Vestibular migraine- a dilemma no more

Background: Vestibular migraine (VM) is an increasingly recognized cause of episodic vertigo. However, the pathophysiology of VM is still a matter of speculation and it is not known to what extent the dysfunction is located in the central or peripheral vestibular system. Though in its earlier version International Headache Society recognized only adult onset VM in the setting of basilar migraine, but in its latest 3rd edition beta version in consensus with Barany Society (2013), VM is included in the International Headache Society classification of migraine in appendix 1. It does not figure in the main list because it is yet to be validated by scientific research. Methods: The purpose of this study is to record and describe the spectrum of clinical findings of VM patients, to study the vestibular system and find out the site of vestibular dysfunction. In this study we studied 20 patients with acute VM in the symptomatic and asymptomatic phase. Results: Abnormal findings in the vestibular work up were present in all 20 VM patients (100%). Central pathology in the vestibular system was seen in 10 patients (50%), 6 patients had peripheral vestibular pathology (30%), and in 4 patients (20%) the site of vestibular dysfunction was indeterminate as they had features of both central and peripheral dysfunction and the exact site of dysfunction could not be determined with certainty. Conclusions: Acute VM should be considered in the differential diagnosis of vertigo. It can present both as a central and a peripheral vestibular disorder. However there are no definitive signs to pin-point the diagnosis. A careful clinical history combined with clinical findings and exclusion of other causes of vertigo, is fundamental for assessing the profile of patients with vestibular migraine.

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Vestibular migraine: diagnosis challenges and need for targeted treatment

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20160037 ◽

2016 ◽

Vol 74 (5) ◽

pp. 416-422 ◽

Cited By ~ 4

Author(s):

Felipe Barbosa ◽

Thaís Rodrigues Villa

Keyword(s):

General Population ◽

Diagnostic Criteria ◽

Clinical Presentation ◽

Clinical History ◽

Clinical Findings ◽

Neural Mechanisms ◽

Vestibular Migraine ◽

Important Interaction ◽

Therapeutic Recommendations ◽

Variable Clinical Presentation

ABSTRACT Approximately 1% of the general population suffers from vestibular migraine. Despite the recently published diagnostic criteria, it is still underdiagnosed condition. The exact neural mechanisms of vestibular migraine are still unclear, but the variability of symptoms and clinical findings both during and between attacks suggests an important interaction between trigeminal and vestibular systems. Vestibular migraine often begins several years after typical migraine and has a variable clinical presentation. In vestibular migraine patients, the neurological and neurotological examination is mostly normal and the diagnosis will be based in the patient clinical history. Treatment trials that specialize on vestibular migraine are scarce and therapeutic recommendations are based on migraine guidelines. Controlled studies on the efficacy of pharmacologic interventions in the treatment of vestibular migraine should be performed.

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Circadian variations in occurrence and the clinical presentation of Vestibular Migraine: A retrospective study

10.21203/rs.3.rs-51224/v1 ◽

2020 ◽

Author(s):

Wei Liu ◽

Le Yang ◽

Hongli Dong ◽

Huifeng Qian ◽

Hongru Zhao ◽

...

Keyword(s):

Retrospective Study ◽

Clinical Presentation ◽

International Headache Society ◽

Onset Time ◽

Vestibular Migraine ◽

Circadian Variations ◽

Episodic Vertigo ◽

Clinical Presentations ◽

Lack Of Sleep ◽

Vestibular Symptoms

Abstract Background: As a new clinical disease entity, vestibular migraine (VM) is considered to be the commonest cause of spontaneous episodic vertigo. This study is trying to explore the circadian variations in occurrence and the clinical presentation of VM.Methods: We conducted a retrospective study and identified female patients who fulfilled the 2012 International Headache Society-Bárány Society Criteria for VM. Population’s clinical data were collected, including onset time and descriptions of sensations experienced by our patients during VM attacks.Results: A total of 189 female VM patients were included in our study. 74.0% of attacks in VM were presented in morning hours before 12 o’clock and the peak of occurrence was at about 7 o'clock. The attack frequency reached the baseline during 12:00-23:59 while there were two abnormal upward fluctuations at about 14:00 and 20:00. The biological circadian cycles may have greater impact of VM than lack of sleep. In addition, clinical presentations of vestibular symptoms including orthostatic vertigo, visually induced vertigo and dizziness showed variations among four 6-hour quadrants per day. Conclusions: Occurrence as well as clinical presentations of vestibular symptoms exhibited circadian variations among VM patients. These data suggested that chronobiological mechanisms may play a role in vestibular migraine pathophysiology.

