Search Results (62)

Vestibular migraine (VM) commonly causes recurrent vertigo, but diagnosing and managing it can be difficult due to symptom overlap with other vestibular and headache disorders. This review provides a comprehensive update on VM, beginning with the diagnostic criteria established by the International Headache Society and the Bárány Society, who have increased awareness of this condition. While the pathophysiology is not yet completely understood, there is evidence of a complex interaction between the nociceptive and vestibular systems. Treatment approaches are primarily empirical and lack robust, high-quality evidence. Often, antihistamines and benzodiazepines are used for quick symptom relief, while the efficacy of triptans is still uncertain. Preventive measures include lifestyle changes, vestibular rehabilitation, oral migraine prophylactics, Botulinum toxin type A, and, more recently, CGRP-targeted therapies. Due to diagnostic uncertainties and the absence of standardised treatment protocols, further research—particularly randomised controlled trials—is crucial for establishing evidence-based guidelines. Full article

Background/Objectives: The association between vestibular symptoms and psychological distress has been previously studied, mainly with the use of questionnaires. The purpose of this study is to compare the consumption of psychotropic drugs between a group of patients with vertigo and a control group. Methods: A prospective cross-sectional, observational, case–control study was carried out, including 506 patients (232 with Ménière’s disease, 79 with vestibular migraine, 34 with vestibular neuritis, and 161 with benign paroxysmal positional vertigo). In total, 253 participants were included in the control group. Both groups were comparable regarding age, sex, and history of previous psychiatric diseases. Results: The percentage of patients with vertigo who consumed psychotropic drugs (41.3%) was higher than the percentage of the control group who did so (26.9%) (Fisher’s exact test, p < 0.0001; OR = 1.914, CI95% (1.377; 2.662)). The mean number of psychotropic drugs consumed was also higher (Mann–Whitney test, p = 0.0003) in cases (0.68 ± 0.959) than in controls (0.47 ± 0.889). This higher consumption in the group of patients with vertigo was found for all pharmacological groups studied, being especially relevant regarding “anxiolytics and hypnotics and sedatives” and “antidepressants”. No statistically significant differences in the consumption of psychotropic drugs between types of vestibular disorders were observed. The longer the symptoms were present, the higher the prevalence of psychotropic drug use was observed. Conclusions: A relationship between vertigo and consumption of psychotropic drugs was found. Recording the consumption of these drugs is proposed as an objective method to better understand the psychological distress that patients with vertigo may suffer from. Full article

Background/Objectives: The most frequent neurologic cause of recurrent vertigo is vestibular migraine (VM). However, its diagnosis relies primarily on patients’ histories, as specific diagnostic tests for VM are currently lacking. We aimed to examine and compare clinical features, vestibulo-ocular reflexes (VORs), and subjective visual vertical (SVV) between the ictal (IC) and inter-ictal (II) phases in VM patients. Methods: A repeated-measures study involved 31 patients with definite VM. Vestibular function was assessed using a video head impulse test (vHIT) to evaluate VOR results, and SVV testing to determine verticality perception. Otoneurological examination, including migraine-related disability, was noted. Analyses of repeated measures for numerical traits (SVV deviations, VOR, and clinical outcomes) were conducted using a linear mixed model (LMM), with phase, age, and sex as fixed effects and individual-specific random intercepts. Differences between the IC and II phases for dichotomous variables were analyzed using the χ2 or Fisher’s exact test. Results: The LMM analysis revealed that SVV deviations were significantly higher ictally (IC-ly) (β = 0.678, p = 1.51 × 10⁻⁶) than interictally (II-ly). VOR results remained normal across phases (p > 0.05), and refixation saccades did not differ significantly based on vHIT results (p > 0.05). Nausea (100% vs. 38.71%, p = 6.591 × 10⁻⁸), photophobia (100% vs. 35.48%, p = 1.839 × 10⁻⁸), and phonophobia (90.32% vs. 6.45%, p = 9.336 × 10⁻¹²) were significantly more frequent IC-ly than II-ly. Conclusions: Our findings highlight phase-dependent alterations in spatial orientation, with increased SVV deviations IC-ly despite stable VOR. The significant differences in migraine-associated symptoms reinforce the dynamic nature of VM. These results emphasize the importance of timing in vestibular assessments and suggest that SVV testing during IC VM episodes may enhance diagnostic accuracy. Full article

