Vestibular migraine – Validity of clinical diagnostic criteria

Department of Neurology, Charité, Augustenburger Platz 1, Berlin, Germany.
Cephalalgia (Impact Factor: 4.89). 06/2011; 31(8):906-13. DOI: 10.1177/0333102411405228
Source: PubMed


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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    • "In summary, CAQEM during head impulses, which have saccade characteristics, might be an indication of small gain asymmetries and could help differentiate vestibular migraine from Menière’s disease, where clinical signs are sometimes ambiguous [20]. "
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    ABSTRACT: Catch-up saccades during passive head movements, which compensate for a deficient vestibulo-ocular reflex (VOR), are a well-known phenomenon. These quick eye movements are directed toward the target in the opposite direction of the head movement. Recently, quick eye movements in the direction of the head movement (covert anti-compensatory quick eye movements, CAQEM) were observed in older individuals. Here, we characterize these quick eye movements, their pathophysiology, and clinical relevance during head impulse testing (HIT). Video head impulse test data from 266 patients of a tertiary vertigo center were retrospectively analyzed. Forty-three of these patients had been diagnosed with vestibular migraine, and 35 with Menière's disease. CAQEM occurred in 38% of the patients. The mean CAQEM occurrence rate (per HIT trial) was 11±10% (mean±SD). Latency was 83±30 ms. CAQEM followed the saccade main sequence characteristics and were compensated by catch-up saccades in the opposite direction. Compensatory saccades did not lead to more false pathological clinical head impulse test assessments (specificity with CAQEM: 87%, and without: 85%). CAQEM on one side were associated with a lower VOR gain on the contralateral side (p<0.004) and helped distinguish Menière's disease from vestibular migraine (p = 0.01). CAQEM are a common phenomenon, most likely caused by a saccadic/quick phase mechanism due to gain asymmetries. They could help differentiate two of the most common causes of recurrent vertigo: vestibular migraine and Menière's disease.
    PLoS ONE 04/2014; 9(4):e93086. DOI:10.1371/journal.pone.0093086 · 3.23 Impact Factor
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    • "This included the measurement of the subjective visual vertical and ocular torsion for vestibular testing as well as video-oculography with caloric irrigation. The neurologists made a clinical diagnosis based on the test results and the established diagnostic criteria for the different vestibular disorders [22] [23] [24] [25] [26] [27] [28]. All psychosomatic outpatients (n = 1136) were referred by their general practitioner (GPs) or by secondary/tertiary care medical specialists. "
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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 · 2.25 Impact Factor
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    • "Vestibular migraine (VM) is the second most common cause of recurrent vertigo after benign paroxysmal positional vertigo,1) and the awareness of migraine as a major cause of dizziness is growing.2) In 2001, Neuhauser, et al.3) formulated diagnostic criteria for VM that were recently validated by the same group.4) They provide a specific category of definite VM and a tentative category of probable VM for patients who do not exhibit all features that VM typically manifests initially.3,4) "
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    ABSTRACT: ACCORDING TO PREVIOUS REPORTS, PATIENTS WITH VESTIBULAR MIGRAINE (VM) DISPLAY VARIABLE RESULTS FROM VESTIBULAR FUNCTION TESTS (VFT): central, peripheral, or normal. The aim of this study was to classify the VM patients into the three groups according to interictal VFT findings (central, peripheral or normal) and to clarify the relationship between VFT results and the clinical manifestations and prognosis in each group. We reviewed the medical records of 81 patients diagnosed as VM using the criteria of Neuhauser, et al. between December 2004 and June 2009. Patients were divided into three groups according to the results of VFT. We compared the clinical manifestations and prognosis between groups. Characteristics including dizziness, the nature of headache, associated otologic symptoms, hearing threshold, duration of illness, and recovery time were analyzed. The number of patients with central, peripheral vestibular dysfunction and normal finding in VFT were 15, 28, and 38 respectively. There were no significant differences in the nature of headache, associated otologic symptoms, hearing threshold, duration of illness, and recovery time. A small difference was observed in the mean age and characteristics of dizziness, but these were not significant. In patients with VM, classification according to the type of vestibular dysfunction was not helpful in the prediction of prognosis and clinical manifestations.
    Korean Journal of Audiology 04/2013; 17(1):18-22. DOI:10.7874/kja.2013.17.1.18
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