Comorbidities in vestibular migraine

Issue title: The Vestibular System: A Clinical andScientific Update in Siena In honor of Professor Daniele Nuti, Siena, Italy,April 5–6, 2013

Guest editors: Marco Mandalàx, Stefano Ramaty and David S. Zee

Article type: Research Article

Authors: Eggers, Scott D.Z.^{a; *} | Neff, Brian A.^b | Shepard, Neil T.^c | Staab, Jeffrey P.^d

Affiliations: [a] Department of Neurology, Mayo Clinic, Rochester, MN, USA | [b] Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA | [c] Division of Audiology, Mayo Clinic, Rochester, MN, USA | [d] Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA | [x] Otological and Skull Base Surgery Department, S.M. delle Scotte Hospital, Siena, Italy | [y] Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy

Correspondence: [*] Corresponding author: Scott D.Z. Eggers, Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA. Tel.: +1 507 284 4037; Fax: +1 507 284 4074; E-mail: [email protected]

Abstract: A growing body of clinical and epidemiological evidence supports a specific relationship between vestibular symptoms and migraine. Without a biomarker or complete understanding of pathophysiology, diagnosis of vestibular migraine (VM) currently depends upon symptoms in two dimensions: episodic vestibular symptoms temporally related to migraine symptoms. The Bárány Society and the International Headache Society have recently developed consensus diagnostic criteria. However, many issues remain unsettled, including the type, duration, and timing of vestibular symptoms related to headache that should be required for diagnosing VM. This paper focuses on the challenging third dimension of comorbidity, a frequent cause of diagnostic uncertainty that may confound clinical application and research validation of VM criteria. Several other neurotologic conditions occur more frequently in migraineurs than controls, including benign paroxysmal positional vertigo, Ménière's disease, and motion sickness. Patients with VM also have high rates of chronic subjective dizziness, which may be associated with anxious, introverted temperaments that can affect clinical presentation and treatment response. Broadly inclusive studies of well-characterized patients with other neurotologic and psychiatric comorbidities are needed to fully understand how vestibular symptoms and migraine interact in order to truly validate vestibular migraine, distill its essential features, define its boundaries, and characterize overlapping comorbidities.

Keywords: Vestibular migraine, comorbidity, epidemiology, validation, diagnostic criteria

DOI: 10.3233/VES-140525

Journal: Journal of Vestibular Research, vol. 24, no. 5-6, pp. 387-395, 2014