Background/Objectives: Headache is one of the most common neurological symptoms associated with COVID-19, affecting approximately 25% of patients. While most headaches resolve within weeks, some persist for months, suggesting underlying structural brain changes. This study aimed to identify brain MRI abnormalities associated with chronic headaches in patients with a history of COVID-19 infection. Methods: This retrospective study included 30 patients with post-COVID-19 headaches and 30 control patients with no history of COVID-19. Demographic characteristics were analyzed using t-tests and chi-square tests. MRI findings were categorized into six types: cortical atrophy, white matter lesions, vascular lesions, lacunar lesions, vascular encephalopathy, and sinusitis. Differences in MRI findings between the two groups were evaluated using chi-square tests. Secondary outcomes included the analysis of symptoms accompanying headaches, diagnoses following MRI, and treatments applied. Results: White matter lesions were significantly more frequent in the post-COVID-19 group (50%) compared to controls (20%) (p = 0.015). Conversely, sinusitis was more prevalent in the control group (36.7%) than in the post-COVID-19 group (6.7%) (p = 0.005). Other MRI abnormalities showed no significant differences. Cognitive dysfunction (30%) and dizziness (33.3%) were the most common associated symptoms. The most frequent diagnoses after MRI in the post-COVID-19 group were headaches/migraines (23.3%), post-COVID-19 headache (20%), and vestibular syndrome (13.3%). Conclusions: Persistent post-COVID-19 headaches may be linked to structural white matter changes observed in MRI. Further research, ideally including pre-infection imaging data, is needed to determine the causal relationship between these lesions and chronic headache symptoms. Trial Registration: This study was registered in ClinicalTrials with the trial registration number NCT06825741 on 13 February 2025. Full article

Vestibular disorders significantly affect individuals by impairing balance, spatial orientation, and quality of life. Despite the focus on neuronal mechanisms, emerging research emphasizes the importance of neuroglia—astrocytes, microglia, oligodendrocytes, and Schwann cells—in the onset, progression, and resolution of these conditions. This narrative review explores the roles of neuroglia in vestibular disorders, including vestibular migraines and unilateral and bilateral vestibulopathies. It discusses established facts, challenges, and future perspectives, offering insights into their pathophysiological roles and therapeutic implications, and the limitations of current research. By understanding the interplay between neuroglia and vestibular function, this review aims to advance diagnostic and treatment strategies for these disorders Full article

Acute vertigo or dizziness is a frequent presentation to the emergency department (ED), making up between 2.1% and 4.4% of all consultations. Given the nature of the ED where the priority is triage, diagnostic delays and misdiagnoses are common, with as many as a third of vertebrobasilar strokes presenting with acute vertigo or dizziness being missed. Here, we review diagnostic errors identified in the evaluation and treatment of the acutely dizzy patient and discuss strategies to overcome them. Lessons learned include focusing on structured history taking, asking about timing and triggers to inform a targeted examination, assessing subtle ocular motor findings (e.g., by use of HINTS(+)), and avoiding overreliance on brain imaging (including early magnetic resonance imaging including diffusion-weighted sequences [DWI-MRI]). Importantly, up to 20% of DWI-MRI may be false negatives if obtained within the first 24–48 h after symptom onset. Likewise, overreliance on focal neurologic findings to confirm a stroke diagnosis should be avoided because isolated dizziness, vertigo, or even unsteadiness may be the only symptoms in some patients with vertebrobasilar stroke. Furthermore, in patients with triggered episodic vestibular symptoms provocation maneuvers should be preferred over HINTS(+), and a potential diagnosis of stroke should not be immediately dismissed in younger patients presenting with a headache (where migraine may be more common), but the possibility of a vertebral artery dissection should be further evaluated. Importantly, moderate training of non-experts allows for significant improvement in diagnostic accuracy in the acutely dizzy patient and thus should be prioritized. Full article

Background/Objectives: Dizziness and vertigo are reported in about half of patients with inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC). Orthostatic dysregulation (OD) is recognized as one of the comorbidities that causes dizziness or vertigo with IBD. Our hospital is affiliated with the Inflammatory Bowel Disease Center, which specializes in diagnosing and treating IBD, so cases with dizziness or vertigo symptoms associated with IBD are sometimes referred to our department, a type of department which is rare in other facilities. The objective of this study is to evaluate IBD cases with dizziness or vertigo symptoms referred to a vertigo outpatient clinic in terms of vestibular function and OD. Methods: The subjects were 221 patients who were referred to the vertigo outpatient clinic of our department from March 2021 to September 2024. Results: Of the 221 patients, 9 cases had CD and 1 case had UC. OD complications were significantly more common in the IBD group than in the non-IBD group, whereas complications of psychogenic vertigo or migraine were not significantly different between groups, and there was no difference in vestibular dysfunction between groups. OD was a complication in all cases using ustekinumab. Conclusions: An orthostatic test will be valuable for diagnosing OD in IBD patients with dizziness or vertigo symptoms. Full article

