Vestibular migraine may be characterized by the occurrence of specific ictal symptoms, including triggered and spontaneous vertigo, nausea, aural symptoms, and headache, as well as common interictal symptoms, psychiatric comorbidities, and abnormal neuro-otologic findings, according to a study published in Headache.
The investigators of this retrospective, single-center study sought to characterize symptoms associated with vestibular migraine attacks (ictal symptoms), symptoms between attacks (interictal symptoms), triggers, psychiatric comorbidities, and neuro-otologic examination findings.
The study investigators identified 131 patients with vestibular migraine who were seen at the UT Southwestern Vestibular & Neuro-Visual Disorders Clinic between August 2014 and March 2018. Participants experienced disease onset at the mean age of 44.3 years and most were women (n=105). Charts were reviewed for patient characteristics and medical history, ictal symptoms (experienced during >50% of attacks), interictal symptoms, relevant family history, self-reported triggers, brain MRI or CT scans, clinical balance tests, and bedside neuro-otologic examination.
Many patients had a history of migraine (57.3%) or motion sickness (61.1%) prior to onset of vestibular symptoms; 50.8% reported a family history of migraine, and 28.1% had a family member who experienced episodic vestibular symptoms. The most common ictal symptoms were triggered and spontaneous vertigo, often accompanied by photophobia and phonophobia, which were experienced by 118 (90.1%) patients. Other ictal symptoms included nausea (51.1%), aural symptoms (60.3%), and headache (49.6%).
Visually induced interictal symptoms were experienced by 116 (88.6%) patients, while 86 (65.6%) patients reported head-motion and 67 (51.1%) patients reported persistent dizziness during the interictal period. Among psychiatric comorbidities, 92 (70.2%) patients had anxiety, 52 (40.5%) had depression, 38 (26.0%) had insomnia, 15 (11.5%) were affected by phobic disorders, and 11 (8.4%) had psychogenic disorders.
The most common triggers for vestibular migraine were
- stress (39.7%),
- bright lights (26.7%),
- weather changes (26.0%), and
- sleep deprivation (26.0%).
Abnormal neuro-otologic examinations impacted 56 (42.7%) patients, including vibration-induced nystagmus, head-shaking induced nystagmus, hyperventilation-induced nystagmus, and positional nystagmus. In balance tests, only 1 patient could not tandem walk, and the sharpened Romberg’s test was abnormal in only 22 (16.9%) patients.
A limitation to the study included data gathered from a single center, and therefore, findings may not be generalizable to other populations. Some historical data may be incomplete, and comorbidities were diagnosed by the patient’s primary physicians and may not have been based on criteria established in the Diagnostic and Statistical Manual of Mental Disorders.
The investigators found that vestibular migraine typically affects more women than men, and many patients reported a personal or family history of migraine. A range of ictal symptoms was observed, including triggered and spontaneous vertigo, nausea, aural symptoms, and headache. Interictal symptoms were common, as were comorbid psychiatric disorders and non-specific neuro-otologic findings.
Beh SC, Masrour S, Smith SV, Friedman DI. The spectrum of vestibular migraine: clinical features, triggers, and examination findings [published online February 8, 2019]. Headache. doi: 10.1111/head.13484