three groups: 86 patients in group A had an earlier onset of migraine than vertigo, 35 patients in group B had an earlier onset of vertigo than migraine, and 51 patients in group C had concurrent vertigo and migraine. No significant difference was found among three groups regarding types, intensity and accompanying symptoms of the vestibular attack. Patients in group C presented higher frequency and longer duration of vertigo than group A and B, while patients in group A presented lower frequency and shorter duration of headaches than group B and C. Additionally, the frequency, duration, intensity and accompanying symptoms of headache in group A decreased significantly after the onset of vertigo, especially in women around menopause. We hypothesized that vestibular stimulation could inhibit the trigeminal pain pathway, while painful trigeminal stimulation could excite the vestibular system. Our findings may contribute to the clinical identification of VM and further clarification of its pathogenesis.

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Section: Discussionmentioning

confidence: 97%

“…However, VM has been remained underdiagnosed despite ongoing studies in recent years. Only 8-20% of VM patients were correctly diagnosed in practice (Neuhauser et al, 2006;Geser and Straumann, 2012;Formeister et al, 2018). A big challenge for diagnosis is multiple temporal patterns of vertigo and migraine in VM.…”

Section: Introductionmentioning

confidence: 99%

Temporal Patterns of Vertigo and Migraine in Vestibular Migraine

et al. 2020

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“…Vestibular migraine (VM) is a disorder where vestibular symptoms are causally related to migraine . While it is less common than migraine (which affects 16% of the adult population), VM is the most common neurologic cause of vertigo, with a prevalence of between 1% and 2.7% of the adult population …”

Section: Introductionmentioning

confidence: 99%

“…Vestibular migraine (VM) is a disorder where vestibular symptoms are causally related to migraine. 1 While it is less common than migraine (which affects 16% of the adult population), 2 VM is the most common neurologic cause of vertigo, 1,3 with a prevalence of between 1% and 2.7% of the adult population. 3,4 Despite its prevalence and high impact on healthcare utilization, 3,4 VM remains a very underrecognized condition, with the rate of diagnosis among referring physicians ranging from 1.8% to 20%.…”

Section: Introductionmentioning

confidence: 99%

“…1 While it is less common than migraine (which affects 16% of the adult population), 2 VM is the most common neurologic cause of vertigo, 1,3 with a prevalence of between 1% and 2.7% of the adult population. 3,4 Despite its prevalence and high impact on healthcare utilization, 3,4 VM remains a very underrecognized condition, with the rate of diagnosis among referring physicians ranging from 1.8% to 20%. [3][4][5] The diagnostic challenge of VM perhaps lies in the broad spectrum of its manifestations, the absence of "typical" migraine headaches with attacks of vestibular symptoms, and its very recent nosological definition as a disease entity.…”

Section: Introductionmentioning

confidence: 99%

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The Spectrum of Vestibular Migraine: Clinical Features, Triggers, and Examination Findings

et al. 2019

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Objective To assess the ictal symptoms, interictal symptoms, psychiatric comorbidities, and interictal neuro‐otologic examination findings in vestibular migraine (VM). Methods Retrospective chart review of 491 patients seen from August 2014 until March 2018 at a tertiary neurology referral center for vestibular disorders to identify patients fulfilling the 2012 VM criteria. Results One hundred and thirty‐one patients (105 women) were identified. Mean age of VM onset was 44.3 (±13.7) years. Preceding the onset of vestibular symptoms, most had migraine (57.3%) and motion sickness (61.1%). It was common to have a family history of migraine (50.8%) and episodic vestibular symptoms (28.1%). Common ictal symptoms were triggered (visually induced and head‐motion) and spontaneous vertigo, accompanied by photophobia and phonophobia (118/131 [90.1%] patients), nausea (105/131 [80.2%] patients), aural symptoms (79/131 [60.3%] patients), and headache (65/131 [49.6%] patients). Interictally, many experienced visually induced (116/131 [88.6%] patients), head‐motion (86/131 [65.6%] patients), and persistent (67/131 [51.1%] patients) dizziness. Psychiatric comorbidities include anxiety (92/131 [70.2%] patients), depression (53/131 [40.5%] patients), insomnia (38/131 [29.0%] patients), phobic disorders (15/131 [11.5%] patients), and psychogenic disorders (11/131 [8.4%] patients). Common triggers were stress (52/131 [39.7%] patients), bright lights (35/131 [26.7%] patients), weather changes (34/131 [26.0%] patients), and sleep deprivation (34/131 [26.0%] patients). Interictal neuro‐otologic examination was abnormal in 56/131 (42.7%), usually hyperventilation‐induced, head‐shaking‐induced, vibration‐induced, and positional nystagmus. The most common balance‐test finding was impaired sharpened Romberg’s test (22/130 [16.9%] patients). Conclusions In this single center study, we found that VM typically affects women in their 40s, with a personal and family history of migraine. Typical ictal symptoms were triggered and spontaneous vertigo, associated with photophobia and phonophobia, nausea, aural symptoms, and headache. Interictal vestibular symptoms, comorbid psychiatric disorders, and non‐specific interictal neuro‐otologic findings were common.