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Migraine-Related Vestibulopathy

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949710600302 ◽

1997 ◽

Vol 106 (3) ◽

pp. 182-189 ◽

Cited By ~ 161

Author(s):

Stephen P. Cass ◽

Jennifer K. P. Ankerstjerne ◽

Sertac Yetiser ◽

Joseph M. Furman ◽

Carey Balaban ◽

...

Keyword(s):

Panic Disorder ◽

Physical Examination ◽

Vestibular System ◽

Symptomatic Relief ◽

Vestibular Function ◽

Clinical Findings ◽

Response To Treatment ◽

Vestibular Disorders ◽

Vestibular Tests ◽

Episodic Vertigo

Migraine has been associated with specific vestibular disorders, including benign paroxysmal vertigo of childhood and benign recurrent vertigo in adults. Migraine may also play a role in chronic nonspecific vestibulopathy. Because scant data exist that describe the clinical findings and vestibular function abnormalities in suspected migraine-related vestibulopathy, we reviewed the history, physical examination, vestibular tests (electronystagmography, rotational chair, posturography), and response to treatment of 100 patients with diagnoses of migraine-related vestibulopathy. Dominant clinical features included chronic movement-associated dysequilibrium, unsteadiness, space and motion discomfort, and occasionally, episodic vertigo as an aura prior to headache, or true vertigo without headache. Common vestibular test abnormalities included a directional preponderance on rotational testing, unilateral reduced caloric responsiveness, and vestibular system dysfunction patterns on posturography. Treatment was usually directed at the underlying migraine condition by identifying and avoiding dietary triggers and prescribing prophylactic anti-migraine medications. Symptomatic relief was also provided using anti-motion sickness medications, vestibular rehabilitation, and pharmacotherapy directed at any associated anxiety or panic disorder.

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Neuralgic amyotrophy: an underrecognized entity

Journal of International Medical Research ◽

10.1177/03000605211006542 ◽

2021 ◽

Vol 49 (4) ◽

pp. 030006052110065

Author(s):

Tae Uk Kim ◽

Min Cheol Chang

Keyword(s):

Clinical Practice ◽

Magnetic Resonance ◽

Clinical Manifestations ◽

Clinical History ◽

Cervical Radiculopathy ◽

Sudden Onset ◽

Clinical Findings ◽

Magnetic Resonance Neurography ◽

Essential Information ◽

Neuralgic Amyotrophy

Neuralgic amyotrophy (NA) is markedly underdiagnosed in clinical practice, and its actual incidence rate is about 1 per 1000 per year. In the current article, we provide an overview of essential information about NA, including the etiology, clinical manifestations, diagnostic investigations, differential diagnosis, treatment, and prognosis. The causes of NA are multifactorial and include immunological, mechanical, or genetic factors. Typical clinical findings are a sudden onset of pain in the shoulder region, followed by patchy flaccid paralysis of muscles in the shoulder and/or arm. A diagnosis of NA is based on a patient’s clinical history and physical examination. Gadolinium-enhanced magnetic resonance imaging and high-resolution magnetic resonance neurography are useful for confirming the diagnosis and choosing the appropriate treatment. However, before a diagnosis of NA is confirmed, other disorders with similar symptoms, such as cervical radiculopathy or rotator cuff tear, need to be ruled out. The prognosis of NA depends on the degree of axonal damage. In conclusion, many patients with motor weakness and pain are encountered in clinical practice, and some of these patients will exhibit NA. It is important that clinicians understand the key features of this disorder to avoid misdiagnosis.

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Skull Vibration-Induced Nystagmus Test (SVINT) in Vestibular Migraine and Menière’s Disease

Audiology Research ◽

10.3390/audiolres11040054 ◽

2021 ◽

Vol 11 (4) ◽

pp. 603-608

Author(s):

Roberto Teggi ◽

Omar Gatti ◽

Marco Familiari ◽

Iacopo Cangiano ◽

Mario Bussi

Keyword(s):

Meniere’S Disease ◽

Vestibular Migraine ◽

Menière’S Disease ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Menière's Disease ◽

