Episodic vertigo related to migraine (90 cases): vestibular migraine?

A retrospective study was conducted on 90 patients with episodic vertigo th at could be related to migraine as the most probable pathomechanism. Since the majority of the patients did not fulfill the criteria of the Internatio nal Headache Society (IHS) for basilar migraine, the diagnosis was substant iated by disease course, medical efficacy in treating (ergotamines) and pre venting (metoprolol, flunarizine) attacks, ocular motor abnormalities in th e symptom-free interval, and careful exclusion of the most relevant differe ntial diagnoses, such as transient ischemic attacks, Meniere's disease, and vestibular paroxysmia. The following clinical features were elaborated. Th e initial manifestation could occur at any time throughout life, with a pea k in the fourth decade in men and a "plateau" between the third and fifth d ecades in women. The duration of rotational (78%) and/or to-and-fro vertigo (38%) could last from a few seconds to several hours or, less frequently, even days; duration of a few minutes or of several hours was most frequent. Monosymptomatic audiovestibular attacks (78%) occurred as vertigo associat ed with auditory symptoms in only 16%. Vertigo was not associated with head ache in 32% of the patients. In the symptom-free interval 66% of the patien ts showed mild central ocular motor signs such as vertical (48%) and/or hor izontal (22%) saccadic pursuit, gaze-evoked nystagmus (27%), moderate posit ional nystagmus (11%), and spontaneous nystagmus (11%). Combinations with o ther forms of migraine were found in 52%. Thus, migraine is a relevant diff erential diagnosis for episodic vertigo. According to the criteria of the I HS, only 7.8% of these patients would be diagnosed as having basilar migrai ne. However, to ensure that at least those presenting with monosymptomatic episodic vertigo (78% in our study) receive effective treatment, we propose the use of the more appropriate term "vestibular migraine."