Background/Objectives: The auditory middle-latency responses (AMLRs) assess central sensory processing beyond the brainstem and serve as a measure of sensory gating. They have clinical relevance in the diagnosis of neurological conditions. In this study, magnitude and habituation of the AMLRs were tested for sensitivity and specificity in classifying dizzy patients with vestibular migraine (VM) and post-concussive syndrome. Methods: Twenty-three healthy individuals, 12 concussion and 26 VM patients were recruited. AMLR were recorded performing five blocks of 200 binaural click-stimulations at 60 dB sensation level with a repetition rate of 6.1 Hz. Reduction in P0, Na and Pa magnitudes between blocks was measured. Group classifications were performed through logistic and multiple regression. Results: Among healthy subjects, a consistent P0 and Na habituation can be observed. Concussed subjects show control-like Na habituation, despite a lower magnitude, while P0 habituation was negligible. VM patients showed poor habituation for all waves. Regression analyses suggest that P0 and Na better distinguish healthy subjects from neurological patients, whereas Pa best distinguishes concussion from VM patients. Conclusions: The results support that AMLR habituation can contribute to unraveling different mechanisms of dizziness due to concussion compared to VM, providing insights that can complement routine diagnostic assessments. Full article

Background/Hypothesis: Motion sensitivity symptoms, such as dizziness or unsteadiness, are frequently reported as non-headache symptoms of migraine. Postural imbalance has been observed in subjects with vestibular migraine, chronic migraine, and aura. We aimed to assess the ability of largest Lyapunov’s exponent for a short time series (sLLE), which reflects the ability to cope with internal perturbations during gait, to detect differences in local dynamic stability between individuals with migraine without aura (MO) with an episodic pattern between attacks and healthy subjects (HS). Methods: Trunk accelerations of 47 MO and 38 HS were recorded during gait using an inertial measurement unit. The discriminative ability of sLLE was assessed through receiver-operating characteristics curves and cutoff analysis. Partial correlation analysis was conducted between the clinical and gait variables, excluding the effects of gait speed. Results: MO showed higher sLLE values, and reduced pelvic rotation, pelvic tilt, and stride length values. sLLEML and pelvic rotation showed good ability to discriminate between MO and HS and were correlated with the perceived pain, migraine disability assessment score, and each other. Conclusions: these findings may provide new insights into the postural balance control mechanism in subjects with MO and introduce the sLLEML as a potential measure of dynamic instability in MO. Full article

Background/Objectives: It is known that balance disorders involve occupational hazards. However, the inverse relationship (between certain occupations and an increased incidence of vertigo or dizziness) has been scarcely studied. The objective of this work was to analyze the occupation of a group of patients with vertigo compared to the economically active general population and to evaluate the prevalence of occupational noise and/or vibration exposure in both groups. Methods: A prospective cross-sectional, observational, case-control study was carried out, including 393 patients (193: Meniere’s disease; 63: vestibular migraine; 21: vestibular neuritis; 116: BPPV) (244 women and 149 men). These patients were compared to a control group from the general population obtained from 6th EWCS-Spain (2015). Possible differences regarding sex, age, occupation, exposure to noise, and exposure to mechanical vibrations were analyzed. Results: Differences in the distribution of occupations between patients with vertigo and the general population were observed (Chi-square, p = 4.065 × e⁻²⁰). Patients with vertigo were significantly more exposed to noise (Fisher’s exact test, p = 2.97 × e⁻¹⁰; OR = 2.595, CI95% (1.916;3.515)) and vibrations (Fisher’s exact test, p = 6.23 × e⁻¹⁰; OR = 2.722, CI95% (1.963;3.775)) than the control group. These differences were observed both between men and women. Conclusions: A relationship between occupational exposure to noise and/or vibrations and the presence of vertigo was observed. Protective and preventive measures could help prevent the occurrence of some diseases involving vertigo. Full article

Background Clinical studies suggest that vestibular migraine patients have psychiatric comorbidities and low life quality. However, the absence of a multidisciplinary approach to vestibular migraine patients, including otorhinolaryngologists and psychiatrists, is concerning. We aimed to investigate these patients comprehensively and to compare the results of three questionnaires—the Hospital Anxiety and Depression Scale (HADS), Dizziness Handicap Inventory (DHI), and Short Form Health Survey (SF-36)—between patients with definite vestibular migraine (dVM), migraine without vertigo (MO), and healthy controls (HCs). Methods: A total of 104 participants were divided into 3 groups: dVM patients (19 participants), MO patients (22 participants), and HCs (63 participants). The scores of the three questionnaires across the three groups were compared using analysis of variance, and linear regression was used to examine the associations between the questionnaire scores within each group. Results: Compared to MO patients and HCs, dVM patients had significantly higher total scores on the HADS (p < 0.0001) and DHI (p < 0.0001) scales, and lower scores for all nine components of the SF-36, indicating poorer health. In the vestibular migraine group, the DHI score was strongly negatively correlated with the Physical Functioning subscale of the SF-36. Conclusions: Anxiety and depression are more prevalent in patients with definite vestibular migraine compared to patients with migraine without vertigo and healthy controls. The physical functioning of patients with definite vestibular migraine is highly affected by their dizziness, resulting in a lower quality of life. Timely screening for psychiatric comorbidity in vestibular migraine patients is essential to prevent psychiatric consequences. Full article

