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

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.

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Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society

Journal of Vestibular Research ◽

10.3233/ves-170622 ◽

2017 ◽

Vol 27 (4) ◽

pp. 191-208 ◽

Cited By ~ 141

Author(s):

Jeffrey P. Staab ◽

Annegret Eckhardt-Henn ◽

Arata Horii ◽

Rolf Jacob ◽

Michael Strupp ◽

...

Keyword(s):

Diagnostic Criteria ◽

Vestibular Disorders ◽

Consensus Document

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Persistent Postural-Perceptual Dizziness

Seminars in Neurology ◽

10.1055/s-0039-3402736 ◽

2020 ◽

Vol 40 (01) ◽

pp. 130-137 ◽

Cited By ~ 1

Author(s):

Jeffrey P. Staab

Keyword(s):

Diagnostic Testing ◽

Multimodality Treatment ◽

Vestibular Disorders ◽

Vestibular Disorder ◽

Ongoing Research ◽

Sufficient Detail ◽

Treatment Plans ◽

Physical Examinations ◽

Vestibular Symptoms

AbstractPersistent postural-perceptual dizziness (PPPD) was defined for the International Classification of Vestibular Disorders in 2017. It is a chronic vestibular disorder that manifests with waxing and waning symptoms of dizziness, unsteadiness, or nonspinning vertigo that last for 3 months or more and are exacerbated by upright posture, active or passive motion of self, and exposure to environments with complex or moving visual stimuli. Triggers of PPPD include a wide variety of conditions that may cause vestibular symptoms or disrupt balance functioning, including neuro-otologic and other medical conditions and psychological distress. The diagnosis is made by identifying key symptoms in patients' histories and conducting physical examinations and diagnostic testing of sufficient detail to establish PPPD as opposed to other illnesses. Ongoing research is providing insights into the pathophysiological mechanisms underlying PPPD and support for multimodality treatment plans incorporating specially adapted vestibular rehabilitation, serotonergic medications, and cognitive-behavior therapy.

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Post-craniotomy headache: A proposed revision of IHS diagnostic criteria

Cephalalgia ◽

10.1111/j.1468-2982.2009.02010.x ◽

2009 ◽

Vol 30 (5) ◽

pp. 560-566 ◽

Cited By ~ 11

Author(s):

PAS Rocha-Filho ◽

JLD Gherpelli ◽

JTT de Siqueira ◽

GD Rabello

Keyword(s):

Diagnostic Criteria ◽

Short Form ◽

Past History ◽

International Headache Society ◽

Temporomandibular Disorder ◽

Mcgill Pain Questionnaire ◽

Headache Frequency ◽

Sex Type ◽

Semistructured Interviews ◽

History Of

Seventy-nine patients with intracranial aneurysms were evaluated in the presurgical period, and followed up to 6 months after surgery. We compare patients who fulfilled with those that did not post-craniotomy headache (PCH) diagnostic criteria, according to the International Classification of Headache Disorders. Semistructured interviews, headache diaries, Short Form-36 and McGill Pain Questionnaire were used. Seventy-two patients (91%) had headaches during the follow-up period. The incidence of PCH according to the International Headache Society diagnostic criteria was 40%. Age, sex, type of surgery, temporomandibular disorder, vasospasm, presence and type of previous headaches, and subarachnoid haemorrhage were not related to headache classification. There were no differences in the quality of life, headache frequency and characteristics or pain intensity between patients with headache that fulfilled or not PCH criteria. We proposed a revision of the diagnostic criteria for PCH, extending the headache outset after surgery from 7 to 30 days, and including the presence of headaches after surgery in patients with no past history of headaches, or an increase in headache frequency during the first 30 days of the postsurgical period followed by a decrease over time. Using these criteria we would classify 65% of our patients as having PCH.

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Migraine and vertigo

Oxford Textbook of Headache Syndromes ◽

10.1093/med/9780198724322.003.0013 ◽

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.

