Occipital Headaches More Common in Patients With vs Without Vestibular Migraine

Compared with patients with migraine without vestibular symptoms, those with vestibular migraine (VM) are more likely to experience headaches in the occipital region, according to study results published in Headache.

The study was a cross-sectional retrospective analysis of medical charts of 169 patients seen at 2 headache clinics between January 2008 and April 2014. Specifically, the investigators assessed the location of the headache in patients with migraine with VM (n=103) vs without vestibular symptoms (M group) (n=66). Questionnaires were used to obtain information about headaches for each patient. Additional secondary outcomes assessed were the association between VM and sex, age of headache onset, age of vestibular symptom onset, aura, motion sickness, other associated symptoms, and family history of headaches and motion sickness.

A significantly greater percentage of patients in the VM group vs those in the M group had a headache in the occipital region (44% vs 18%, respectively; odds ratio [OR], 3.5; 95% CI, 1.7-7.2; P <.001). The age of onset of vestibular symptoms was also significantly later than headache onset in the VM vs M group (32±12 vs 3 years, respectively; P =.005). There was no significant difference between women and men in terms of the age of headache onset in the M group (18±8 vs 17±12 years, respectively; P =.914). However, the age of headache onset was significantly earlier in women than men in the VM group (26±11 vs 34±14 years, respectively; P =.012)

Patients in the VM group were also significantly older than those in the M group at headache onset (28±12 vs 18±9 years, respectively; P <.001) and were more likely to report motion sickness since childhood (42% vs 2%, respectively; P <.001). No difference was found between the 2 groups of patients with regard to family history of headache. A significantly greater percentage of patients with vs without vestibular symptoms reported a family history of motion sickness (30% vs 3%, respectively; OR, 13.48; 95% CI, 3.47-58.61; P <.001).

In addition, no difference was found between the groups in terms of headache frequency (P =.82). Patients with vs without vestibular symptoms reported significantly less aura (2% vs 23%, respectively; OR, 0.07; 95% CI, 0.01-0.27; P <.001) and vomiting (24% vs 41%, respectively; OR, 0.46; 95% CI, 0.24-0.92; P <.034).

Study limitations included its retrospective nature and the reliance on different types of questionnaires between the 2 clinics. Investigators noted that the study sample did not reflect the estimated percentage of patients with VM vs those with migraine without vestibular symptoms in the general population.

According to the investigators, findings from this study support work for a future “prospective study investigating whether a patient who develops migraine headache later in life, has pain localized in the back of the head, and has a history of motion sickness is more likely to suffer from vestibular migraine at a later age.”

Reference

Wattiez A-S, O’Shea SA, Eyck PT, et al. Patients with vestibular migraine are more likely to have occipital headaches than those with migraine without vestibular symptoms. Headache. Published online July 25, 2020. doi:10.1111/head.13898