Le diagnostic de la migraine vestibulaire

Diagnosis of vestibular migraine

Aug 18, 2021

An inaccurate diagnosis of vestibular migraine

No blood or imaging tests allow the diagnosis. But the International Headache Society and other organizations have recently established the first criteria to help your doctor diagnose this disorder.

Diagnosis is based on symptoms of vestibular migraine .

You might have a vestibular migraine if:

  • You have migraines or have had them in the past.
  • You have at least 5 episodes of vertigo that makes you feel like spinning or moving. It's not the same as motion sickness or fainting.
  • These sensations last between 5 minutes and 72 hours .
  • Your symptoms are moderate to severe . This means that they prevent you from carrying out your daily tasks or that they are so serious that you cannot do anything at all.
  • At least half of episodes occur with one of the following migraine symptoms :
    • A headache that has two of the following characteristics: it is unilateral, throbbing, moderate to severe, or worsens with activity.
    • Sensitivity to light or sound.
    • Vision of flickering or flashing lights (migraine aura).

Complication of vestibular migraine

Watch out for cerebrovascular accident (CVA) of the brainstem. In addition to dizziness, you may have numbness, weakness, difficulty speaking, and other symptoms of a stroke. If you experience any of these symptoms , or if you have a new, undiagnosed vertigo , call for emergency help immediately.

Diagnoses close to vestibular migraines

Meniere's disease

Ménière's disease is the main differential diagnosis.

At an early stage of the disease, it can be difficult to differentiate Ménière's disease from vestibular migraine if auditory symptoms are absent in Ménière's disease. Even in the presence of auditory symptoms, this can be difficult as auditory symptoms such as impaired hearing , tinnitus and auditory pressure were also found in 38% of patients with vestibular migraines.

To complicate matters, several studies have found a link between Ménière's disease and vestibular migraine . The prevalence of migraine in patients with Ménière's disease is twice as high as in healthy subjects, and the most reliable differentiator is low-frequency hearing loss in Ménière's disease.

A retrospective study showed that 13% of patients fulfilled the criteria for both disorders , making the differential diagnosis even more complicated. This can be explained either by a coincidence between Ménière's disease and vestibular migraine, or by the hypothesis that the hydrops (hyperpressure in the inner ear) is the consequence of a lesion of the inner ear. due to vestibular migraine. Ménière's disease and vestibular migraine have also been considered part of a broad spectrum of disorders with a possible common genetic basis .

Benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV), for example, should also be considered in the differential diagnosis in patients with attacks of positional vertigo, as BPPV is also often associated with migraine .

Anxiety is a common comorbidity of migraine and is frequently associated with vestibular disorders, especially vestibular migraines. To define this association, a new disorder called MARD (migraine-anxiety related to vertigo) has been proposed.

Thus the treatment of vestibular migraine must be specific to each patient.

dizziness illustrated with a view from below of trees

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