Episodic Vertigo ◽

Ménière's Disease ◽

Low Sensitivity ◽

Vestibular Pathways

Background: Vestibular migraine (VM) and Menière’s disease (MD) are the two most frequent episodic vertigo apart from Benign Paroxysmal Positional Vertigo (BPPV) differential diagnosis for them may be troublesome in the early stages. SVINT is a newly proposed vestibular test, which demonstrated to be fast and reliable in diagnoses above all of peripheral vestibular deficits. Methods: We retrieved clinical data from two groups of subjects (200 VM and 605 MD), enrolled between 2010 and 2020. Among others, these subjects were included when performing a SVINT. The purpose of the study is to assess if SVINT can be useful to differentiate the two episodic disorders. Results: 59.2% of MD subjects presented as positive with SVINT while only 6% did so with VM; among other tests, only video HIT demonstrated a different frequency in the two groups (13.1% and 0.5%, respectively), but the low sensitivity in these subjects makes the test unaffordable for diagnostic purposes. Conclusions: Since SVINT demonstrated to be positive in a peripheral vestibular deficit in previous works, we think that our data are consistent with the hypothesis that, in the pathophysiology of VM attacks, the central vestibular pathways are mainly involved.

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USE OF FLUNARIZINE AS A PREVENTIVE FOR VESTIBULAR MIGRAINE CRISES IN COMPARISON WITH OTHER DRUGS: SYSTEMATIC LITERATURE REVIEW

10.1101/2021.11.13.21266224 ◽

2021 ◽

Author(s):

Lara Estupina Braghieri ◽

Paula Lopes ◽

Osmar Person ◽

Fernando Junior ◽

Priscila Bogar

Keyword(s):

Literature Review ◽

Systematic Literature Review ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Vestibular Migraine ◽

Moderate Degree ◽

Level Of Evidence ◽

Grade Method ◽

Episodic Vertigo ◽

Preventive Drug

INTRODUCTION: Vestibular migraine is the main cause of episodic vertigo and the second most common cause of dizziness in adults. Treatment for vestibular migraine encompasses the prevention of crises and the control of acute symptoms. Flunarizine works by preventing the contraction of labyrinthine vessels and altering blood flow, thus preventing symptoms. Due to the high prevalence of the disease, its negative impacts on individual health and increased expenditure on public health, preventive pharmacological and non-pharmacological treatment must be implemented early. PURPOSE: To evaluate the efficacy of Flunarizine as a preventive for migraine and vestibular crises compared to other preventive drugs. MATERIAL AND METHODS: Scientific articles were searched in the databases using the terms (vestibular migraine OR migrainous vertigo) AND (flunarizine) AND (prophylaxis). Subsequently, a systematic literature review and meta-analysis was performed, including 3 randomized clinical trials comparing flunarizine and other preventive drugs in terms of efficacy and safety for preventing migraine vertigo attacks. The studies were analyzed using a ROB table, analysis using the GRADE method and meta-analysis. RESULTS: Qualitatively, the analysis showed that flunariniza was positive for decreasing the frequency of vertigo in cases of vestibular migraine, with a moderate degree of evidence, a relative risk of 0.34 and a confidence interval of 0.15 to 0.76. CONCLUSIONS: There are few studies available in the scientific literature on the use of flunarizine in vestibular migraine, many of which are heterogeneous among themselves, mainly in the way of evaluating and monitoring patients, carried out mainly through subjective methods. The meta-analysis showed a positive result for flunarizine as a preventive drug for the studied population. Furthermore, in all the studies analyzed, no serious side effects resulting from the use of the medication were reported, which makes it safe for patients to use. Flunarizine is a good drug for the prevention of vestibular migraine, especially in reducing the number of attacks, with a good level of evidence.

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Delay in presentation of acute ischemic stroke in Lahore General Hospital, Lahore

Annals of King Edward Medical University ◽

10.21649/akemu.v11i3.1013 ◽

2016 ◽

Vol 11 (3) ◽

Author(s):

Rafiq A Basharat ◽

Kamran Rashid Mirza ◽

Muhammad Yousuf Qamar

Keyword(s):

