| Background:Vestibular migraine (VM) is generally considered to be a primary headache syndrome that is characterized by episodic vertigo, onset during the third and sixth decade, predominantly in women, with or without auditory symptoms and responsive to migraine symptomatic and prophylactic treatment [1-3]. VM is also known as ’migraine-associated vertigo/dizziness’,’migraine-related vestibulopathy’ and ’migrainous vertigo’[4-6]. A population-based study revealed that the lifetime prevalence of VM is 1%, which is the second most common cause of episodic vertigo after benign paroxysmal positional vertigo (BPPV)[4]. The International Classification of Headache Disorders,3rd edition beta version (ICHD-III beta), proposed the diagnostic criteria for VM [7] in 2013. Compared with Neuhauser 2001 criteria, ICHD-Ⅲ beta criteria specified the classification of vestibular symptoms and the migraine subtypes. However,30-50% of patients did not fulfill all of the ICHD-Ⅲ beta criteria, such as the duration of vertigo attacks [1,4,8-9]. Whether the current criteria were practical to the diagnosis of VM was still an open issue, and there was still lack of the study on the efficacy of prophylactic treatments in Chinese VM patients.Objectives:The aim of this study was to explore the demographic, clinical characteristics of vestibular migraine (VM) in Chinese, especially to field test the criteria of the International Classification of Headache Disorders 3rd edition beta version (ICHD-III beta), and assess the efficacy of migraine prophylactic treatment in patients with VM.Methods:1. During study period, consecutive patients with VM were surveyed and registered in a neurologic clinic of the First Affiliated Hospital of Chongqing Medical University. The demographic and clinical characteristics of patients with VM were recorded and ICHD-Ⅲ beta-based field-testing was conducted. Assessments, including standardized neuro-otology bedside examination, pure-tone audiometry, bithermal caloric testing, neurological imaging, cervical X-ray or MRI, Doppler ultrasound of cerebral arteries and laboratory tests, were performed when appropriate.2. Prophylactic treatments were given if the attack was more than once per month. Response to medication was recorded using face-to-face or telephone interviews after a 1-month treatment period.Results:1. A total of 67 patients (62 F/5 M,47.8±10.3 years) were enrolled in this study. The mean age of migraine onset was 32.2±11.5 years and vertigo onset was 37.9±10,1 years. The most common migraine subtype was migraine without aura (79%), followed by migraine with aura (12%) and chronic migraine (9%). The duration of vertigo attacks was varied from seconds to days and 25% of patients had attacks lasting less than 5 minutes. Among patients with short-lasting attacks,75% of them had ≥5 attacks per day within 72 hours. Auditory symptoms were reported in 36% of patients. None of patients showed spontaneous, positional and optokinetic nystagmus. Horizontal gaze-evoked nystagmus was showed in 4 (6%) patients. The type of smooth pursuit curve in 47 (70%) patients was Ⅰ-Ⅱ and the rest 11 (30%) patients was Ⅲ. One (2%) patient showed symmetric but slow saccades. PTA results showed that 4 (6%) patients had sensorineural hearing loss, mainly bilateral, mild to moderate. All patients had normal bilateral caloric responsiveness and canal paresis< 24%.2. Six (9%) patients received lifestyle adaptations exclusively for the treatment of low frequency headaches and vertigo attacks (less than 1 episode per month). Among 61 patients who were given medications,13 (21%) patients lost within one-month treatment period, and moderate to severe headache or vertigo days were significantly decreased in 37 (77%, of 48) patients.Conclusion:VM in our study was a primary headache syndrome that was characterized by episodic vertigo lasting seconds to days, accompanying with migrainous symptoms (migrainous headache, photophobia and phonophobia). The onset was during the fourth decade of life, and occurring predominantly in women. Our study showed that the clinical features of VM in China were similar to those of Western studies. The proportion of MA was lower than that in Western-based studies. The current classifications of vestibular symptoms were well-organized when applied in clinical work. The definition of vertigo episodes and migraine subtypes of VM in ICHD-III beta might be further modified. More than five vertigo attacks per day within 72 hours might be helpful to identify VM patients with short-lasting attacks. Cochlear symptoms were reported in one-third of VM patients, and the sensorineural hearing loss was symmetric, mild and non-progressive. Therefore, the coexistence of cochlear symptoms should not be a reason to exclude VM. Finally, migraine prophylactic treatments could significantly reduce the moderate to severe headache or vertigo days. |
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