Conflict of Interest: Dr. Cohen has nothing to disclose. Dr. Bigal is a full-time employee of Merck & Co., Inc. He owns stocks and stock options of Merck. Dr. Newman reports no conflicts that relate to this subject or paper.
Migraine and Vestibular Symptoms—Identifying Clinical Features That Predict “Vestibular Migraine”
Article first published online: 7 JUN 2011
© 2011 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 51, Issue 9, pages 1393–1397, October 2011
How to Cite
Cohen, J. M., Bigal, M. E. and Newman, L. C. (2011), Migraine and Vestibular Symptoms—Identifying Clinical Features That Predict “Vestibular Migraine”. Headache: The Journal of Head and Face Pain, 51: 1393–1397. doi: 10.1111/j.1526-4610.2011.01934.x
- Issue published online: 5 OCT 2011
- Article first published online: 7 JUN 2011
- Accepted for publication April 4, 2011.
- vestibular migraine;
- atypical migraine;
- headache and vestibular symptom
Background.— Migraine and symptoms that may suggest a vestibular disorder (referred to herein broadly as vestibular symptoms—VS) often co-exist. In part due to a lack of standardized diagnostic criteria, this relationship remains unknown to many physicians.
Objective.— To determine common clinical features that may be associated with “vestibular migraine” (VM).
Methods.— We retrospectively reviewed charts of patients diagnosed with VM at a headache center. In this group we recorded certain demographic and clinical features related to their disorder, including the most common triggers of the VS and the specific characteristics of the symptoms that suggested VM.
Results.— Our sample consisted of 147 patients (68% women, mean age = 45 years, 39% with aura). Migraine onset preceded the onset of VS by a mean of 8 years. A total of 62 patients (42%) had gradual onset of VS, while in 48 (33%) symptoms began suddenly. The most commonly reported symptoms that led to the diagnosis of VM were: unsteadiness (134; 91%), balance disturbance (120; 82%), “light-headedness” (113; 77%), and vertigo (84; 57%). VS and headache occurred concomitantly in 48% of patients. A total of 67 (47%) patients had VS that were chronic from onset, 29 (21%) had episodic symptoms, and in 46 (32%) the VS had evolved from episodic to chronic (with an average duration of 7.04 years required for this evolution to occur).
Conclusions.— Vestibular migraine is a heterogeneous condition with varying symptomatology. As with migraine itself, symptomatic expression varies along a spectrum that extends from episodic to chronic. As the histories of many of the patients we evaluated would not meet current International Classification of Headache Disorders criteria, we suggest that new criteria which account for the heterogeneity and natural history of the disorder may be required to adequately diagnose and treat those who suffer from VM.