Age-related features in vestibular migraine onset: A multiparametric analysis

Cephalalgia ◽  
2020 ◽  
Vol 40 (14) ◽  
pp. 1605-1613 ◽  
Author(s):  
Michele Ori ◽  
Gabriele Arra ◽  
Michela Caricato ◽  
Rocco Freccia ◽  
Francesco Frati ◽  
...  
Keyword(s):  
Migraine Headache ◽  
Age Of Onset ◽  
Vestibular Migraine ◽  
Vestibular Disorders ◽  
Positional Vertigo ◽  
Multiparametric Analysis ◽  
Age Related ◽  
Vestibular Symptoms ◽  
Clinical Records ◽  
Migraine Onset

Background Clinical heterogeneity is a peculiarity of vestibular migraine, in contrast to other vestibular disorders that have a more stereotypical expression. Migraine presents a range of variability in symptoms depending on the age of the patient. Supposing that migraine headache and vestibular migraine share the same pathogenetic mechanisms, a multiparametric analysis was performed to verify the hypotheses of an age-related influence on the clinical features of vestibular migraine at the onset. Methods In this retrospective study, we analysed the clinical records of 72 consecutive patients affected by vestibular migraine from June 2012 to November 2018: 64 females and eight males; mean age 38.2 ± 9.6. We considered only patients that reported onset of vestibular symptoms within 12 months preceding inclusion into the study. Results Statistical analysis shows a significant increase in the diagnosis of probable vestibular migraine with increasing age and a decrease in vestibular migraine diagnosis ( p = 0.034). The incidence of spontaneous dizziness increases with age ( p = 0.012); by contrast, external spontaneous vertigo, and visually induced vertigo decrease after 40 years of age ( p = 0.018), clinically characterising the onset of juvenile forms. Spontaneous vertigo, head motion-induced vertigo/dizziness, and positional vertigo did not show significant variations with age. Conclusion Our data show that the type of vestibular symptoms in vestibular migraine varies according to the age of onset.

scholarly journals Rocking dizziness and headache: A two-way street

Cephalalgia ◽  
2013 ◽  
Vol 33 (14) ◽  
pp. 1160-1169 ◽  
Author(s):  
Yoon-Hee Cha ◽  
Yongyan Cui
Keyword(s):  
Migraine Headache ◽  
Prolonged Exposure ◽  
Age Of Onset ◽  
Interview Study ◽  
Vestibular Migraine ◽  
Passive Motion ◽  
Chronic Dizziness ◽  
Mal De Debarquement Syndrome ◽  
New Onset

Background Chronic rocking dizziness, often described as the feeling of being on a boat, is classically triggered by prolonged exposure to passive motion. Patients with this motion-triggered sensation of rocking, which is also known as mal de debarquement syndrome, often develop new onset headaches along with the dizziness. Chronic rocking dizziness has also been noted in vestibular migraine, occurring without a motion trigger. We sought to clarify the association between both motion-triggered (MT) and non-motion-triggered (non-MT) chronic rocking dizziness and headache history. Methods Our methods included questionnaire and interview study of subjects with either MT or non-MT chronic rocking dizziness. Results Onset of headaches was earlier in patients with non-MT rocking dizziness (median 26 years: MT; 16 years: non-MT). In MT subjects, there was a bimodal peak of age of onset of headache (20–29 years and 40–49 years). Most headache met criteria for migraine in both groups. By the time that chronic dizziness occurred, both groups had a comparable prevalence of migraine headache (41%: MT; 46%: non-MT). Pre-existing headache usually worsened after the onset of dizziness. Discussion Though rocking dizziness does not meet current criteria for vestibular migraine, migraine physiology may predispose to, develop in, or worsen with the onset of chronic rocking dizziness.

