An Insight about Vestibular Migraine; Diagnosis and Management

Abstract

Vestibular migraine (VM) is a syndrome characterized by recurrent episodes of vertigo or other vestibular symptoms attributed to migraine.Since 1984 several studies have investigated the association of vestibular symptoms and migraine in adults.The International Headache Society and the International Ba´ra´ny Society for Neurotology have developed a consensus document with diagnostic criteria for VM.The mechanisms underlying vestibular dysfunction that are related to migraine still need further study and clarification. One explanation proposed is a parallel activation of vestibular and cranial nociceptive pathways.Laboratory tests such as posturography, measurements of vestibular evoked myogenic potentials (VEMPs) and subjective visual vertical (SVV) have been used in different studies, but the results have been inconsistent.Meniere’s disease is the main differential diagnosis. At an early stage of the disease it may be difficult to differentiate Meniere’s disease from VM if aural symptoms are absent in Meniere’s disease. Even with the presence of aural symptoms it may be difficult since auditory symptoms like hearing disturbances, tinnitus, and aural pressure have also been found in 38 % of VM patients.Only a few randomized controlled clinical studies have been conducted on the specific treatment of VM: during the attack or as prophylaxis. Two of these studies addressed the use of triptans for attack therapy. One study showed that 38 % of patients with VM attacks (3 of 8 episodes) benefitted from 5 mg zolmitriptan, whereas only 22 % in the placebo group (2 of 9 episodes) showed a positive effect.Prophylactic treatment was analyzed recently in The Cochrane Collaboration for randomized controlled trials in adults with the diagnosis of VM or probable VM.