Clinical Epidemiological and Neurotological Approaches to Migraine-related Vertigo and Dizziness

• Main Authors: Chi-Te Wang, 王棨德
• Other Authors: Mei-Shu, Lai
• Format: Others
• Language: en_US
• Published: 2008
• Online Access: http://ndltd.ncl.edu.tw/handle/42944911307510159519

碩士 === 國立臺灣大學 === 預防醫學研究所 === 96 === Objective This study was designed to analyze the clinical manifestation of patients with migraine-related vertigo and dizziness, and explore the association between clinical characteristics and treatment effectiveness. The relationships between different diagnostic groups were investigated as well. Method The source population was comprised of patients visiting a vertigo special clinic from July 2007 to January 2008. Subjects with other potential diagnoses were excluded. Inclusion criteria consisted of > 5times of migrainous headache and > 2 times of vertigo/dizziness episodes. One-hundred and ten subjects were enrolled and eligible for this study. All the patients received structured interview of clinical presentations, and the results of audiovestibular function tests were recorded. Further classification of study subjects were based on the diagnostic criteria of basilar type migraine (BtM), definite migrainous vertigo (dMV) and probable migrainous vertigo (pMV). Excluding 7 subjects lost from clinic, treatment effectiveness was evaluated in 103 subjects after a consecutive 3-month medication. Result The demographic characteristics constitute a mean age of 40 years old, female predominance (85%), strong family preponderance (72%), plateau of onset of symptoms around 20-29 years old, and headache as the first presenting symptom in 61% of subjects. Migraine precipitants were identified in 106 subjects (96%). Significant factors associated with poor response are: younger age at presentation (adjusted odds ratio (aOR) =2.38 for each 10-year decline, 95% confidence interval (CI): 1.39 ~ 4.07), frequent vestibular episodes (aOR=7.73, 95% CI: 2.05 ~ 19.1), and abnormal optokinetic nystagmus (OKN) tests (aOR=5.40, 95% CI: 1.60 ~ 18.2). Food precipitation showed borderline correlation with treatment response (aOR=0.31, 95% CI: 0.09 ~ 1.04). Furthermore, BtM and dMV group are similar in clinical presentation, e.g. migrainous symptoms, motion sickness and sequential relationship between migraine and vertigo, but differs in that BtM had more extensive neurological symptoms, more frequent vestibular symptoms, more central signs on electronystagmography tests, and also, the worst treatment effectiveness. In contrast, pMV group represents the least severe clinical manifestation. Conclusion This study enrolled a representative sample of migraine-related vertigo and dizziness in Taiwan. The significant factors in relation to treatment effectiveness are identified, i.e. frequency of vestibular episodes, age at presentation, and OKN abnormalities. The relationship between these three diagnostic groups is most likely a distribution of severity across the disease spectrum, with BtM presenting the most extensive involvement of the brainstem and the worst treatment response.