Migraine-associated vertigo and dizziness as presenting complaint in a private general medical practice

Abstract

Background: Migraine-associated vertigo (MV) remains a developing entity because accepted diagnostic criteria are unavailable. Patients present with debilitating dizziness without experiencing headache, and are often misdiagnosed as anxious. The condition is manageable in primary care without the need for neurological referral. The aim of this study was to investigate the prevalence of MV and migraine-associated dizziness (MD) as presenting complaints.
Methods: Patients presented with dizziness probably or definitely associated with migraine history based on the criteria of the International Headache Society. Patients with other vestibulopathies and medical conditions were excluded. Patients were evaluated over a period of nine months. Seven hundred and seventeen patients were examined. The numbers of patients were recorded as a percentage of the population visiting a general practitioner. Response to migraine prophylactic medications was regarded as supporting evidence of the diagnosis. Response was regarded as a complete resolution of symptoms.
Results: Of the 717 patients seen, 12 were identified as having probable or definite MV. Five patients were treated with migraine prophylactic medications, namely amitriptyline 25 mg nocte and/or sodium valproate CR 300 mg bd, and all showed a response to the treatment.
Conclusions: We conclude that the prevalence of MV as presenting complaint may be as high as 1.67%. This figure does however not reflect the total patient population that suffers from the condition – this figure may be much higher. Of those patients treated for MV the response was 100%, further supporting the diagnosis. MV is a relevant complaint that is often misdiagnosed as psychogenic in origin.

Keywords: migraine-associated dizziness; migraine-associated vertigo; psychogenic dizziness; spreading cortical depression; dopamine hypersensitivity