Vertigo syndromes and mechanisms in migraine

This paper attempts to define and categorize the vertigo associated with mi graine. A retrospective chart review of 344 cases of vertigo identified 19 cases with headaches characteristic of migraine as per strictly defined cri teria (International Headache Society, 1988). Four distinct types of vertig inous syndromes were noted. The commonest syndrome (Group I) manifested tra nsient episodes of imbalance with additional momentary subjective rotary ve rtigo worsened by movement. The attacks lasted a few hours and evaluation i n the inter-episode interval demonstrated no vestibular deficit. Group II m anifested transient objective rotatory vertigo of from 10 minutes to a few hours but no demonstrable permanent vestibular deficit. Group III displayed symptoms and signs characteristic of benign paroxysmal positional vertigo (BPPV) and Group IV manifested a permanent unilateral labyrinthine weakness . Causation of vertigo by migraine was implied in 10 of 19 cases where the headache and vertigo occurred simultaneously and in two other cases where t he vertigo improved with anti-migraine prophylactic treatment. Four distinct and characteristic vertigo syndromes have been noted with mig raine. Their spectrum ranges from a transient reversible dysfunction to a m ore permanent destruction, and includes involvement of both the peripheral and the central vestibular systems.