Vestibular migraine - validity of clinical diagnostic criteria
ABSTRACT Clinical recognition of vestibular migraine (VM) is still hampered by the lack of consensus diagnostic criteria. The aim of this study is a long-term evaluation of clinical criteria for definite (dVM) and probable (pVM) vestibular migraine.
We re-assessed 75 patients (67 women, age 24-76 years) with dVM (n=47) or pVM (n=28) according to previously published criteria after a mean follow-up of 8.75±1.3 years. Assessment included a comprehensive neurotological clinical examination, pure tone audiometry and caloric testing.
dVM was confirmed in 40 of 47 patients with a prior diagnosis of dVM (85%). Fourteen of 28 patients initially classified as pVM met criteria for dVM (50%), nine for pVM (32%). Six additional patients with dVM and two with pVM had developed mild sensorineural hearing loss, formally fulfilling criteria for bilateral Menière's disease (MD), but had clinical features atypical of MD. Seven of these also met criteria for dVM at follow-up. The initial diagnosis was completely revised for four patients.
Although VM diagnosis lacks a gold standard for evaluation of diagnostic criteria, repeated comprehensive neurotological evaluation after a long follow-up period indicates not only high reliability but also high validity of presented clinical criteria (positive predictive value 85%). Half of patients with pVM evolve to meet criteria for dVM. However, in a subgroup of VM patients with hearing loss, criteria for dVM and MD are not sufficiently discriminative.
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ABSTRACT: Given the prevalence and costs of somatoform disorders, it is important to identify and adequately treat these patients as early as possible. Instruments assessing experiences, perceptions, and behaviors of somatoform disorders are rare. In this study we evaluated the structure and validity of the German version of the Health Attitude Survey (HAS), a multidimensional self-report questionnaire for somatoform disorders. This cross-sectional study involved 1452 participants. The sample was randomly split for independent exploratory (EFA) and confirmatory factor analyses (CFA). Each of the two samples (n1=726; n2=726) included patients with organic vertigo and current mental disorders (somatoform and other mental disorders). Somatic symptom burden was assessed using the Patient Health Questionnaire (PHQ-15). The CFA did not confirm the original HAS factor structure. The EFA revealed six factors. To enhance the fit of the model, we deleted two factors with the poorest reliability and items with low factor loadings. A modified and shortened version achieved good fit indices (CFI=0.92; RMSEA=0.068). It consists of 14 instead of 27 items and four scales ("dissatisfaction with care," "frustration with ill health," "high utilization of care," "excessive health worry"). HAS subscales discriminated among somatoform patients and physically ill and/or patients with a mental but not somatoform disorder, controlled for age, sex and number of (comorbid) mental diagnoses, confirming its construct validity. A modified shortened version of the HAS appears to be a reliable, valid, and economical instrument for assessing facets of somatoform disorders or of the recently published DSM-5 Somatic Symptom Disorder.Comprehensive Psychiatry 01/2014; 55(1):155-164. DOI:10.1016/j.comppsych.2013.08.013 · 2.26 Impact Factor
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ABSTRACT: Both migraine and dizziness/vertigo rank among the most common complaints in the general population. Worldwide, the lifetime prevalence of migraine is about 14%. Approximately 20% to 30% of the general population are affected by dizziness and vertigo. Given the high prevalence of vertigo and migraine in the general population it is not surprising that many patients suffer from both symptoms. Nonetheless, in the last decade epidemiological arguments have progressively accumulated to strengthen the hypothesis that vertigo is linked to migraine beyond a mere chance concurrence. Several studies with selected patient groups have shown that the prevalence of vertigo is increased in patients with migraine. Vice versa, patients presenting to a dizziness clinic have a history of migraine more often than would be expected by chance. The epidemiological link between vertigo and migraine has recently been confirmed on the population level. The relation between vertigo and migraine is intricate. In vestibular migraine, vertigo is conceptualized as a vestibular symptom caused by migraine. Vestibular migraine is the most common cause for recurrent spontaneous vertigo with a lifetime-prevalence in the general population of about 1%. Other vestibular disorders that display an increased prevalence of migraine are benign paroxysmal positional vertigo and Menière's disease. Furthermore, migraine is associated with motion sickness, rare ataxia disorders and psychiatric syndromes that can also manifest with vertigo and dizziness.Journal of Vestibular Research 01/2011; 21(6):299-304. DOI:10.3233/VES-2011-0423 · 1.46 Impact Factor
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