Migraine and vertigo

2020 ◽  
pp. 128-137
Author(s):  
Yoon-Hee Cha
Keyword(s):  
Migraine Headache ◽  
Clinical Characteristics ◽  
Vestibular Migraine ◽  
Headache Disorders ◽  
Temporal Profile ◽  
Growing Body ◽  
Vestibular Symptoms ◽  
The Common ◽  
Treatment Responses

The phenomena of migraine headache and vertigo share many epidemiological, anatomical, and clinical characteristics. The historically parallel development of the neuroscience of each field has formally intersected in the development of consensus criteria for vestibular migraine and the inclusion of vestibular migraine in the International Classification of Headache Disorders. Differences exist in the temporal profile of head pain and vertigo as manifestations of migraine, which can obscure the association. However, the growing body of evidence on the common demographic, neurochemical signature, and treatment responses of pain and vestibular symptoms indicate that they exist as symptoms of a common syndrome, one which can only be fully understood by recognizing the significance of each kind of manifestation.

Vestibular migraine of childhood and recurrent vertigo of childhood: Diagnostic criteria consensus document of the committee for the classification of vestibular disorders of the bárány society and the international headache society

2020 ◽  
pp. 1-9
Author(s):  
Raymond van de Berg ◽  
Josine Widdershoven ◽  
Alexandre Bisdorff ◽  
Stefan Evers ◽  
Sylvette Wiener-Vacher ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Past History ◽  
International Headache Society ◽  
Vestibular Migraine ◽  
Future Research ◽  
Vestibular Disorders ◽  
Consensus Document ◽  
Severe Intensity ◽  
Vestibular Symptoms

This paper describes the diagnostic criteria for “Vestibular Migraine of Childhood”, “probable Vestibular Migraine of Childhood” and “Recurrent Vertigo of Childhood” as put forth by the Committee for the Classification of Vestibular Disorders of the Bárány Society (ICVD) and the Migraine Classification subgroup of the International Headache Society. Migraine plays an important role in some subgroups of children with recurrent vertigo. In this classification paper a spectrum of three disorders is described in which the migraine component varies from definite to possibly absent. These three disorders are: Vestibular Migraine of Childhood, probable Vestibular Migraine of Childhood and Recurrent Vertigo of Childhood. The criteria for Vestibular Migraine of Childhood (VMC) include (A) at least five episodes with vestibular symptoms of moderate or severe intensity, lasting between five minutes and 72 hours, (B) a current or past history of migraine with or without aura, and (C) at least half of episodes are associated with at least one migraine feature. Probable Vestibular Migraine of Childhood (probable VMC) is considered when at least three episodes with vestibular symptoms of moderate or severe intensity, lasting between five minutes and 72 hours, are accompanied by at least criterion B or C from the VMC criteria. Recurrent Vertigo of Childhood (RVC) is diagnosed in case of at least three episodes with vestibular symptoms of moderate or severe intensity, lasting between 1 minute and 72 hours, and none of the criteria B and C for VMC are applicable. For all disorders, the age of the individual needs to be below 18 years old. It is recommended that future research should particularly focus on RVC, in order to investigate and identify possible subtypes and its links or its absence thereof with migraine.

scholarly journals Recurrent Vestibular Symptoms Not Otherwise Specified: Clinical Characteristics Compared With Vestibular Migraine and Menière's Disease

2021 ◽  
Vol 12 ◽  
Author(s):  
Julia Dlugaiczyk ◽  
Thomas Lempert ◽  
Jose Antonio Lopez-Escamez ◽  
Roberto Teggi ◽  
Michael von Brevern ◽  
...  
Keyword(s):  
Meniere’S Disease ◽  
Vestibular Migraine ◽  
Menière’S Disease ◽  
Meniere's Disease ◽  
Ménière’S Disease ◽  
Vestibular Disorders ◽  
Menière's Disease ◽  
Not Otherwise Specified ◽  
Ménière's Disease ◽  
Vestibular Symptoms

