Vestibular migraine

Vestibular Migraine Shuu-Jiun Wang, MD College of Medicine & Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan The prevalence of vestibular migraine (VM) ranges from 1% to 2.7%. Despite migraine and vertigo are both common disorders, a close association between vestibular symptoms and migraine is beyond coincidence. VM, a clinical entity that incorporates vestibular and migrainous symptoms, is now defined by the International Headache Society and Barany Society. According to the proposed criteria, VM is defined as a migraine patient who has episodes of moderate-to-severe vestibular symptoms, and > 50% of them with migrainous headache. Diagnosis of VM depends on a thorough clinical history because there are no definitive signs nor laboratory tests. The pathophysiology still remains unknown. However, based on current understanding of migraine pathophysiology, the main hypothesis focuses on the connections between trigeminal-vascular system, vestibular system, thalamus, and associated cortices. The theory is supported by recent evidence from human functional neuroimaging studies and animal studies. There is still no consensus on how to treat this group of patients due to the lack of strong evidence. Most patients only need symptomatic treatment during attacks of vestibular symptoms. For acute treatment, triptans, anti-histamines, anti-emetic agents, or even steroids can be used. For preventive treatment, calcium channel blockers (such as flunarizine), and antidepressants may be considered. In addition, vestibular rehabilitation may also be effective.