Migraine-Associated Vertigo

Book
In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
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Excerpt

Patients explain a sensation of motion when no motion is taking place or an altered sensation with a normal motion to define vertigo. In a vestibular migraine, the sensation is often described as a "to-and-fro" sensation, and this can complicate diagnosis. Simultaneous headaches do not always accompany the vestibular symptoms, thus making an in-depth history and multi-specialty evaluation pivotal in order to make a diagnosis.

The International Headache Society in the International Classification of Headache Disorders, Second Edition classified a migraine into distinct diagnoses; however, only benign paroxysmal vertigo of childhood-type and basilar-type migraine included vertigo. The Neuheuser criteria were historically the most widely accepted classifier of dizziness related to a migraine. It divided a vestibular migraine into "definite" versus "probable" disease.

Definite vestibular migraine criteria included:

  1. At least 2 vestibular vertigo attacks

  2. Migraine according to ICHD-II classification

  3. Concomitant migrainous symptoms during at least 2 vertigo attacks (migraine headache, photophobia, phonophobia, visual or other auras)

  4. No evidence of other central or otological causes of vertigo

Probable vestibular migraine diagnostic criteria included:

  1. At least 2 vestibular vertigo attacks

  2. At least 1 of the following:

  1. An ICHD-II migraine

  2. At least 1 migrainous symptom during at least 2 vertigo attacks (migrainous headaches, photophobia, phonophobia, visual or other auras)

  3. No evidence of other causes of vertigo

In 2012, definite and probable diagnostic criteria were replaced with diagnostic criteria for a vestibular migraine put forth by both the Barany Society and the International Headache Society.

The currently accepted vestibular migraine diagnostic criteria consist of the following:

  1. At least 5 episodes of vestibular symptoms of moderate or severe intensity lasting 5 minutes to 72 hours

  2. Current or previous history of migraines with or without aura according to the ICHD classification

  3. One or more of the following migraine features with at least 50% of vestibular episodes:

  1. Headache with at least 2 of the following characteristics

  2. One-sided location, pulsating quality, moderate or severe pain intensity; photophobia or phonophobia

  3. Visual aura

  1. Not better accounted for by another vestibular or ICHD diagnosis

Due to the relatively new diagnostic criteria, much of the reviewed literature is based on the Neuheuser criteria.

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