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Proposals for New Standardized General Diagnostic Criteria for the Secondary Headaches

Cephalalgia ◽

10.1111/j.1468-2982.2009.01965.x ◽

2009 ◽

Vol 29 (12) ◽

pp. 1331-1336 ◽

Cited By ~ 32

Author(s):

J Olesen ◽

T Steiner ◽

M-G Bousser ◽

H-C Diener ◽

D Dodick ◽

...

Keyword(s):

Diagnostic Criteria ◽

International Headache Society ◽

Medication Overuse Headache ◽

Good News ◽

Secondary Headache ◽

Main Body ◽

Headache Classification ◽

Secondary Headaches ◽

The Many

Headache classification is a dynamic process through clinical testing and re-testing of current and proposed criteria. After publication of the second edition of the International Classification of Headache Disorders (ICHD-II), need arose for revisions in the classification of medication overuse headache and chronic migraine. These changes made apparent a further need for broader revisions to the standard formulation of diagnostic criteria for the secondary headaches. Currently, the fourth criterion makes impossible the definitive diagnosis of a secondary headache until the underlying cause has resolved or been cured or greatly ameliorated by therapy, at which time the headache may no longer be present. Given that the main purpose of diagnostic criteria is to enable a diagnosis at the onset of a disease in order to guide treatment, this is unhelpful in clinical practice. In the present paper we propose maintaining a standard approach to the secondary headaches using a set of four criteria A, B, C and D, but we construct these so that the requirement for resolution or successful treatment is removed. The proposal for general diagnostic criteria for the secondary headaches will be entered into the internet-based version of the appendix of ICHD-II. During 2009 the Classification Committee will apply the general criteria to all the specific types of secondary headaches. These, and other changes, will be included in a revision of the entire classification entitled ICHD-IIR, expected to be published in 2010. ICHD-IIR will be printed and posted on the website and will be the official classification of the International Headache Society. Unfortunately, it will be necessary to translate ICHD-IIR into the many languages of the world, but the good news is that no major changes to the headache classification are then foreseen for the next 10 years. Until the printing of ICHD-IIR, the printed ICHD-II criteria remain in place for all other purposes. We issue a plea to the headache community to use and study these proposed general criteria for the secondary headaches in order to provide more evidence for their utility—before their incorporation in the main body of the classification.

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Altered brain network functional connectivity patterns in patients with vestibular migraine diagnosed according to the diagnostic criteria of the Bárány Society and the International Headache Society

Journal of Neurology ◽

10.1007/s00415-021-10868-0 ◽

2021 ◽

Author(s):

Zhe-Yuan Li ◽

Li-Hong Si ◽

Bo Shen ◽

Xu Yang

Keyword(s):

