Vestibular migraine (VM) is a variant of migraine resulting in vestibular symptoms in addition to symptoms typical of migraine. However, without a biomarker or a complete understanding of the pathophysiology, VM remains underrecognized and underdiagnosed. Therefore, the diagnosis of VM is still challenging. Meanwhile, VM should be clearly differentiated from other similar diseases. Here, we highlight these challenges, discuss common vestibular symptoms and clinical presentations in VM, and review the current aspects of its clinical diagnosis and evaluation. The concepts related to the treatment of VM are also discussed.
Vestibular migraine and Menière’s disease have similar clinical features which are recurrent dizziness or auditory symptoms, so it is challengeable to establish the correct diagnosis. Herein, a 31-year-old male and a 56-year-old female showed recurrent dizziness with auditory symptoms and suffered from vestibular migraine. They met the diagnostic criteria for vestibular migraine, but the Menière’s diagnostic criteria were not satisfied as there was no hearing loss. Delayed intravenous gadolinium enhanced magnetic resonance imaging of the inner ear was taken to find out of correlation of the inner ear and revealed endolymphatic hydrops. This case can improve the understanding of the pathophysiology of a vestibular migraine associated Menière’s disease.
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Functional and Molecular Markers for Hearing Loss and Vertigo Attacks in Meniere’s Disease Chao-Hui Yang, Ming-Yu Yang, Chung-Feng Hwang, Kuang-Hsu Lien International Journal of Molecular Sciences.2023; 24(3): 2504. CrossRef
Objectives The purpose of this study is to investigate characteristics of nystagmus during attacks of vestibular migraine (VM), and to find a distinct clinical feature compared to other migraine and peripheral vestibular disorders.
Methods This study is a retrospective chart review of 82 patients satisfied with VM criteria, which is formulated by the new Bárány Society. Spontaneous and positional nystagmus provoked by various head positions were examined with video-nystagmography in all patients. Bithermal caloric test and cervical vestibular evoked myogenic potential test (cVEMP) were also performed. The direction and peak slow-phase velocity (SPV) of nystagmus, unilateral caloric weakness and interaural difference of cVEMP were analyzed. Control groups were lesion side in acute VN for nystagmus results and healthy side in the patients with benign paroxysmal positional vertigo of posterior semicircular canal for caloric and cVEMP results. Chi-square test and Mann-Whitney U-test were used for statistical analysis.
Results During the acute attack, nystagmus was seen in 71.9% (59 of 82) of patients. Horizontal nystagmus was the predominant type. Peak SPV in VM patients was much slower than in the control group (2.37±1.73 °/sec vs. 17.05±12.69 °/sec, p<0.0001). There was no significant difference on the result of both caloric and cVEMP test, compared to those of control groups.
Conclusion Nystagmus with horizontal directions and low SPV was dominant form in the attack of VM. Close observation of nystagmus can be helpful to make a correct diagnosis and to understand the pathomechanism of vertigo in VM.
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Citations to this article as recorded by
Vestibular Migraine: A Recent Update on Diagnosis and Treatment Young Seo Kim, Hak Seung Lee Research in Vestibular Science.2022; 21(3): 67. CrossRef