Nearly a third of patients with migraine were found to experience vestibular-type episodic vertigo before and/or during an acute attack, according to a study published in the Journal of Headache and Pain.
Episodic vertigo is not currently classified as a migraine variant or equivalent in the International Classification of Headache Disorders, 3rd edition. Investigators sought to examine whether episodic vertigo was associated with acute migraine.
For this prospective re-analysis of data from the Migraine and Neck Pain Study, investigators examined questionnaire responses from 487 participants (73.1% women; age 18-65 years; mean age, 38 years; mean age at migraine onset, 21 years; median migraine days per month, 6) diagnosed with migraine with or without aura. Questions dealt with the occurrence of episodic vertigo and its relation to an acute attack. Migraine attacks were divided into 3 time periods: headache onset, 0 to 2 hours after onset, and 2 to 48 hours prior to onset.
There were 375 (77%) and 112 (23%) individuals with migraine with and without aura, respectively. A total of 146 (30%) patients experienced episodic vertigo at any time during an acute attack, 79 (16.2%) patients reported detecting episodic vertigo symptoms at headache onset, 51 (10.5%) individuals noticed episodic vertigo less than 2 hours before onset, and 16 (3.3%) patients reported experiencing episodic vertigo 2 to 48 hours before the start of a headache (ie, prodromal or premonitory symptoms). In the latter 2 groups, episodic vertigo progressed to the headache phase in 100% and 18.8% of individuals, respectively.
Based on reporting of photophobia and/or phonophobia by 16.6% and 14.3% of patients, respectively, 130 (26.7%) participants qualified for a definitive or likely diagnosis of vestibular migraine, supporting a possible clinical association between migraine and vertigo. In all 3 groups of patients experiencing episodic vertigo, there was a strong association between episodic vertigo and neck pain (P =.015).
Study strengths include a high participation rate, low selection bias, and reliable symptom timing documentation. Study limitations include the lack of e-diary use, the inability to perform physical examinations, and the possibility that some reported episodic vertigo episodes were actually cases of nonvertiginous “dizziness.”
“Our results seem to further support the concept that vertigo in migraine is best thought of as an integral manifestation of migraine, rather than a prodromal or aura symptom,” suggested the authors. They recommended that future research look to clarify vestibular dysfunction mechanisms and focus on migraineur vertigo duration and character.
Lampl C, Rapoport A, Levin M, Bräutigam E. Migraine and episodic vertigo: a cohort survey study of their relationship. J Headache Pain. 2019;20(1):33.