Despite the huge progress in the definition and classification of vestibular disorders within the last decade, there are still patients whose recurrent vestibular symptoms cannot be attributed to any of the recognized episodic vestibular syndromes, such as Menière's disease (MD), vestibular migraine (VM), benign paroxysmal positional vertigo (BPPV), vestibular paroxysmia, orthostatic vertigo or transient ischemic attack (TIA). The aim of the present international, multi-center, cross-sectional study was to systematically characterize the clinical picture of recurrent vestibular symptoms not otherwise specified (RVS-NOS) and to compare it to MD and VM. Thirty-five patients with RVS-NOS, 150 patients with VM or probable VM and 119 patients with MD were included in the study. The symptoms of RVS-NOS had been present for 5.4 years on average before inclusion, similar to VM and MD in this study, suggesting that RVS-NOS is not a transitory state before converting into another diagnosis. Overall, the profile of RVS-NOS vestibular symptoms was more similar to VM than MD. In particular, the spectrum of vestibular symptom types was larger in VM and RVS-NOS than in MD, both at group comparison and the individual level. However, in contrast to VM, no female preponderance was observed for RVS-NOS. Positional, head-motion and orthostatic vertigo were reported more frequently by patients with RVS-NOS than MD, while external vertigo was more prevalent in the MD group. At group level, the spectrum of attack durations from minutes to 3 days was evenly distributed for VM, while a small peak for short and long attacks in RVS-NOS and a big single peak of hours in MD were discernible. In general, vertigo attacks and associated vegetative symptoms (nausea and vomiting) were milder in RVS-NOS than in the other two disorders. Some patients with RVS-NOS described accompanying auditory symptoms (tinnitus: 2.9%, aural fullness and hearing loss: 5.7% each), migrainous symptoms (photophobia, phonophobia or visual aura in 5.7% each) or non-migrainous headaches (14%), but did not fulfill the diagnostic criteria for MD or VM. Absence of a life time diagnosis of migraine headache and attack duration of <5 min were further reasons not to qualify for VM. In some RVS-NOS patients with accompanying ear symptoms, attack durations of <20 min excluded them from being diagnosed with MD. These findings suggest that RVS-NOS is a stable diagnosis over time whose overall clinical presentation is more similar to VM than to MD. It is more likely to be composed of several disorders including a spectrum of mild or incomplete variants of known vestibular disorders, such as VM and MD, rather than a single disease entity with distinct pathognomonic features.

Metabolic factors in pathogenesis of migraine and unsteadiness

2021 ◽  
pp. 18-20
Author(s):  
A. S. Bedenko
Keyword(s):  
Vestibular Migraine ◽  
Common Element ◽  
Primary Headaches ◽  
Vestibular Disorders ◽  
Metabolic Factors ◽  
Meniere Disease ◽  
Positional Vertigo ◽  
Common Causes ◽  
Menière Disease ◽  
High Comorbidity

Headache and dizziness are common causes of applicion for neurological care. Migraine, being one of the most common causes of primary headaches, may lead to development of vestibular disorders both transient and persistent. Pathogenesis of vestibular migraine is poorly investigated. It is remarkable, that the high comorbidity between migraine and peripherial vestibular disorders, such as Meniere disease and benign paroxysamal positional vertigo is observed. Metabolic factors may be such an integrative common element of pathogenesis for these conditions. The crucial research works of recent years, devoted to this problem, are considered in this manuscript.

scholarly journals The Bucket Test Differentiates Patients with MRI Confirmed Brainstem/Cerebellar Lesions from Patients Having Migraine and Dizziness Alone

2019 ◽  
Author(s):  
Tzu-Pu Chang ◽  
Ariel A Winnick ◽  
Yung-Chu Hsu ◽  
Pi-Yu Sung ◽  
Michael C Schubert
Keyword(s):  
Likelihood Ratio ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Vestibular Migraine ◽  
Clinical Test ◽  
Vestibular Disorders ◽  
Clinical Exam ◽  
Neurological Exam ◽  
Vestibular Symptoms ◽  
A Prospective Study

