Vestibular Migraine: Clinical Challenges and Opportunities for Multidisciplinarity

Abstract

Migraine and vertigo are two very prevalent conditions in general population. The coexistence of both in the same subject is a significant clinical challenge, since it is not always possible to understand whether they are causally related or associated by chance, requiring different diagnostic and therapeutic approaches. In this review we analyze and summarize the actual knowledge about vestibular migraine (VM), focusing on the new concepts proposed by the International Classification of Headache Disorders 3-beta and by the Bárány Society and also addressing the former concepts, which are still present in clinical practice. We conclude that clinical studies using a multidisciplinary approach are crucial in this field, since different specialists observe the same pathology with different eyes. Clinical presentation of VM is variable in what concerns vestibular symptoms temporal relation with migraine headache, as well as in their accompanying manifestations. Biomarkers, either genomics or functional, and molecular imaging techniques will be helpful to clarify many aspects of the complexity of this entity, helping to define to what extent can VM be considered a separate and independent clinical entity.

Sexual dimorphism in vestibular function and dysfunction

“…Since vestibular migraine has only recently emerged as a diagnostic category, there are few epidemiological studies available at present (Luzeiro et al 2016). Nonetheless, Radtke et al (2012) reported that a vestibular migraine occurred more frequently in women during the fourth decade of life.…”

The Treatment of Vestibular Migraine: A Narrative Review

“…[ 11 ] Familial occurrence has been reported in some patients with an autosomal dominant pattern of inheritance and decreased penetrance in men. [ 12 ]…”

“…[ 13 ] The headache might be from moderate to severe. [ 12 ] However, nearly 30% of VM attacks found no associated headache. Only a quarter or less of the patients tend to have throbbing migraine attacks.…”

“…Only a quarter or less of the patients tend to have throbbing migraine attacks. [ 12 ] In addition, migraine and vertigo can never occur together. The International Headache Society (IHS) published a consensus document of diagnostic criteria for VM, which was added in the appendix of the new ICHD-3 version of the International Headache Classification[ 6 ] [ Table 1 ].…”

Research Article Study of the features of systemic dizziness in patients with chronic and recurrent migraine

“…Accurate diagnosis of vertigo in migraine is complicated by the similarity and combination of groups of symptoms. In accordance with the provisions of the International Classification of Headache, 3 rd edition (ICHD-3) published criteria for migraine-associated vertigo (migrainous vertigo, migraine-associated dizziness), developed jointly with the International society for the study of headache and the Barani Society (Furman and Balaban, 2015;Luzeiro et al, 2016;O'Connell Ferster et al, 2017;).…”