Neuropediatrics 2014; 45 - fp004
DOI: 10.1055/s-0034-1390509

Vestibular Migraine: New Entity or New Label?

M. Dieterich 1, 2, 3, M. Strupp 1, 2
  • 1German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University of Munich, Munich, Germany
  • 2Department of Neurology, Ludwig-Maximilians-University of Munich, Munich, Germany
  • 3SyNergy, Munich Cluster for Systems Neurology, Munich, Germany

About 50% of the vertigo syndromes in childhood are associated with migraine.1 The most frequent type of episodic vertigo in adults is vestibular migraine (VM). Although the clinical characteristics of VM have been known since 1999 from a study on 90 patients2 and confirmed in further clinical and epidemiological studies, the long-lasting controversy surrounding VM ended just recently in 2013. At that time, a consensus paper3 of the International Bárány Society and the International Headache Society finalized the definition of VM that now appears in the third edition of the International Classification of Headache Disorders (ICHD-3). Key symptoms are recurrent attacks of vertigo with various combinations of imbalance of stance and gait, blurred vision, brain stem signs and nausea, and vomiting associated or followed by headache (mostly occipital; absent in ∼ 30%). It is helpful for the diagnosis to know that approximately 60% of patients with VM show mild-to-moderate signs of central ocular motor disorders in the symptom-free interval (e.g., gaze-evoked nystagmus, central positional nystagmus, and impaired smooth pursuit). So far, results of prospective double-blind randomized controlled studies are not available, with the exception of one on flunarizine,4 which was shown to improve the frequency, intensity, and duration of vertigo but not the headache symptoms. Thus, on analogy with migraine without aura, a prophylactic medication is recommended for frequent attacks, for example, β-receptor blockers such as metoprolol retard, topiramate, valproic acid, lamotrigine, or flunarizine.

References

Referenzen

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2 Dieterich M, Brandt T. Episodic vertigo related to migraine (90 cases): vestibular migraine? J Neurol 1999;246(10):883–892

3 Lempert T, Olesen J, Furman J, et al. Vestibular migraine: diagnostic criteria: consensus document of the Bárány Society and the International Headache Society [Article in German]. Nervenarzt 2013;84(4):511–516

4 Lepcha A, Amalanathan S, Augustine AM, Tyagi AK, Balraj A. Flunarizine in the prophylaxis of migrainous vertigo: a randomized controlled trial. Eur Arch Otorhinolaryngol 2013; (Oct):29