Objective: We aimed to investigate the association between the angular trajectory of the vestibular aqueduct (ATVA) with other radiological parameters of temporal bone and clinical characteristics in patients with Ménière’s disease (MD). Methods: A total of 125 unilateral MD patients and 118 controls were enrolled. Computer tomography (CT)-based radiological parameters included ATVA, vestibular aqueduct (VA) visibility, VA morphology, the vertical part of the posterior semicircular canal—the posterior fossa distance (PPD), and peri-VA pneumatization. The clinical characteristics of MD patients included gender, age of diagnosis/onset, disease duration, migraine history, clinical staging, and the results of audio-vestibular tests. The radiological parameters and clinical characteristics in MD patients were compared. Results: Compared with control ears, ATVA ≥ 140° was more prevalent and ATVA ≤ 120° was less frequent in the MD-affected side. For the MD-affected side, MD patients with ATVA ≥ 140° exhibited more severe VA invisibility and obliteration and higher male preponderance than those with ATVA ≤ 120°. Other radio-clinical features did not differ between these two subgroups. Conclusion: In the current study, ATVA ≥ 140°, an indicator of a hypoplastic endolymphatic sac, was found in approximately one-third of the affected and unaffected ears of patients with MD, as well as in a minority of controls. This suggests that the indices may be a predisposing factor rather than a specific marker for the MD ear. The male preponderance in MD patients with hypoplastic ES suggests a gender difference in the anatomical factors for MD pathogenesis. Full article

Background: Audiovestibular disorders in childhood occur with considerable frequency. However, the difficulty of obtaining medical history, the nonspecificity of symptoms, and the lack of cooperation during complementary tests often contribute significantly to diagnostic biases, attributing clinical presentations to psychosomatic disorders. The objectives of this work are, firstly, to characterize, from an auditory and vestibular perspective, the most frequent causes of vertigo in childhood and a possible relationship with emotional symptoms. On the other hand, to propose the usefulness of the MSSQ-Short questionnaire as a predictive variable in the evolution of children diagnosed with recurrent vertigo of childhood (RVC). Methods: An observational cross-sectional study was designed with retrospective data collection at three tertiary hospitals. Results: Among the 117 patients recruited between 2016 and 2024, 32 patients (27.35%) were diagnosed with an anxious-depressive syndrome prior to audiovestibular testing. The mean age was 11.19 ± 5.61 years and the most frequent final diagnoses were vestibular migraine (VM) with 41.03% and RVC with 23.93%. Patients with VM, compared with RVC, are approximately 1.12 times more likely to have psychosomatic pathology (CI 0.39 to 3.25). The most sensitive and frequently altered test was VEMPS (39.32%), with statistical significance in VM and otic capsule dehiscence, while regarding the MSSQ-Short questionnaire, the linear regression of 0.28 indicates an increase in clinical duration with high questionnaire scores. Conclusions: Vestibular disorders causing dizziness and vertigo are challenging to diagnose, often due to lack of cooperation and/or symptom nonspecificity. A thorough medical history and complementary tests, including audiovestibular and imaging studies, are advisable, thus avoiding systematically attributing children’s complaints to other psychosomatic disorders. Full article

Background: The purpose of this review is to clarify the natural course of benign paroxysmal torticollis (BPT) and update the information on the relationship of this disorder with migraine. BPT belongs to a group of “episodic syndromes that may be associated with migraine” and is diagnosed according to diagnostic criteria of the International Classification of Headache Disorders, 3rd edition. BPT affects infants and young children and is often an underdiagnosed manifestation since it is not recognized in cases with a benign evolution, requiring a careful differential diagnosis. It was first described by Snyder in 1969 as a movement disorder, a cervical dystonia consequent to labyrinthic disorder. Materials and methods: The PubMed and Web of Science databases were consulted from 1968 to 2024, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Results: In total, 113 articles were identified, 86 selected, and 25 considered for the purpose of this review. Clinical studies were considered in relation to evolution, cognitive, and motor development; genetic and not genetic etiology; the relationship with migraine with and without aura; vestibular migraine; hemiplegic migraine; and paroxysmal vertigo. Full article