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Vertigo
Published in Alexander R. Toftness, Incredible Consequences of Brain Injury, 2023
Migraines can also be associated with vertigo in a condition called vestibular migraine (see Migraine Headaches). People with this condition lose their sense of balance while they are experiencing migraine attacks, finding themselves off-balance before, during, or even after the headache (Schettino & Navaratnam, 2019). These attacks can vary in length from minutes to days (Neuhauser et al., 2001). Vertigo is also affiliated with seizures, which is sometimes called epileptic vertigo (see Seizures). In fact, vertigo or dizziness is a frequently reported symptom of epilepsy in general (Lawal & Navaratnam, 2019).
Imbalance
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
In addition to vestibular sedatives, vestibular migraine may be treated with an array of adjuncts: Domperidone, cinnarizine, and cyclizine are used for associated nausea during acute attacks.5HT1B/1D receptor agonists are used for headaches.Propranolol and pizotifen are preventive treatments.If the above fail, seek pediatric neurology input to consider the full complement of adult pharmacological therapy.
Vestibular Migraine
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
To be confident of the diagnosis of VM, note that criterion B in Box 67.4 must be fulfilled, i.e. the patient must have a history of typical migraine, although this does not necessarily need to be highly active at the time of presentation. There is also a definition of probable vestibular migraine, in which criteria A and E are fulfilled but only one of B or C. Definite vestibular migraine was found to be a highly stable and valid diagnosis over 10 years or so in a longitudinal study, with probable VM unsurprisingly much less so.5 Note also that migraine may be a risk factor for incomplete compensation from an acute vestibular episode, the pathophysiological basis for which is as yet incompletely understood.6
Central vestibular dysfunction: don’t forget vestibular rehabilitation
Published in Expert Review of Neurotherapeutics, 2022
Sulin Zhang, Dan Liu, E. Tian, Jun Wang, Zhaoqi Guo, Weijia Kong
Vestibular migraine (VM) is now a distinct disease entity as proposed by both the Barany Society and the International Headache Society [59,60]. VM patients may suffer from peripheral or central vestibular dysfunction between episodes [61,62]. The pathophysiology of VM is not fully known, and it is generally believed to involve trigemino-vascular reflex, cortical spreading depression, ion channel dysfunction, genetic factors and neurotransmitter abnormality (Figure 3) [63]. Meanwhile, the growing base of knowledge concerning migraine generally points to both central and peripheral mechanisms. In the cerebral cortex, evidence suggests that visual auras are due to cortical spreading depression, a transient reversible wave of depolarization triggered by the activation of cortical pyramidal cells [64]. The diagnosis of vestibular migraine is based on recurrent vestibular symptoms, a history of migraine, a temporal association between vestibular symptoms and migraine ones and elimination of other causes of vestibular symptoms. It mimics virtually all forms of dizziness in terms of symptoms, duration, and pattern of attacks and tends to be misdiagnosed [65,66]. The prevalence of VM is 2.7% in population studies and 10% in outpatient clinics [67–69]. For patients with VM, it is also important to consider comorbidities such as Meniere’s disease, BPPV, anxiety and depression, which significantly affect the quality of life. Subjects with VM also pose a heavy burden on the health-care system [68].
Plasma levels of inflammatory mediators in vestibular migraine
Published in International Journal of Neuroscience, 2020
Zerrin Karaaslan, Pınar Özçelik, Çağrı Ulukan, Canan Ulusoy, Kadir Serkan Orhan, Elif Kocasoy Orhan, Cem İsmail Küçükali, Erdem Tüzün, Betül Baykan, Gülden Akdal
Vertigo and migraine are both common and disabling diseases affecting a large population with a lifetime prevalence of about 7% and 16%, respectively [1]. The co-existence of these conditions is expected to occur in about 1.1% of the general population by chance [2], but physicians recognize that the association between recurrent vestibular symptoms and migraine is more frequent as well as complicated. Several studies showed consistently that vertigo is more common in migraine patients than controls while a higher prevalence of migraine has been found in patients complaining of vertigo [3–6]. In 2002, Neuhauser and colleagues defined vestibular symptoms as a part of migrainous disorder and developed diagnostic criteria for vestibular migraine (VM) [7]. After a while the Barany Society and the International Headache Society considered VM as a distinct entity and internationally proposed diagnostic criteria was recently included in the 3rd edition of the International Classification of Headache Disorders (ICHD-3) [8,9].
Dysautonomia in the pathogenesis of migraine
Published in Expert Review of Neurotherapeutics, 2018
Parisa Gazerani, Brian Edwin Cairns
Another example of a condition that may reflect ANS dysfunction is vestibular migraine; a migraine variant that is a cause of recurrent vertigo in children. In about a third of vestibular migraine patients, dizziness and vertigo, with or without phono- or photophobia, occur without headache. The vertigo and associated symptoms are often worsened by movement. As discussed, many migraineurs report dizziness and vertigo associated with their migraine, although the exact reason for this association is not clear. It is possible that interactions between the vestibular nuclei and the trigeminal sensory nucleus, perhaps at the level of the caudal parabrachial nucleus, coupled to either hyperexcitability of the vestibular or trigeminal systems, result in symptoms of dizziness and vertigo. It is also possible that the same trigeminovascular reflex that leads to dural blood vessel dilation during migraine attacks in some individuals alters blood perfusion to the vestibular apparatus. Thus, vestibular migraine could also be speculated to be due to ANS dysfunction.