Dizziness and Vertigo: Recognizing Vestibular Migraine in the Primary Care Setting
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Expires June 30, 2015
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Vestibular migraine (VM) is the most common cause of recurrent dizziness and vertigo but is often unrecognized by health care providers. VM causes significant impairment in level of function and quality of life, and the diagnosis should be considered when symptoms cannot be explained by other etiologies. Information and guidance are provided to raise clinicians’ awareness of VM in order to increase accurate diagnosis, guide management decisions, and improve patient health outcomes.
MÉNIÈRE DISEASE VERSUS VM
When headaches and dizziness coincide, VM is the most probable diagnosis.5 BPPV, Ménière disease, cerebellar disorders, motion sickness, and psychiatric syndromes (major depression and panic disorder) occur more often in patients with migraine than in those without.1 Ménière disease and VM often coexist, and up to 50% of patients with Ménière disease also meet criteria for migraine.5 (For more information, see Pearson T. Ménière disease: a lifelong merry-go-round. Clinician Reviews. 2013;23[10]:38-43.) Because many of their symptoms overlap, differentiating between Ménière disease and VM is critical; key differences in symptom presentation are as follows.17,18
Vertigo. The vertigo of Ménière disease is short-lived, lasting up to 24 hours.17 In contrast, episodes of vertigo with VM can last more than 24 hours; patients may experience a continuous rocking sensation for several weeks or even months.
Hearing loss. Sensorineural hearing loss in patients with Ménière disease is progressive and most often unilateral, but can be bilateral. In patients with VM, sensorineural hearing loss is rare; if it occurs, it is usually episodic and not progressive.17
Tinnitus. Tinnitus is a symptom of both Ménière disease and VM and may be unilateral or bilateral in both. In Ménière disease, patients report tinnitus of significant intensity, low in pitch, and “roaring,” whereas in VM, the tinnitus is usually high-pitched and unobtrusive.
Headache. Unless a concurrent diagnosis of migraine exists, patients with Ménière disease do not present with headache or photophobia. Many patients with VM, though not all, confirm a positive history of headache.
Phonophobia. Phonophobia is a frequent symptom in patients with VM.17
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