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Assessment of the Cost Burden of Episodic Recurrent Vestibular Vertigo in the US

Jeong

Simpson

Johnson

et al. 2022

JAMA Otolaryngol Head Neck Surg

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ImportanceUnderstanding of the economic burden of recurrent vestibular causes of vertigo and areas contributing to the cost is needed.ObjectiveTo analyze and identify the factors contributing to the direct medical costs associated with Ménière disease (MD), vestibular migraine (VM), and benign paroxysmal positional vertigo (BPPV).Design, Setting, and ParticipantsThis economic evaluation used MarketScan Commercial Database claims data from 2018 to identify the non-Medicare patient population with the diagnoses of MD, VM, or BPPV. Data were analyzed January 1 to December 31, 2018.Main Outcomes and MeasuresThe total direct medical costs associated with MD, VM, and BPPV.ResultsA total of 53 210 patients (mean [SD] age, 47.8 [11.8] years; 67.6% female) were included in this study, with 34 738 normal comparisons. There were 5783 (10.9%) patients with MD, 3526 (6.6%) patients with VM, and 43 901 (82.5%) patients with BPPV in the data set. Mean age and sex were different across the different vestibular disorders. Across the different groups, patients with no comorbidities or with a Charlson Comorbidity Index score of zero ranged from 98.4% to 98.8%. Around 5% of patients were hospitalized with inpatient stay lasting between 4.6 and 5.2 days. After adjusting for age, sex, and comorbidities, there were large differences in mean adjusted annual payments/direct costs across the different groups (MD, $9579; VM, $11 371; and BPPV, $8247). This equated to a total incremental estimated cost of $60 billion compared with the normal population. The number of outpatient brain magnetic resonance imaging or computed tomography scans per patient ranged anywhere from 1 to 20, while the number of inpatient brain magnetic resonance imaging or computed tomography scans per patient ranged anywhere from 1 to 6. A heat map of the total cost expenditure indicated that the costs were concentrated around the Midwest, Lake Michigan, and the East Coast.Conclusions and RelevanceIn this economic evaluation, the 3 most common causes of recurrent vertigo—MD, VM, and BPPV—had considerable medical costs associated with them. Extraneous imaging orders and vestibular testing are factors to consider for cost reduction. However, further research and widespread education is needed to optimize the diagnosis, treatment, and care of patients presenting with vestibular disorders or dizziness.

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The Epidemiology of Vestibular Migraine: A Population-based Survey Study

Abstract: Using a representative database, we found a much higher prevalence of VM in the United States than previously reported. Results from this study indicate likely under-diagnosis of VM.

Cited by 172 publications

References 22 publications

Temporal Patterns of Vertigo and Migraine in Vestibular Migraine

Temporal Patterns of Vertigo and Migraine in Vestibular Migraine

The Spectrum of Vestibular Migraine: Clinical Features, Triggers, and Examination Findings

Assessment of the Cost Burden of Episodic Recurrent Vestibular Vertigo in the US

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