Childhood vestibular symptoms may predict adult vestibular migraine

By Naveed Saleh, MD, MS, for MDLinx
Published May 1, 2018

Key Takeaways

Vestibular symptoms experienced during childhood, such as motion sickness, may predict vestibular migraine (VM) earlier in adulthood, according to authors of a recent cross-sectional study published in Headache.

“The aim of our work was to assess the features of vertiginous episodes, accompanying symptoms, familial history, and migraine precursors in a large sample of subjects with a diagnosis of definite VM,” wrote lead author Roberto Teggi, MD, San Raffaele Scientific Hospital, Milan, Italy.

Migraine and vertigo are closely linked, and patients often complain of both.

In this cross-sectional study, Dr. Teggi and colleagues enrolled 252 participants sampled from participating specialty centers in Italy and Spain between January 2016 and March 2017 (average age: 45.8 years; 84.9% women).

Before choosing subjects for their study, they performed a bedside examination, audiometric exam, and CNS MRI in each, excluding those with low-frequency sensorineural hearing loss or an MRI indicative of microischemic lesions. The authors defined VM according to criteria published by the International Classification of Headache Disorders (ICHD-III) in 2013. A senior neurologist evaluated its presence in all subjects.

All participants answered a structured questionnaire, which recorded symptoms and further characteristics of VM. The researchers distinguished the exact symptoms of vertigo—in particular, whether it was internal or external.

Subjects were queried about their age at onset of vestibular symptoms and migraines and about characteristics of the headache, such as photophobia, aura, and nausea. Data on patient demographics, familial history, and migraine precursors were also gathered.

Dr. Teggi and fellow researchers found that the average age of onset of migraine was 23 years, and the average age of onset of vertigo was 38 years. They also found that 73% of participants complained of internal vertigo and 25% reported external vertigo. Nausea was the most common accompanying symptom experienced by 59.9% of participants, followed by photophobia (44.4%).

A full 69% of participants reported a pediatric precursor to VM, with 42.8% reporting motion sickness. In addition, 73.1% of participants reported a family history of migraine and 66.2% reported episodic vertigo.

According to the researchers, it is not surprising that many participants reported a family history of both migraines and episodic vertigo. Other researchers have observed this aggregation and “both disorders may arise from the interplay between genetic predisposition and environmental factors,” they wrote.

In line with previous research, the authors found much variability in the duration of vertigo experienced by participants and categorized it as follows:

  • < 5 minutes (23%)
  • 6 to 60 minutes (21.8%)
  • 1 to 4 hours (11.5%)
  • 5 to 24 hours (17.5%)
  • up to 3 days (5.5%)
  • > 3 days (2.8%)

Dr. Teggi and colleagues also found that vestibular symptoms in childhood, or pediatric precursors, may predict VM in adulthood. More specifically, benign paroxysmal vertigo, benign paroxysmal torticollis, and motion sickness predicted a lower age of onset of vertigo in adulthood.

Most participants had lived with migraine for about 15 years before being affected by VM. Patients who experienced both simultaneously were younger.

“Our study also supports the view that an association between vestibular symptoms when patients were of pediatric age may act as a predisposing factor to develop VM at an earlier age in adulthood,” wrote the researchers, “and suggests the presence of genetic factors predisposing to vestibular disorder in this early onset VM.”

In conclusion, not only do these research findings provide clinicians a better understanding of VM, they can also help clinicians predict who is at risk for later VM.

This study was partially funded by Fondazione Italiana Cefalee.

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