Migraine-Related Vestibulopathy

TLDR

Migraine has been linked to specific vestibular disorders such as benign paroxysmal vertigo of childhood and benign recurrent vertigo in adults, and may also contribute to chronic nonspecific vestibulopathy. The study aimed to describe the clinical findings and vestibular function abnormalities in suspected migraine‑related vestibulopathy by reviewing history, physical exam, vestibular tests, and treatment responses in 100 patients. Treatment focused on migraine management through trigger avoidance and prophylactic anti‑migraine drugs, supplemented by anti‑motion sickness agents, vestibular rehabilitation, and therapy for associated anxiety or panic disorders. Key clinical features were chronic movement‑associated dysequilibrium, unsteadiness, space and motion discomfort, and occasional episodic vertigo as aura or without headache, while vestibular tests revealed directional preponderance on rotational testing, unilateral reduced caloric responsiveness, and abnormal posturography patterns.

Abstract

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.