VESTIBULAR MIGRAINE-CASE REPORT
Journal
Abstract book VIth congress of neurologists of R. Macedonia with international participation
Date Issued
2016
Author(s)
Babunovska Marija
Kuzmanovski Igor
Cvetkovska Emilija
Boshkovski Bojan
Mitrevska Velkov Jasmina
Abstract
Background: Vestibular migraine is a term that is included in the classification of the International Headache Society (ICH) 2016. Diagnostic criteria for vestibular migraine include: A) at least 5 episodes that fulfill criteria C and D; B) current or past history of migraine without or with aura; C) vestibular symptoms with moderate to severe intensity, lasting from 5 minutes till 72 hours; D) At least 50% of the episodes have one of the following migrenous characteristics:1. a) unilateral localization b) pulsatile quality c) moderate or severe intensity d) worsening after routine physical activity 2. Photophobia and phonophobia 3. Visual aura.
Approximately 40% of the migraine patients have vestibular migraine. It is also important to emphasize that headache is not always present. Case presentation: We present 32 year old female patient who complained of attacks of vertigo, caused by movement of the head, lasting 10 minutes, several times a week that was sometimes accompanied by unilateral headache, with pulsatile quality and nausea. Otherwise, her physical and neurological examination was normal.The following investigations were made: laboratory blood analysis, nuclear magnetic resonance (NMR) of the brain and cervical spine, color duplex sonography of the carotid and vertebral arteries and audiovestibular testing- all with normal findings. A suspicion for vestibular migraine was raised and the patient was recommended therapy with SSRI, management of stress and appropriate life-style modification. Her control examination after one month showed reduction of her symptoms.Conclusion:Young adult women (20-40 years) have increased risk for vestibular migraine. Differential diagnosis includes benign positional vertigo, Menier disease, transient ischemic attack in the vertebra-basilar system and vestibular nerve irritation. Treatment includes Ca channels blockers, SSRI, Clonazepam, Beta blockers, stress management, exercise and life-style modification.
Approximately 40% of the migraine patients have vestibular migraine. It is also important to emphasize that headache is not always present. Case presentation: We present 32 year old female patient who complained of attacks of vertigo, caused by movement of the head, lasting 10 minutes, several times a week that was sometimes accompanied by unilateral headache, with pulsatile quality and nausea. Otherwise, her physical and neurological examination was normal.The following investigations were made: laboratory blood analysis, nuclear magnetic resonance (NMR) of the brain and cervical spine, color duplex sonography of the carotid and vertebral arteries and audiovestibular testing- all with normal findings. A suspicion for vestibular migraine was raised and the patient was recommended therapy with SSRI, management of stress and appropriate life-style modification. Her control examination after one month showed reduction of her symptoms.Conclusion:Young adult women (20-40 years) have increased risk for vestibular migraine. Differential diagnosis includes benign positional vertigo, Menier disease, transient ischemic attack in the vertebra-basilar system and vestibular nerve irritation. Treatment includes Ca channels blockers, SSRI, Clonazepam, Beta blockers, stress management, exercise and life-style modification.
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