Objective:
The aim of the study was to assess the evolution of clinical symptoms and vestibulocochlear function in patients with definite vestibular migraine (dVM).
Methods:
We reassessed 61 patients (54 women, 7 men, aged 24-76 years) with dVM according to validated diagnostic criteria after a median follow-up time of 9 years (range, 5.5-11). Assessment comprised a clinical interview and neurotologic examination, including pure-tone audiometry and caloric testing.
Results:
The majority of patients (87%) had recurrent vertigo at follow-up. Frequency of vertigo was reduced in 56%, increased in 29%, and unchanged in 16%. Impact of vertigo was severe in 21%, moderate in 43%, and mild in 36%. Eighteen percent reported mild persistent unsteadiness. Interictal ocular motor abnormalities had increased from 16% initially to 41% of patients at follow-up. The most frequent finding was positional nystagmus (PN), in 28%, including definite central-type PN in 18%. However, only 1 of 9 patients with ocular motor abnormalities at initial presentation showed similar findings on follow-up. Concomitant cochlear symptoms with vertigo had increased from 15% initially to 49%. Eleven patients (18%) had developed mild bilateral sensorineural hearing loss, which also involved the low-frequency range.
Conclusions:
The majority of patients continue to have recurrent vertigo in the long-term evolution of VM, and the impact of vertigo may remain severe. Whereas interictal ocular motor abnormalities may show some variation over time, vestibulo-cochlear dysfunction progresses slowly in some patients with VM. Interictal central-type PN may help distinguish VM from peripheral vestibular disorders such as Me ยดnie re disease. Neurology ยฎ 2012;79:1607-1614 GLOSSARY AAO ฯญ American Academy of Otolaryngology; COD ฯญ central ocular motor dysfunction; dVM ฯญ definite vestibular migraine; ICHD ฯญ International Classification of Headache Disorders; MD ฯญ Me ยดnie re disease; PN ฯญ positional nystagmus; PTA ฯญ pure-tone audiometry; PVD ฯญ peripheral vestibular dysfunction; pVM ฯญ probable vestibular migraine; UCP ฯญ unilateral canal paresis; VM ฯญ vestibular migraine; VOR ฯญ vestibulo-ocular reflex. From the Department of Neurology, Charite ยด(A.R.); Parkklinik Weissensee (M.v.B.