Abstract Background: Amongst the most challenging diagnostic dilemmas managing patients with vestibular symptoms (i.e. vertigo, nausea, imbalance) is differentiating dangerous central vestibular disorders from benign causes. Migraine has long been recognized as one of the most common causes of vestibular symptoms, but the clinical hallmarks of vestibular migraine are notoriously inconsistent and thus the diagnosis is difficult to confirm. Here we conducted a prospective study investigating the sensitivity and specificity of combining standard vestibular and neurological examinations to determine how well central vestibular disorders (CVD) were distinguishable from vestibular migraine (VM). Method: Thirty symptomatic patients diagnosed with CVD and 36 symptomatic patients with VM underwent brain imaging and clinical assessments including; 1) SVV bucket test, 2) ABCD2, 3) headache/vertigo history, 4) presence of focal neurological signs, 5) nystagmus, and 6) clinical head impulse testing. Results: Mean absolute SVV deviations measured by bucket testing in CVD and VM were 4.8±4.0° and 0.7±1.0°, respectively. The abnormal rate of SVV deviations (>2.3°) in CVD was significantly higher than VM (p<0.001). Using the bucket test alone to differentiate CVD from VM, sensitivity was 73.3%, specificity 91.7%, positive likelihood ratio (LR+) 8.8, and negative likelihood ratio (LR-) 0.3. However, when we combined the SVV results with the clinical exam assessing gaze stability (nystagmus) with an abnormal focal neurological exam, the sensitivity (93.3%) and specificity (88.9%) were optimized (LR+ (8.4), LR- (0.08)). Conclusion: The SVV bucket test is a useful clinical test to distinguish CVD from VM, particularly when interpreted along with the results of a focal neurological exam and clinical exam for nystagmus.

scholarly journals The Bucket Test Differentiates Patients with MRI Confirmed Brainstem/Cerebellar Lesions from Patients Having Migraine and Dizziness Alone

2019 ◽  
Author(s):  
Tzu-Pu Chang ◽  
Ariel A Winnick ◽  
Yung-Chu Hsu ◽  
Pi-Yu Sung ◽  
Michael C Schubert
Keyword(s):  
Likelihood Ratio ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Vestibular Migraine ◽  
Clinical Test ◽  
Vestibular Disorders ◽  
Clinical Exam ◽  
Neurological Exam ◽  
Vestibular Symptoms ◽  
A Prospective Study

Abstract Background: Among the most challenging diagnostic dilemmas managing patients with vestibular symptoms (i.e. vertigo, nausea, imbalance) is differentiating dangerous central vestibular disorders from benign causes. Migraine has long been recognized as one of the most common causes of vestibular symptoms, but the clinical hallmarks of vestibular migraine are notoriously inconsistent and thus the diagnosis is difficult to confirm. Here we conducted a prospective study investigating the sensitivity and specificity of combining standard vestibular and neurological examinations to determine how well central vestibular disorders (CVD) were distinguishable from vestibular migraine (VM). Method: Twenty-seven symptomatic patients diagnosed with CVD and 36 symptomatic patients with VM underwent brain imaging and clinical assessments including; 1) SVV bucket test, 2) ABCD2, 3) headache/vertigo history, 4) presence of focal neurological signs, 5) nystagmus, and 6) clinical head impulse testing. Results: Mean absolute SVV deviations measured by bucket testing in CVD and VM were 4.8±4.1° and 0.7±1.0°, respectively. The abnormal rate of SVV deviations (>2.3°) in CVD was significantly higher than VM (p<0.001). Using the bucket test alone to differentiate CVD from VM, sensitivity was 74.1%, specificity 91.7%, positive likelihood ratio (LR+) 8.9, and negative likelihood ratio (LR-) 0.3. However, when we combined the SVV results with the clinical exam assessing gaze stability (nystagmus) with an abnormal focal neurological exam, the sensitivity (92.6%) and specificity (88.9%) were optimized (LR+ (8.3), LR- (0.08)). Conclusion: The SVV bucket test is a useful clinical test to distinguish CVD from VM, particularly when interpreted along with the results of a focal neurological exam and clinical exam for nystagmus.

scholarly journals Risk of Vestibulocochlear Disorders in Patients with Migraine or Non-Migraine Headache

2021 ◽  
Vol 11 (12) ◽  
pp. 1331
Author(s):  
Sang-Hwa Lee ◽  
Jong-Ho Kim ◽  
Young-Suk Kwon ◽  
Jae-June Lee ◽  
Jong-Hee Sohn
Keyword(s):  
Hearing Loss ◽  
Data Warehouse ◽  
Clinical Data ◽  
Migraine Headache ◽  
Vestibular Disorders ◽  
Clinical Data Warehouse ◽  
Migraine Headaches ◽  
Increased Risk ◽  
Vestibular Symptoms ◽  
Vestibular Neuronitis

