Migraine-Associated Vertigo

Excerpt

Vertigo is defined as a sensation or feeling of motion, especially spinning, when there is no actual movement of the patient or their surroundings. Migraine-associated vertigo occurs when vertigo is the main symptom of the patient's migraine presentation. This type of migraine is now more uniformly referred to as vestibular migraine (VM). Older terms for this condition include migraine-associated vertigo, migraine-related vestibulopathy, and migrainous vertigo.

In VM, patients often experience a sensation described as a "to-and-fro" motion, which can complicate the diagnosis process. Simultaneous headaches do not always accompany these vestibular symptoms. Consequently, a detailed patient history and comprehensive multispecialty evaluation are pivotal for an accurate diagnosis.

In the International Classification of Headache Disorders (ICHD), third edition, the International Headache Society categorized migraines into distinct diagnoses. Notably, only benign paroxysmal vertigo of childhood-type and basilar-type migraine were classifications that included vertigo. Historically, the Neuheuser criteria held widespread acceptance for classifying dizziness related to migraines. This system divided VM into "definite" and "probable" disease categories.

Definite VM criteria include:

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

1. Current or previous history of migraine with or without aura according to the ICHD.

1. Presence of 1 or more migraine features with at least 50% of the vestibular episodes, including:

   1. Headache with at least 2 of the following characteristics: 1-sided location, pulsating quality, moderate or severe pain intensity, aggravation by routine physical activity

   2. Photophobia and phonophobia

   3. Visual aura

1. Symptoms should not be better explained by another vestibular or ICHD diagnosis.

The diagnostic criteria for probable VM include:

1. Experiencing at least 5 episodes with moderate or severe intensity vestibular symptoms, lasting 5 min to 72 hours.

1. Fulfilling only 1 of the criteria B and C for vestibular migraine (either a migraine history or migraine feature during the episode).

1. Symptoms should not be more accurately explained by another vestibular or ICHD diagnosis.

In 2018, the International Headache Society replaced the definite and probable diagnostic criteria for VM with updated guidelines. The pivotal element of these new and broadly accepted criteria is the requirement of at least 5 episodes of vestibular symptoms of moderate or severe intensity, lasting 5 minutes to 72 hours.