Search

Introduction: Persistent postural-perceptual dizziness (PPPD) and vestibular migraine (VM) share symptoms of visual vertigo and motion sickness that can be confusing for clinicians to distinguish. We compare the severity of these symptoms and dynamic subjective visual vertical (dSVV) in these two common vestibular conditions., Method: Twenty-nine patients with PPPD, 37 with VM, and 29 controls were surveyed for subjective symptoms using the visual vertigo analogue scale (VVAS) and motion sickness susceptibility questionnaire during childhood (MSA) and the past 10 years (MSB). dSVV is a measure of visual dependence measures perception of verticality against a rotating background (5 deg./s)., Results: VVAS revealed contextual differences for dizziness between those with PPPD and VM. Ratings of visual vertigo were most severe in PPPD, less in VM, and mild in controls (VVAS PPPD 27.1, VM 11.2, control 4.6, p < 0.001). MSA was more severe in VM than in PPPD or control (12.8 vs 7.6 vs 8.5, p = 0.01). MSB was more severe in VM than controls (MSB score 12.9 VS 8.1 p = 0.009) but was not different than PPPD (MSB score 10.0, p = 0.10). dSVV alignment was similar among the three groups (p = 0.83). Both VM and PPPD groups had greater simulator sickness than controls after completing the dSVV., Conclusions: Patients with PPPD report more visual vertigo than those with VM, but a history of motion sickness as a child is more common in VM. Additionally, the environmental context that induces visual vertigo is different between PPPD and VM., Competing Interests: Declaration of competing interest None of the authors have competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: We assessed frequency of vestibular symptoms in Headache Clinic patients over 10 years., Methods: A descriptive study of 5111 consecutive patients with tension-type headache or migraine, analyzed for dizziness/ vertigo accompanying headache and for a lifetime history of motion-sickness, cyclic vomiting, recurrent abdominal pain or atopy. Migraine patients were re-grouped as those with vestibular symptoms (dizziness/vertigo or motion sickness) and those without and their data then re-analyzed., Results: There were 1880 migraine patients and 3231 tension-type headache patients. Significantly more migraine patients than tension-type headache patients experienced vestibular symptoms (p< 0.0001). The migraine with vestibular symptoms group was significantly younger (p< 0.05) had more aura, more phonophobia with migraine attacks (p< 0.0001). Menstruation and reported sleep problems impacted on headaches. While past history of cyclical vomiting, recurrent abdominal pain or atopy was about twice as common in migraine with aura and it was also more common in migraine with vestibular symptoms than migraine without vestibular symptoms., Conclusions: Vestibular symptoms are common in migraine patients. Migraine with vestibular symptoms might constitute a special group, one more likely to have had cyclic vomiting, recurrent abdominal pain or atopy.

While both discus and hammer throwing involve rotating movements resulting in the throw of an object, discus throwers sometimes report dizziness, a condition never experienced by hammer throwers. We investigated whether this susceptibility was related to the sensitivity of the thrower or to the type of throwing achieved. For the latter, we compared the determining features of gesture, gaze stabilization and projectile trajectory in both sports. A total of 22 high-level sportsmen in these 2 disciplines, half of them practising both sports, were interviewed. Slow motion video recordings of discus and hammer throwing were examined to determine the visual referential, head movements and plantar surface support area involved at each stage of the motions. Discomfort was reported by 59% of the sportsmen while throwing discus, but by none while throwing hammer. Because several individuals practised both sports, these results exclude the hypothesis of individual susceptibility to dizziness. Video analysis evidenced that during hammer throwing, visual bearings can be used more easily than during discus throwing. Moreover, there is a loss of plantar afferents and generation of head movements liable to induce motion sickness, such as Coriolis acceleration. In conclusion, although hammer and discus-throwing present numerous similarities, we demonstrate here that crucial differences in the specific execution of each sport are responsible for the dizziness experienced by discus throwers.

Much diagnostic confusion arises from the fact that dizziness is a vague symptom with multiple individual interpretations. A systematic approach to eliciting a history from a dizzy patient is presented, differential diagnoses of vertigo are delineated, and appropriate treatment for peripheral labyrinthine disorders is suggested.