Headaches, especially migraines, have been associated with various vestibular symptoms and syndromes. Tinnitus and hearing loss have also been reported to be more prevalent among migraineurs. However, whether headaches, including migraine or non-migraine headaches (nMH), are associated with vestibular and cochlear disorders remains unclear. Thus, we sought to investigate possible associations between headache and vestibulocochlear disorders. We analyzed 10 years of data from the Smart Clinical Data Warehouse. In patients with migraines and nMH, meniere’s disease (MD), BPPV, vestibular neuronitis (VN) and cochlear disorders, such as sensorineural hearing loss (SNHL) and tinnitus, were collected and compared to clinical data from controls who had health check-ups without headache. Participants included 15,128 with migraines, 76,773 patients with nMH and controls were identified based on propensity score matching (PSM). After PSM, the odds ratios (OR) in subjects with migraine versus controls were 2.59 for MD, 2.05 for BPPV, 2.98 for VN, 1.74 for SNHL, and 1.97 for tinnitus, respectively (p < 0.001). The OR for MD (1.77), BPPV (1.73), VN (2.05), SNHL (1.40), and tinnitus (1.70) in patients with nMH was also high after matching (p < 0.001). Our findings suggest that migraines and nMH are associated with an increased risk of cochlear disorders in addition to vestibular disorders.

scholarly journals Five reasons COVID-19 is less severe in younger age groups

2020 ◽  
Author(s):  
Paul W Turke
Keyword(s):  
Life History ◽  
Life History Theory ◽  
Age Of Onset ◽  
Age Groups ◽  
Medical Community ◽  
System Function ◽  
The Third ◽  
Immune System Function ◽  
Age Related ◽  
Younger Age

Abstract The severity of COVID-19 is age-related, with the advantage going to younger age groups. Five reasons are presented. The first two are well-known, are being actively researched by the broader medical community, and therefore are discussed only briefly here. The third, fourth, and fifth reasons derive from evolutionary life history theory, and potentially fill gaps in current understanding of why and how young and old age groups respond differently to infection with SARS-CoV-2. Age of onset of generalized somatic aging, and the timing of its progression, are identified as important causes of these disparities, as are specific antagonistic pleiotropic tradeoffs in immune system function.

scholarly journals The TOMM40 ‘523’ polymorphism in disease risk and age of symptom onset in two independent cohorts of Parkinson’s disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Megan C. Bakeberg ◽  
Madison E. Hoes ◽  
Anastazja M. Gorecki ◽  
Frances Theunissen ◽  
Abigail L. Pfaff ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Symptom Onset ◽  
Disease Risk ◽  
Age Of Onset ◽  
Sequencing Analysis ◽  
Age Related ◽  
Australian Cohort ◽  
Progression Markers ◽  
Age Related Cognitive Decline

AbstractAbnormal mitochondrial function is a key process in the pathogenesis of Parkinson’s disease (PD). The central pore-forming protein TOM40 of the mitochondria is encoded by the translocase of outer mitochondrial membrane 40 homologue gene (TOMM40). The highly variant ‘523’ poly-T repeat is associated with age-related cognitive decline and age of onset in Alzheimer’s disease, but whether it plays a role in modifying the risk or clinical course of PD it yet to be elucidated. The TOMM40 ‘523’ allele length was determined in 634 people with PD and 422 healthy controls from an Australian cohort and the Parkinson’s Progression Markers Initiative (PPMI) cohort, using polymerase chain reaction or whole genome sequencing analysis. Genotype and allele frequencies of TOMM40 ‘523’ and APOE ε did not differ significantly between the cohorts. Analyses revealed TOMM40 ‘523’ allele groups were not associated with disease risk, while considering APOE ε genotype. Regression analyses revealed the TOMM40 S/S genotype was associated with a significantly later age of symptom onset in the PPMI PD cohort, but not after correction for covariates, or in the Australian cohort. Whilst variation in the TOMM40 ‘523’ polymorphism was not associated with PD risk, the possibility that it may be a modifying factor for age of symptom onset warrants further investigation in other PD populations.

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