Migraine and Vertigo

Migraine and vertigo are common disorders in medicine, affecting about 14–16% and 7–10%, respectively, of the general population. Recent epidemiologic studies indicate that 3.2% of the population have both migraine and vertigo. Vertigo may occur in up to 25% of patients with migraine. Migraine is the most frequent vascular disorder causing vertigo in all age groups. Migraine leads to various central or peripheral vestibular syndromes with vertigo such as migrainous vertigo, basilar-type migraine, benign paroxysmal vertigo of childhood, and other vertigo syndromes related to migraine. Migrainous vertigo is the most common cause of spontaneous recurrent vertigo. Diagnostic criteria for migrainous vertigo have been proposed but are not included in the most recent International Headache Society classification of migraine. On the other hand, there are statistical associations between migraine and vertigo syndromes including benign paroxysmal positional vertigo, Meniere's disease, persistent cerebellar symptoms, anxiety-related dizziness, and motion sickness. Vertigo can also act as a migraine trigger. Although some mutations in the CACNA1A gene have been identified in some familial cases, the mechanism of migraine-associated vertigo is still obscure. Treatment includes vestibular suppressants for acute attacks and migraine prophylaxis for patients with frequent attacks.

Migraine-Related Vertigo: Eight Years of Experience with Pharmacologic Prophyilaxis

In 2001, our dizziness unit elaborated a diagnostic-therapeutic protocol for patients affected by migraine-related vertigo (MRV). This protocol contemplated the selection from March 2001 to December 2009 of 98 patients affected by MRV out of 1357 consecutive patients who came to our dizziness unit and the administration of pharmacologic prophylaxis. The results obtained constitute the object of this prospective, observational study. The efficacy of a 6-month treatment was registered by the patients by means of a self-assessment questionnaire where the results were divided into 5 categories, and, in case of patients with recurrent vertiginous attack, we recorded the percentage of the reduction in the frequency of the attacks. Of the sixty-four patients who completed the treatment, 43 (67.2%) reported complete resolution or substantial control, and, of the 57 patients suffering from recurrent vertigo attacks, 44 (77.2%) reported a reduction in the frequency of the attacks of at least 50%.