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Vertigo, Dizziness Often Reported
With Migraine, but Are They Related |
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BY MAURY BREECHER
Contributing Writer |
SCOTTSDALE, ARIZ. (ECCC)—
Because a significant portion of migraineurs also report having
dizziness or vertigo at the same time as their headache, one of
the first important features of diagnosis is to determine
whether the dizziness or vertigo is connected with the migraine,
said Dr. Jan Lewis Brandes on February 20 during a headache
conference presented by the Diamond Headache Clinic Research and
Educational Foundation.
“The epidemiologic association between migraine and vertigo has
been established and suggests that migrainous vertigo affects a
significant proportion of patients presenting with headache and
dizziness to outpatient clinics,” said Dr. Brandes, an assistant
clinical professor of neurology at Vanderbilt University,
Nashville (Neurology 2001;56:684-686).
She pointed out that vertigo and dizziness can be two completely
separate disorders in an individual patient and be presented in
the same patient by chance, or they may be related.
“Migraineurs frequently have dizziness and vertigo as part of
their initial symptomatology and these complaints can range from
vague symptoms of disequilibrium or unsteadiness to profound
vertigo,” Dr. Brandes continued.
She said it may be useful to categorize the association of
migraine with vertigo in one of three categories: migrainous
vertigo or vertigo that is causally related to migraine; vertigo
syndromes not part of migraine but statistically associated with
it; and vertigo that simply coexists by chance in a migraine
patient (Cephalalgia 2004;24:83-91).
The current International Headache Society (IHS) classification
of migraine refers to vertigo as a feature of migraine only in
the classification of basilar migraine where vertigo may occur
as an aura. However, published case series have included vertigo
in association with migraine under various clinical entities,
including benign recurrent vertigo, migraine associated
dizziness, vestibular migraine, and migraine-related
vestibulopathy.
“Migrainous vertigo does appear more common in patients without
aura than in patients who have migraine with aura,” Dr. Brandes
continued.
In one report from a dizziness clinic, the three most common
diagnoses in patients presenting with vestibular symptoms were
benign positional vertigo, psychiatric dizziness due to panic
disorder or depression, and migrainous vertigo.
According to Dr. Brandes, a differential diagnosis of migrainous
vertigo must include common causes of recurrent vertigo, such as
vertigo secondary to infection, autoimmune inner ear disease,
labyrinthine infarction, vestibular neuritis, cerebella infarct
or hemorrhage, brain stem infarct, multiple sclerosis, and
Arnold Chiari malformation.
She added that propranolol, metoprolol, and acetazolomide have
all been used successfully in the treatment of migrainous
vertigo.
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