Vestibular migraine (VM) is characterized by recurrent, episodic vertigo associated with migrainous headache. These symptoms are similar to those of Meniere's disease (MD), which often coexists with VM. The term “VM/MD overlapping syndrome (VMOS)” has been suggested for the clinical syndrome characterized by simultaneous occurrence of different types of vertigo associated with VM and MD. Diagnosis of VM is often missed in patients presenting with vertigo, because it is still not well-recognized by otorhinolaryngologists.
The medical records of 29 patients diagnosed as having VM at the Department of Otorhinolaryngology of our hospital were reviewed retrospectively to evaluate the diagnostic steps. These 29 patients accounted for 4.3% of all patients who visited our hospital with the chief complaint of vertigo over a 32-month period. Of the 29 patients, while 19 primarily had VM or VMOS (primary VM group), 10 developed VM or VMOS subsequently, during follow-up for MD or benign paroxysmal positional vertigo (“subsequent” VM group). Significantly fewer patients with “subsequent” VM, as compared to primary VM, complained of concomitant headache (Fisher's exact test, p=0.03); in total, 14 and 3 patients in the primary and “subsequent” VM groups, respectively, complained of headache without being prompted, whereas the remaining patients of both groups answered “yes” only when they were asked if they suffered from headache. Furthermore, significantly fewer patients with differing onset times in life of their vertigo and headache complained of headache unless they were asked the leading question by the doctor (Fisher's exact test, p=0.02).
These results indicate the importance of asking patients with recurrent vertigo if they also suffer from headache. Vertigo patients are less likely to complain of headache spontaneously when they visit a hospital, especially if they have been diagnosed with other vestibular disorders previously.