Emergency Department ◽

Ischemic Stroke ◽

Ct Scan ◽

Acute Ischemic Stroke ◽

General Hospital ◽

Clinical History ◽

Clinical Findings ◽

Study Data ◽

Time Interval ◽

Time Required

Objectives: To find out the time interval from onset of the symptoms to admission in the hospital of patients suffering from acute ischemic stroke, in order to assess the feasibility of thrombolytic therapy in Lahore General Hospital. Design: Hospital-based, prospective and observational study Setting: Lahore General Hospital Lahore. Duration: Six months from January - June 2004. Patients: Seventy two patients with acute ischemic stroke diagnosed on basis of clinical findings and CT scan. Methods: Patients o f a cute ischemic stroke including cerebral infarct, T IA, venous infarct and lacunar infarct were diagnosed on basis of clinical history, examination and CT scan and enrolled in the study. Data was collected on a Performa. Time taken by patients to reach hospital after onset of symptoms, distance of patients` residences from hospital, education level of patients and time required to do a CT scan after arrival of patient in hospital were studied. Results: 54.2% were male and mean age of patients was 60 years. 58 patients had cerebral infarction, TIA`s and venous infarction were 8 and 6 respectively. Delay in presentation was divided in three groups. Within three hours (hrs) 15 (21%) patients arrived. 54 and 18 patients arrived in 3-- 24 hrs group and >24 firs group. Mean distance was roughly 44 km. Mean distance for 0-3hrs, 3-24hrs and >24hrs group was 14, 35, and 85 Km respectively. Average time required to do CT scan was nine hours after arrival of patient in emergency department. Sixty-five percent of patients coming were illiterate. Conclusion: Majority of the patients with ischemic stroke present late to. emergency department. Many factors including distance from hospital, illiteracy, non-availability of ambulance services responsible for it. Evaluation-of patients and provision of urgent CT scan is required. in hospitals.

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Treatment Options for Vestibular Migraine

US Neurology ◽

10.17925/usn.2016.12.01.39 ◽

2016 ◽

Vol 12 (01) ◽

pp. 39 ◽

Cited By ~ 1

Author(s):

Steffen Naegel ◽

◽

Manjit Matharu ◽

Mark Obermann ◽

◽

...

Keyword(s):

Prophylactic Treatment ◽

International Headache Society ◽

Controlled Trial ◽

Treatment Options ◽

Evidence Base ◽

Vestibular Migraine ◽

Controlled Trials ◽

Common Cause ◽

Randomized Controlled ◽

Trial Testing

Although vestibular migraine is a common cause of vertigo, affecting approximately 1% of the Western world’s population, it remains widely under-recognized and is under-diagnosed. Diagnostic criteria for vestibular migraine were recently published in collaboration with the International Headache Society and the Bárány-Society. Trials investigating the treatment of vestibular migraine are sparse but some are now underway. This review focuses on the treatments options available for vestibular migraine, based on the existing evidence base where available. Regarding acute treatments, there are two randomized controlled trials that provide evidence for the use of triptans (zolmitriptan and rizatriptan) for the management of vestibular migraine attacks. For prophylactic treatment, the evidence base is largely non-existent, since the only multicenter randomized placebo-controlled trial testing metoprolol versus placebo is still underway. Consequently, the treatment recommendations for the prophylactic treatment of vestibular migraine are mainly based on expert opinion and the treatments guidelines for migraine with and without aura.

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STABILOMETRIC DIAGNOSIS OF VERTIGO IN ELDERLY PATIENTS WITH VESTIBULAR MIGRAINE

Успехи геронтологии ◽

10.34922/ae.2021.34.5.015 ◽

2021 ◽

pp. 771-774

Author(s):

Е.М. Илларионова ◽

Н.П. Грибова ◽

Е.Д. Голованова

Keyword(s):

Elderly Patients ◽

Quantitative Assessment ◽

Vestibular Dysfunction ◽

Vestibular Migraine ◽

Vestibular Vertigo

Цель исследования - изучение возможности компьютерной стабилометрической диагностики для объективизации головокружения у пожилых пациентов с вестибулярной мигренью. В исследование были включены 57 пожилых пациентов с вестибулярной мигренью и 57 пожилых пациентов с центральным вестибулярным головокружением без мигрени. Для объективизации головокружения применяли специализированные тесты функциональной компьютерной стабилометрии. Проведенное исследование позволило выявить особенности базовых стабилометрических параметров в специализированных тестах у пожилых пациентов, которые можно использовать для получения количественной оценки вестибулярной дисфункции и объективизации головокружения. The purpose of the study was to study the possibility of computer stabilometric diagnostics for the objectification of vertigo in elderly patients with vestibular migraine. The study included 57 elderly patients with vestibular migraine and 57 elderly patients with central vestibular vertigo, without migraine. Specialized tests of functional computer stabilometry were used to objectify vertigo. The study revealed the features of the basic stabilometric parameters in specialized tests in elderly patients, which can be used to obtain a quantitative assessment of vestibular dysfunction and objectification of vertigo.

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Using Unidirectional Rotations to Improve Vestibular System Asymmetry in Patients with Vestibular Dysfunction

Journal of Visualized Experiments ◽

10.3791/60053 ◽

2019 ◽

Author(s):

Nayer Rassaian ◽

Navid G. Sadeghi ◽

Bardia Sabetazad ◽

Kathleen M. McNerney ◽

Robert F. Burkard ◽

...

Keyword(s):

Vestibular System ◽

Vestibular Dysfunction

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