The Spectrum of Vestibular Migraine: Clinical Features, Triggers, and Examination Findings

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Abstract

Objective: To assess the ictal symptoms, interictal symptoms, psychiatric comorbidities, and interictal neuro-otologic examination findings in vestibular migraine (VM). Methods: Retrospective chart review of 491 patients seen from August 2014 until March 2018 at a tertiary neurology referral center for vestibular disorders to identify patients fulfilling the 2012 VM criteria. Results: One hundred and thirty-one patients (105 women) were identified. Mean age of VM onset was 44.3 (±13.7) years. Preceding the onset of vestibular symptoms, most had migraine (57.3%) and motion sickness (61.1%). It was common to have a family history of migraine (50.8%) and episodic vestibular symptoms (28.1%). Common ictal symptoms were triggered (visually induced and head-motion) and spontaneous vertigo, accompanied by photophobia and phonophobia (118/131 [90.1%] patients), nausea (105/131 [80.2%] patients), aural symptoms (79/131 [60.3%] patients), and headache (65/131 [49.6%] patients). Interictally, many experienced visually induced (116/131 [88.6%] patients), head-motion (86/131 [65.6%] patients), and persistent (67/131 [51.1%] patients) dizziness. Psychiatric comorbidities include anxiety (92/131 [70.2%] patients), depression (53/131 [40.5%] patients), insomnia (38/131 [29.0%] patients), phobic disorders (15/131 [11.5%] patients), and psychogenic disorders (11/131 [8.4%] patients). Common triggers were stress (52/131 [39.7%] patients), bright lights (35/131 [26.7%] patients), weather changes (34/131 [26.0%] patients), and sleep deprivation (34/131 [26.0%] patients). Interictal neuro-otologic examination was abnormal in 56/131 (42.7%), usually hyperventilation-induced, head-shaking-induced, vibration-induced, and positional nystagmus. The most common balance-test finding was impaired sharpened Romberg’s test (22/130 [16.9%] patients). Conclusions: In this single center study, we found that VM typically affects women in their 40s, with a personal and family history of migraine. Typical ictal symptoms were triggered and spontaneous vertigo, associated with photophobia and phonophobia, nausea, aural symptoms, and headache. Interictal vestibular symptoms, comorbid psychiatric disorders, and non-specific interictal neuro-otologic findings were common.

Original languageEnglish (US)
JournalHeadache
DOIs
StatePublished - Jan 1 2019

Fingerprint

Migraine Disorders
Hyperacusis
Psychiatry
Photophobia
Stroke
Vertigo
Head
Nausea
Ear
Headache
Comorbidity
Physiologic Nystagmus
Motion Sickness
Sleep Deprivation
Hyperventilation
Phobic Disorders
Weather
Sleep Initiation and Maintenance Disorders
Dizziness
Neurology

Keywords

  • dizziness
  • migraine
  • neuro-otology
  • vertigo
  • vestibular migraine

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

@article{4fe9691ac3b142b48b060fde8e87a90e,
title = "The Spectrum of Vestibular Migraine: Clinical Features, Triggers, and Examination Findings",
abstract = "Objective: To assess the ictal symptoms, interictal symptoms, psychiatric comorbidities, and interictal neuro-otologic examination findings in vestibular migraine (VM). Methods: Retrospective chart review of 491 patients seen from August 2014 until March 2018 at a tertiary neurology referral center for vestibular disorders to identify patients fulfilling the 2012 VM criteria. Results: One hundred and thirty-one patients (105 women) were identified. Mean age of VM onset was 44.3 (±13.7) years. Preceding the onset of vestibular symptoms, most had migraine (57.3{\%}) and motion sickness (61.1{\%}). It was common to have a family history of migraine (50.8{\%}) and episodic vestibular symptoms (28.1{\%}). Common ictal symptoms were triggered (visually induced and head-motion) and spontaneous vertigo, accompanied by photophobia and phonophobia (118/131 [90.1{\%}] patients), nausea (105/131 [80.2{\%}] patients), aural symptoms (79/131 [60.3{\%}] patients), and headache (65/131 [49.6{\%}] patients). Interictally, many experienced visually induced (116/131 [88.6{\%}] patients), head-motion (86/131 [65.6{\%}] patients), and persistent (67/131 [51.1{\%}] patients) dizziness. Psychiatric comorbidities include anxiety (92/131 [70.2{\%}] patients), depression (53/131 [40.5{\%}] patients), insomnia (38/131 [29.0{\%}] patients), phobic disorders (15/131 [11.5{\%}] patients), and psychogenic disorders (11/131 [8.4{\%}] patients). Common triggers were stress (52/131 [39.7{\%}] patients), bright lights (35/131 [26.7{\%}] patients), weather changes (34/131 [26.0{\%}] patients), and sleep deprivation (34/131 [26.0{\%}] patients). Interictal neuro-otologic examination was abnormal in 56/131 (42.7{\%}), usually hyperventilation-induced, head-shaking-induced, vibration-induced, and positional nystagmus. The most common balance-test finding was impaired sharpened Romberg’s test (22/130 [16.9{\%}] patients). Conclusions: In this single center study, we found that VM typically affects women in their 40s, with a personal and family history of migraine. Typical ictal symptoms were triggered and spontaneous vertigo, associated with photophobia and phonophobia, nausea, aural symptoms, and headache. Interictal vestibular symptoms, comorbid psychiatric disorders, and non-specific interictal neuro-otologic findings were common.",
keywords = "dizziness, migraine, neuro-otology, vertigo, vestibular migraine",
author = "Beh, {Shin C} and Shamin Masrour and Smith, {Stacy V.} and Friedman, {Deborah I}",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/head.13484",
language = "English (US)",
journal = "Headache",
issn = "0017-8748",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - The Spectrum of Vestibular Migraine

T2 - Clinical Features, Triggers, and Examination Findings

AU - Beh, Shin C

AU - Masrour, Shamin

AU - Smith, Stacy V.

