Vestibular migraine patients are more anxious than migraine patients without vestibular symptoms

Kutay, Özge; Akdal, Gülden; Keskįnoğlu, Pembe; Balci, Birgül; Alkın, Tunç

doi:10.1007/s00415-017-8439-6

Cited by 33 publications

(25 citation statements)

References 28 publications

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“…The special temporal patterns of vertigo and migraine make it difficult for many clinicians to accurately diagnose VM, and patients usually undergo a painful and protracted course until they visit a headache or vertigo specialist. During the course, VM patients are usually anxious about unexpected and intense vertigo attacks, afraid of falling and avoid going out or entering various environments triggering dizziness (Kutay et al, 2017). Additionally, many of them complain of decreased daily activities and nearly constant dizziness and lightheaded (von Brevern and Lempert, 2016).…”

Section: Discussionmentioning

confidence: 99%

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: 99%

Temporal Patterns of Vertigo and Migraine in Vestibular Migraine

et al. 2020

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“…Similar to its use in the treatment of migraine, venlafaxine is a safe and effective medication for the prophylaxis of VM. It is well known that the link between vertigo and anxiety, VM patients were more anxious than migraine patients without vestibular symptoms ( 21 , 22 ). As a medication to treat anxiety, it has obvious effects on emotional symptom relief that differ from the other medications investigated in the current study.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Venlafaxine, Flunarizine, and Valproic Acid in the Prophylaxis of Vestibular Migraine

Liu

Che

et al. 2017

Front. Neurol.

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BackgroundDifferent types of medications are currently used in vestibular migraine (VM) prophylaxis, although recommendations for use are generally based on expert opinion rather than on solid data from randomized trials. We evaluated the efficacy and safety of venlafaxine, flunarizine, and valproic acid in a randomized comparison trial for VM prophylaxis.MethodsSubjects were randomly allocated to one of three groups (venlafaxine group, flunarizine group, and valproic acid group). To assess the efficacy of treatment on vertigo symptoms, the following parameters were assessed at baseline and 3 months after treatment: Dizziness Handicap Inventory (DHI) scores, number of vertiginous attacks in the previous month, and Vertigo Severity Score (VSS). Adverse events also were evaluated.ResultsA decrease in DHI total scores was shown following treatment with all three medications, with no obvious differences between the groups. Treatment effects differed, however, in the DHI physical, functional, and emotional domains with only venlafaxine showing a decreased effect in all of three domains. Flunarizine and valproic acid showed an effect in only one DHI domain. Venlafaxine and flunarizine showed decreased VSS scores (p = 0 and p = 0.03, respectively). Although valproic acid had no obvious effect on VSS (p = 0.27), decreased vertigo attack frequency was observed in this group (p = 0). Venlafaxine also had an effect on vertigo attack frequency (p = 0), but flunarizine had no obvious effect (p = 0.06). No serious adverse events were reported in the three groups.ConclusionOur data confirm the efficacy and safety of venlafaxine, flunarizine, and valproic acid in the prophylaxis of VM, venlafaxine had an advantage in terms of emotional domains. Venlafaxine and valproic acid also were shown to be preferable to flunarizine in decreasing the number of vertiginous attacks, but valproic acid was shown to be less effective than venlafaxine and flunarizine to decrease vertigo severity.Trial registrationChiCTR-OPC-17011266 ().

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“…Several authors have described an accompanying Alice in Wonderland Syndrome -a rare and fascinating sensory perception disorder, with the symptoms of visual distortions, extrapersonal misperceptions, or somesthetic distortions [16,45]. Some studies show that VM patients are significantly more anxious and agoraphobic, have depression symptoms and insomnia, have higher sensitivity to separation, and are prone to seek medical reassurance [16,46].…”

Section: Other Symptomsmentioning

confidence: 99%

Vestibular migraine — an underdiagnosed cause of vertigo. Diagnosis and treatment

Nowaczewska

2020

Neurol Neurochir Pol.

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Introduction. Migraine and vertigo are two common conditions. The main disorder connecting both these entities is vestibular migraine (VM). State of the art. VM may affect 1-3% of the general population. It is a disabling disease of recurrent attacks of vestibular symptoms accompanied by migraine features which occur in patients with a current or previous history of migraine. The episodes can last minutes, hours or even days, and may occur without any concurrent headache, which can prompt misdiagnosis. VM often begins several years after a typical migraine, and the delay between onset of headache and vertigo may be long. The diagnosis is based on the patient's clinical history and can be challenging due to the lack of an established confirmatory diagnostic test or biomarkers. The mechanism of vestibular migraine remains unclear and is still under investigation, but it seems to be an interaction between trigeminal and vestibular systems. Due to the lack of specific trials, treatment recommendations are based on migraine guidelines. Several drugs seem to be effective, although there have been few randomised controlled trials in this area. Regardless of the published strict and detailed diagnostic criteria, this condition remains little known, and as a consequence is underdiagnosed and undertreated. Clinical implications. Efforts should be made to educate medical communities and patients about this disease and to encourage neurologists and ENT specialists to cooperate. Every patient with vertigo of unknown origin should be directly asked about a past or present history of migraine, or migraine symptoms experienced during their vertigo episodes. Future directions. There is a growing need for studies regarding the pathophysiology of VM as well as randomised trials to establish clear treatment recommendations and to improve management of this surprisingly common disorder.

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Vestibular migraine patients are more anxious than migraine patients without vestibular symptoms

Cited by 33 publications

References 28 publications

Temporal Patterns of Vertigo and Migraine in Vestibular Migraine

Temporal Patterns of Vertigo and Migraine in Vestibular Migraine

The Efficacy of Venlafaxine, Flunarizine, and Valproic Acid in the Prophylaxis of Vestibular Migraine

Vestibular migraine — an underdiagnosed cause of vertigo. Diagnosis and treatment

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