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Vestibular Migraine

Vestibular Migraine

Vestibular migraine, also known as Migraine Vertigo, as defined by Neuhauser and Lempert in 2001, is a condition of episodic vertigo associated with migraine headache. The patient has dizzying symptoms and headache that precede, accompany, or follow the balance disorder. It can last from hours to days, making it extremely disabling.

Symptoms can present:

  • headset fullness
  • tinnitus
  • hearing loss (accentuated during seizures)
  • motion sickness (an important symptom capable of preceding the onset of the disease even by years)

Common features are:

  • It mainly affects young people, with a prevalence of women.
  • Very high familiarity.
  • Worsens with alcohol intake, metabolic-hormonal disorders, alteration or irregularity of the sleep-wake patterns, states of fatigue, stress or anxiety.
  • Headache / migraine may be absent during vertigo epidosed. In practice, headache / migraine and vertigo can be dissociated.
  • Often no auditory symptoms are associated, except for ear fullness which may be recurrent.
  • Vertigo episodes can be both spontaneous and positional.
  • Aura-related symptoms that may occur: phonophobia, photophobia, visual aura, etc.

The pathophysiology of VESTIBULAR MIGRAINE seems to be linked to mechanisms of SPREADING DEPRESSION, or a depressive dysfunction of the neurological wave that affects the corticovestibular system.
Alterations of neurotransmitters seem to have a significant influence (serotonin, norepinephrine, dopamine among the main ones) in causing an alteration of the vestibular balance so as to determine the onset of vertiginous syndrome.
For diagnostic purposes tests such as the functional head impulse test is instrumental.

A useful classification is the one studied by Prof. Pagnini, who distinguishes Vestibular Migraine in:

  • MAV (MIGRAINE ASSOCIATED VERTIGO): headache and vertigo occur simultaneously during the acute episode
  • MEV (MIGRAINE EQUIVALENT VERTIGO): headache and vertigo are alternate symptoms that occur at different times.

MEV can in turn be classified into Early, Intercritical and Late.

  1. Early MEV is characterized by the presence of vestibular symptoms already in infancy. Two syndromes in particular are of clinical importance: Paroxysmal Vertigo of Infancy, and Benign Paroxysmal Torticollis of Infancy. These are syndromes that in almost all cases herald a vestibular migraine in adulthood.

Paroxysmal Vertigo of Infancy occurs mainly within the first 5 years of age. Symptoms become less frequent within 10-11 years of age. Ataxia is often present with associated intense autonomic symptoms. The duration of the symptoms and the number of onset episodes are very variable.

Benign Paroxysmal Torticollis of Infancy, or Spasmodic Torticollis, is less frequent than the previous syndrome, it is characterized by a child who assumes a position with the head tilted to one side, in rotation, for a time varying between twenty minutes and a few hours. It is the result of an alteration of the otolithic system. Symptom resolution is typically spontaneous.

  1. Intercritical MEV is characterized by alternating onsets of headache / migraine and vertigo, which can occur in the postmenopausal phase and sometimes, more rarely, in pregnancy.
  2. Late MEV, or vertigo that occurs in patients whose headache or migraine symptoms have been reduced or disappeared for some time.

VESTIBULAR MIGRAINE is one of the pathologies that benefits most from