Vestibular disorders in patients with migraine

Abstract

Vestibular symptoms frequently occur in patients with migraine headache. The common migraine is defined in neurology as a unilateral, pulsating headache, which may be associated with nausea and vomiting, and lasts one or several days. In the classic form patients have visual prodromal symptoms. Focal neurological signs in the migraine complique include, for example, oculomotor palsy and vestibular abnormalities. This so-called vestibular migraine is different from basilar migraine, which involves the irritation of the cervical sympathetic system, and can cause symptoms that resemble transient brainstem ischemia. In order to evaluate vestibular dysfunction electronystagmography (ENG) was used. Patients frequently had abnormal caloric test responses, especially with a directional preponderance, and most had a spontaneous nystagmus. In the migraine attack the patients are presumed to have hypersensitivity of the labyrinth with nausea and vomiting, while in the headache-free period the ENG was almost normal. At present, we have had a high success rate in treating patients with pyracetam. Diazepam was used to treat basilar migraine and flunarizine to prevent vestibular migraine.

Vestibular disorders in migrainous children and adolescents

“…Normally, the caloric responsiveness is symmetrical in the two labyrinths. As in adults, most of the patients had central vestibular disorders [2] with pure directional preponderance in the caloric test. In childhood, the mixed type of vestibular lesion (both central and peripheral) seems to be a characteristic form of migraine-associated vestibular disease.…”

Loss of α-Calcitonin Gene-Related Peptide (αCGRP) Reduces Otolith Activation Timing Dynamics and Impairs Balance

“…It is also possible that CGRP-dependent modulation influences vestibular pathways over a shorter time scale. For instance, increased CGRP levels have been linked to migraine (Villalon and Olesen, 2009), and migraine can often by accompanied by vertigo, dizziness, nausea, and sometimes by abnormal caloric or vestibular-evoked myogenic potentials (Szirmai, 1997; Furman and Marcus, 2012; Furman et al, 2013; Lempert et al, 2013; Furman and Balaban, 2015). While we have observed rotarod balance deficits with the complete loss of CGRP, right/left imbalances between CGRP signaling in migraine feedback could also contribute to migraine-associated vertigo and balance disturbances.…”

Physical Therapy for Migraine‐Related Vestibulopathy and Vestibular Dysfunction With History of Migraine

“… 4 Often the vestibular symptoms occur during the headache, 5 although there is evidence to support that the vestibular complaints can also occur before or after the actual migraine. 3,6–8 Depending on the type of migraine, the patient may complain of dizziness or vertigo. 6,9,10 If the migraine is very severe, along with vertigo, the individual may experience nausea, vomiting, 7 motion sensitivity, 9,11–13 and postural instability.…”