AU - Friedman, Deborah I

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: To assess the ictal symptoms, interictal symptoms, psychiatric comorbidities, and interictal neuro-otologic examination findings in vestibular migraine (VM). Methods: Retrospective chart review of 491 patients seen from August 2014 until March 2018 at a tertiary neurology referral center for vestibular disorders to identify patients fulfilling the 2012 VM criteria. Results: One hundred and thirty-one patients (105 women) were identified. Mean age of VM onset was 44.3 (±13.7) years. Preceding the onset of vestibular symptoms, most had migraine (57.3%) and motion sickness (61.1%). It was common to have a family history of migraine (50.8%) and episodic vestibular symptoms (28.1%). Common ictal symptoms were triggered (visually induced and head-motion) and spontaneous vertigo, accompanied by photophobia and phonophobia (118/131 [90.1%] patients), nausea (105/131 [80.2%] patients), aural symptoms (79/131 [60.3%] patients), and headache (65/131 [49.6%] patients). Interictally, many experienced visually induced (116/131 [88.6%] patients), head-motion (86/131 [65.6%] patients), and persistent (67/131 [51.1%] patients) dizziness. Psychiatric comorbidities include anxiety (92/131 [70.2%] patients), depression (53/131 [40.5%] patients), insomnia (38/131 [29.0%] patients), phobic disorders (15/131 [11.5%] patients), and psychogenic disorders (11/131 [8.4%] patients). Common triggers were stress (52/131 [39.7%] patients), bright lights (35/131 [26.7%] patients), weather changes (34/131 [26.0%] patients), and sleep deprivation (34/131 [26.0%] patients). Interictal neuro-otologic examination was abnormal in 56/131 (42.7%), usually hyperventilation-induced, head-shaking-induced, vibration-induced, and positional nystagmus. The most common balance-test finding was impaired sharpened Romberg’s test (22/130 [16.9%] patients). Conclusions: In this single center study, we found that VM typically affects women in their 40s, with a personal and family history of migraine. Typical ictal symptoms were triggered and spontaneous vertigo, associated with photophobia and phonophobia, nausea, aural symptoms, and headache. Interictal vestibular symptoms, comorbid psychiatric disorders, and non-specific interictal neuro-otologic findings were common.

AB - Objective: To assess the ictal symptoms, interictal symptoms, psychiatric comorbidities, and interictal neuro-otologic examination findings in vestibular migraine (VM). Methods: Retrospective chart review of 491 patients seen from August 2014 until March 2018 at a tertiary neurology referral center for vestibular disorders to identify patients fulfilling the 2012 VM criteria. Results: One hundred and thirty-one patients (105 women) were identified. Mean age of VM onset was 44.3 (±13.7) years. Preceding the onset of vestibular symptoms, most had migraine (57.3%) and motion sickness (61.1%). It was common to have a family history of migraine (50.8%) and episodic vestibular symptoms (28.1%). Common ictal symptoms were triggered (visually induced and head-motion) and spontaneous vertigo, accompanied by photophobia and phonophobia (118/131 [90.1%] patients), nausea (105/131 [80.2%] patients), aural symptoms (79/131 [60.3%] patients), and headache (65/131 [49.6%] patients). Interictally, many experienced visually induced (116/131 [88.6%] patients), head-motion (86/131 [65.6%] patients), and persistent (67/131 [51.1%] patients) dizziness. Psychiatric comorbidities include anxiety (92/131 [70.2%] patients), depression (53/131 [40.5%] patients), insomnia (38/131 [29.0%] patients), phobic disorders (15/131 [11.5%] patients), and psychogenic disorders (11/131 [8.4%] patients). Common triggers were stress (52/131 [39.7%] patients), bright lights (35/131 [26.7%] patients), weather changes (34/131 [26.0%] patients), and sleep deprivation (34/131 [26.0%] patients). Interictal neuro-otologic examination was abnormal in 56/131 (42.7%), usually hyperventilation-induced, head-shaking-induced, vibration-induced, and positional nystagmus. The most common balance-test finding was impaired sharpened Romberg’s test (22/130 [16.9%] patients). Conclusions: In this single center study, we found that VM typically affects women in their 40s, with a personal and family history of migraine. Typical ictal symptoms were triggered and spontaneous vertigo, associated with photophobia and phonophobia, nausea, aural symptoms, and headache. Interictal vestibular symptoms, comorbid psychiatric disorders, and non-specific interictal neuro-otologic findings were common.

KW - dizziness

KW - migraine

KW - neuro-otology

KW - vertigo

KW - vestibular migraine

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U2 - 10.1111/head.13484

DO - 10.1111/head.13484

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