Vestibular symptoms are more frequent in migraine than in tension type headache patients

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SCIENCE
Vestibular symptoms are more frequent in migraine than in tension type headache patients
Key Take-Away: 

Vestibular symptoms, especially dizziness (up to 69%, p ≤ 0.001) and vertigo (up to 47.4%, p = 0.067) help in differentiating migraine without aura from other primary headache disorders like tension type headache.

Headache and vestibular symptoms, vertigo or dizziness, are common complaints that impact quality of life. In general population, the prevalence of migraine is about 16%, of tension-type headache 42% and of vertigo/dizziness 23%. Many patients have both headaches and vertigo/dizziness. 

ABSTRACT: 
Background: 

Headache and vestibular symptoms, vertigo or dizziness, are common complaints that impact quality of life. In general population, the prevalence of migraine is about 16%, of tension-type headache 42% and of vertigo/dizziness 23%. Many patients have both headaches and vertigo/dizziness. We found in a headache clinic population that about 25% of those with migraine but only about 5% with tension type headache (TTH) experience vertigo/dizziness simultaneously with headache.

This association of vertigo with migraine has led to the concept of “vestibular migraine” with a lifetime prevalence of 1%.

  • Rationale behind research

According to International Headache Society (IHS) criteria, there is considerable overlap between migraine and TTH. This has created the need to analyze the characteristics of headache and vestibular symptoms

  • Objective

To re-analyze the characteristics of headache and vestibular symptoms in the population of headache clinic patients studied previously to find out whether the presence of vestibular symptoms helps differentiate migraine from TTH and whether this differentiating ability varies with patient age

Methods: 

 

NOTE: This is part of a study based on data from 10,140 primary headache patients seen between 1999 and 2010 in the Mersin University Hospital Neurology Department Headache Center, diagnosed according to IHS criteria.

Study outcomes

  • Primary headaches: Primary headaches were grouped into 4 categories according to ICHD-II criteria: migraine with aura (MWA), migraine without aura (MWoA), episodic tension type headache (ETTH) and chronic tension type headache (CTTH).
  • Frequency of vertigo and dizziness: The frequency of vertigo and dizziness was analyzed in 3 age bands: 18–34, 35–49 and 50–64 years.
Results: 

 

Outcomes

  • Compared to TTH patients, migraineurs had headaches for about 2 x as long (p< 0.05), were nauseated about 2 x as often (p<0.001), had phonophobia 3 x as often (p<0.001), vomited about 5 x as often (p< 0.001) and had vertigo or dizziness about 10 x as often (p<0.001). 

 

 

  • Young migraineurs were 4 x often associated with a history of motion sickness, cyclic vomiting, recurrent abdominal pain and atropic disorders (p<0.001).
  • Of possible headache triggers such as stress, seasonal changes, sleep irregularity and menstruation, only menstruation had an effect on migraine patients (p<0.001)

 

Conclusion: 

Migraine and TTH as defined by HIS criteria have a considerable symptomatic overlap which varies with gender, age and some biopsychosocial variables. This has been confirmed by this study result where 1/3rd of TTH patients had migrainous symptoms. Vestibular symptoms were about 10 times more common in definite migraine than definite TTH.

Vertigo and dizziness were 4 times more common in younger (18–34) than older migraineurs (50–64) and no greater incidence of vertigo/dizziness in younger than older TTH patients. The previous report also supported that vestibular symptoms, especially dizziness (up to 69%, p ≤ 0.001) and vertigo (up to 47.4%, p = 0.067) help in differentiating migraine without aura from other primary headache disorders. 

Journal of Neurological Sciences 2015; 295-296
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