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Much has changed since our last review of recent advances in neuro-otology 7 years ago. Unfortunately there are still not many practising neuro-otologists, so that most patients with vestibular problems need, in the first instance, to be evaluated and treated by neurologists whose special expertise is not neuro-otology. The areas we consider here are mostly those that almost any neurologist should be able to start managing: acute spontaneous vertigo in the Emergency Room—is it vestibular neuritis or posterior circulation stroke; recurrent spontaneous vertigo in the office—is it vestibular migraine or Meniere's disease and the most common vestibular problem of all—benign positional vertigo. Finally we consider the future: long-term vestibular monitoring and the impact of machine learning on vestibular diagnosis. [ABSTRACT FROM AUTHOR]

Vertigo attacks lasted longer in VM patients than in MDO and in MDM patients and headaches lasted longer during vertigo attacks in VM than in MDM patients. There were no significant age or gender differences between MD and VM patients, but MD patients had a significantly longer history of vertigo attacks than VM patients ( I p i < 0.001). Vertigo attacks were more severe both in our MDO and MDM patients than in our VM patients, suggesting that MD and migraine, both occuring in one patient, amplifies vertigo severity. Dear Sirs, Menière Disease (MD) and Vestibular migraine (VM) both cause recurrent vertigo attacks. [Extracted from the article]

To find out clinical features associated with poor response to treatment in vestibular migraine (VM) VM patients treated with drugs recommended in migraine prophylaxis were included in this multicenter study. Migraine features including type, age of onset of headache and vertigo attacks, attack frequency, intensity, associated symptoms, triggering factors, presence of interictal dizziness/imbalance, anxiety, depression, history of motion sickness, and family history of migraine were noted. Amitriptyline, flunarizine, propranolol, topiramate and venlafaxine were chosen depending on patients' individual requirements. Maximum dose of each drug was tried for 2 months to decide its efficacy. In the case of inefficacy, it was changed with another preventive drug of different class. If there was still no improvement, two drugs of different classes were combined. ≥ 50% reduction in attack frequency and severity in patients using one drug and a combination of two drugs was compared, with patients showing <50% reduction despite combination therapy, regarding their clinical features. The results of 430 VM patients, 65 men and 365 women with a mean age of 42.2 ± 12.2 years (range: 17–74 years), were analyzed. Cutaneous allodynia frequently associated with female sex, comorbid anxiety and depression and interictal dizziness/imbalance enhanced with comorbid anxiety were risk factors for reduced treatment response. Aural fullness might be the clue of impending concomitant Meniere's disease not responding to migraine preventives. [ABSTRACT FROM AUTHOR]

Background: The term "motion sickness" (also called "kinetosis") describes a set of symptoms that occur in association with motion of a person or his or her surroundings, triggering a stress reaction that results in autonomic symptoms. The onset is often insidious, with drowsiness/yawning, dizziness, reduced alertness, and symptoms progress through cold sweating, pallor, excessive salivation, and occasionally headache, to nausea and vomiting with incapacitation that can be severe. Motion sickness usually occurs due to a visuo-vestibular conflict. Part of it is psychological as well as the symptoms of motion sickness are triggered in some people by just reading about it. Method: A cross-sectional study was performed in college going students for six months using the MSSQ-short and the Mini BESTest to assess the susceptibility of motion sickness as well as balance and gait respectively. Conclusion: Balance and gait was found to be significantly affected in people with motion sickness. [ABSTRACT FROM AUTHOR]

This paper presents diagnostic criteria for vestibular migraine, jointly formulated by the Committee for Classification of Vestibular Disorders of the Bárány Society and the Migraine Classification Subcommittee of the International Headache Society (IHS). It contains a literature update while the original criteria from 2012 were left unchanged. The classification defines vestibular migraine and probable vestibular migraine. Vestibular migraine was included in the appendix of the third edition of the International Classification of Headache Disorders (ICHD-3, 2013 and 2018) as a first step for new entities, in accordance with the usual IHS procedures. Probable vestibular migraine may be included in a later version of the ICHD, when further evidence has accumulated. The diagnosis of vestibular migraine is based on recurrent vestibular symptoms, a history of migraine, a temporal association between vestibular symptoms and migraine symptoms and exclusion of other causes of vestibular symptoms. Symptoms that qualify for a diagnosis of vestibular migraine include various types of vertigo as well as head motion-induced dizziness with nausea. Symptoms must be of moderate or severe intensity. Duration of acute episodes is limited to a window of between 5 minutes and 72 hours. [ABSTRACT FROM AUTHOR]

Background: Vestibular migraine (VM) is one of the most common causes of vertigo in clinical practice but it is not always easy to make the correct diagnosis. Our aims were to find out how VM patients differ from migraine only (MO) patients, to evaluate co-morbid depression in these two groups and to determine if their disease has an effect on their quality of life. Methods: We studied 50 definite VM and 35 MO patients. Each patient was asked about: age of onset, duration of headaches, presence of aura, headache characteristics, triggering factors, associated features, motion sickness history and family history of migraine. VM patients were also asked about their vertigo attacks and accompanying symptoms. Each patient also completed the following questionnaires: (1) Migraine Disability Assessment Scale (MIDAS); (2) headache severity with VAS (Visual Analog Scale); (3) Allodynia Symptom Checklist (ASC-12); (4) Beck Depression Inventory (BDI); (5) World Health Organization Quality of Life Questionnaire Short Form-12 (WHOQL-SF12); (6) Activities Specific Balance Confidence Scale (ABC). VM patients also completed the Dizziness Handicap Inventory (DHI). Results: We found that VM patients were more likely than MO patients to be female, post-menopausal, depressed, motion sick, complaining of imbalance and of food-triggered headaches. In contrast, MO patients were more likely than VM patients to have severe headaches and that these can be triggered by certain odors and by noise. Conclusion: Our findings showed differences between VM and MO patients and attention to these differences could help clinicians diagnose, characterize and manage their VM patients. [ABSTRACT FROM AUTHOR]

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Treatment of vestibular migraine currently lacks a firm scientific basis, as high quality randomized controlled trials are not available. Therefore, recommendations are largely borrowed from the migraine sphere. The first therapeutic step is explanation and reassurance. Many patients do not need pharmacological treatment, as attacks may be infrequent and tolerable. Acute attacks can be ameliorated in some patients with antiemetic drugs such as diphenhydramine, meclizine, and metoclopramide. Frequent attacks may warrant pharmacological prophylaxis with metoprolol, amitriptyline, topiramate, valproic acid, or flunarizine. Nonpharmacological measures including regular exercise, relaxation techniques, stress management, and biofeedback may be similarly effective and can be combined with a pharmacological approach. Limited data indicate that the prognosis appears to be less favorable for vestibular migraine than for migraine headaches. [ABSTRACT FROM AUTHOR]