Functional Connectivity ◽

Diagnostic Criteria ◽

International Headache Society ◽

Brain Network ◽

Vestibular Migraine ◽

Caloric Test ◽

Cingulate Gyrus ◽

Sensorimotor Network ◽

Connectivity Patterns ◽

History Of

Abstract Background Vestibular migraine (VM) is considered one of the most common causes of episodic central vestibular disorders, the mechanism of VM is currently still unclear. The development of functional nuclear magnetic resonance (fMRI) in recent years offers the possibility to explore the altered functional connectivity patterns in patients with VM in depth. The study aimed to investigate altered patterns of brain network functional connectivity in patients with VM diagnosed based on the diagnostic criteria of the Bárány Society and the International Headache Society, and hope to provide a scientific theoretical basis for understanding whether VM is a no-structural central vestibular disease, i.e., functional central vestibular disease with altered brain function. Methods Seventeen patients with VM who received treatment in our hospital from December 2018 to December 2020 were enrolled. Eight patients with migraine and 17 health controls (HCs) were also included. Clinical data of all patients were collected. Blood pressure, blood routine tests and electrocardiography were conducted to exclude other diseases associated with chronic dizziness. Videonystagmography, the vestibular caloric test, the video head impulse test and vestibular-evoked myogenic potentials were measured to exclude peripheral vestibular lesions. MRI was utilized to exclude focal lesions and other neurological diseases. All subjects underwent fMRI. The independent component analysis was performed to explore changes in intra- and inter-network functional connectivity in patients with VM. Results Among 17 patients with VM, there were 7 males and 10 females with an average age of 39.47 ± 9.78 years old. All patients had a history of migraine. Twelve (70.6%) patients had recurrent spontaneous vertigo, 2 (11.7%) patients had visually induced vertigo, and 3 (17.6%) patients had head motion-induced vertigo. All 17 patients with VM reported worsening of dizziness vertigo during visual stimulation. The migraine-like symptoms were photophobia or phonophobia (n = 15, 88.2%), migraine-like headache (n = 8, 47.1%), visual aura during VM onset (n = 7, 41.2%). 5 (29.4%) patients with VM had hyperactive response during the caloric test, and 12 (70.6%) patients had caloric test intolerance. Eleven (64.7%) patients had a history of motion sickness. Totally 13 independent components were identified. Patients with VM showed decreased functional connectivity in the bilateral medial cingulate gyrus and paracingulate gyrus within sensorimotor network (SMN) compared with HCs. They also showed weakened functional connectivity between auditory network (AN) and anterior default mode network (aDMN) compared with HCs, and enhanced functional connectivity between AN and the salience network (SN) compared with patients with migraine. Conclusion Patients with vestibular migraine showed obvious altered functional connectivity in the bilateral medial cingulate gyrus and paracingulate gyrus within the SMN. The median cingulate and paracingulate gyri may be impaired, the disinhibition of sensorimotor network and vestibular cortical network may result in a hypersensitivity state (photophobia/phonophobia). Altered functional connectivity between AN and DMN, SN may lead to increased sensitivity to vestibular sensory processing.

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

Frontiers in Neurology ◽

10.3389/fneur.2021.674092 ◽

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.

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

10.21203/rs.2.10460/v1 ◽

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.

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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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Vestibular migraine in multicenter neurology clinics according to the appendix criteria in the third beta edition of the International Classification of Headache Disorders

Cephalalgia ◽

10.1177/0333102415597890 ◽

2015 ◽

Vol 36 (5) ◽

pp. 454-462 ◽

Cited By ~ 34

Author(s):

Soo-Jin Cho ◽

Byung-Kun Kim ◽

Byung-Su Kim ◽

Jae-Moon Kim ◽

Soo-Kyoung Kim ◽

...

Keyword(s):

Headache Disorder ◽

International Classification ◽

Vestibular Migraine ◽

Headache Disorders ◽

The Third ◽

Common Term ◽

Vestibular Symptoms ◽

The Common ◽

Probable Migraine

Background Vestibular migraine (VM), the common term for recurrent vestibular symptoms with migraine features, has been recognized in the appendix criteria of the third beta edition of the International Classification of Headache Disorders (ICHD-3β). We applied the criteria for VM in a prospective, multicenter headache registry study. Methods Nine neurologists enrolled consecutive patients visiting outpatient clinics for headache. The presenting headache disorder and additional VM diagnoses were classified according to the ICHD-3β. The rates of patients diagnosed with VM and probable VM using consensus criteria were assessed. Results A total of 1414 patients were enrolled. Of 631 migraineurs, 65 were classified with VM (10.3%) and 16 with probable VM (2.5%). Accompanying migraine subtypes in VM were migraine without aura (66.2%), chronic migraine (29.2%), and migraine with aura (4.6%). Probable migraine (75%) was common in those with probable VM. The most common vestibular symptom was head motion-induced dizziness with nausea in VM and spontaneous vertigo in probable VM. The clinical characteristics of VM did not differ from those of migraine without VM. Conclusion We diagnosed VM in 10.3% of first-visit migraineurs in neurology clinics using the ICHD-3β. Applying the diagnosis of probable VM can increase the identification of VM.

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