Otoneurologic dysfunctions in migraine patients with or without vertigo

Augusto P Casani, Stefano Sellari-Franceschini, Alessandro Napolitano, Luca Muscatello, Iacopo Dallan
Otology & Neurotology 2009, 30 (7): 961-7

OBJECTIVE: To evaluate the neurotologic findings in patient suffering from migraine with and without vestibular symptoms.

STUDY DESIGN: Comparative cross-sectional and observational study.

SETTING: Tertiary referral center.

BACKGROUND: Migraine headache is often associated with other symptoms, including dizziness, head motion intolerance, or rotational-type vertigo. The neuro-otologic examination in migrainous patients often gives unremarkable results. To date, it is not fully understood why some migraine patients complain of vestibular symptoms and some do not, and it is not yet clear whether neuro-otologic abnormalities among migraine patients are more common in patients complaining of vestibular symptoms or whether they can be considered a hallmark of migraine itself.

MATERIALS AND METHODS: Forty-four migrainous patients were divided into 2 groups regarding the presence (22 patients, Group 1) or absence (22 patients, Group 2) of vestibular symptoms, and the results were compared with those obtained from a control group (22 normal subjects). All the patients underwent a complete neurotologic study to verify the presence of vestibular abnormalities.

RESULTS: : Neurotologic abnormalities were observed in only 34% of the total, and the incidence was very similar in the 2 groups (36.3 versus 31.8%). Central vestibular involvement was observed in 18% of Group 1 and in 18% of Group 2 patients. Peripheral vestibular involvement was demonstrated in 18% of Group 1 patients and in 16% of Group 2 patients.

CONCLUSION: Our data seem to confirm that migraine itself can affect vestibular pathways even if patients do not complain of vestibular symptoms. Vestibular examination alone does not provide enough information for a diagnosis of migrainous vertigo. A careful clinical history is fundamental for assessing the profile of patients with migrainous vertigo.

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