Sasan Dabiri, MD, Assistant Professor

Transcription

1 Sasan Dabiri, MD, Assistant Prfessr Department f Otrhinlarynglgy Head & Neck Surgery Amir Alam Hspital Tehran University f Medical Sciences March 2016 s - d a b i r t u m s. a c. i r

2 Backgrund Diagnsis Histry 131 BC: First link descriptin between migraine and vertig by Aretaeus f Cappadcia 1917: The earliest use f the term vestibular migraine by Benheim Migraine-assciated vertig/dizziness Migraine-related Vestibulpathy Migrainus vertig. 1999: Dieterich and Brandt reintrduced vestibular migraine 2001: First diagnstic criteria by Neuhauser et al. 2012: Current diagnstic criteria by IHS & Barany sciety

3 Backgrund Diagnsis Epidemilgy Prevalence: mre than 3% (Meniere's disease : upt 0.1% ) Mean age f nset: Wmen: 37 years Men: 42 years Strng female predminance (up t 5 t 1) Autsmal dminant inheritance (lw male penetrance)

4 Backgrund Diagnsis Pathphysilgy Evidence f vestibular dysfunctin in Migraine Episdic vertig in Migraine: 20-30% (lifetime prevalence f vertig : less than 10%) Prevalence f mtin sickness in Migraine: tw t five times Abnrmal vestibular tests in 25% in Migraine Specific assciatin f vertig and Migraine (nt ther headaches) Auditry symptms during Migraine attacks (The mst cmmn is phnphbia [tw-thirds f patients]) Sudden permanent r Meniere's like Migraine in patients with vertig Mre prevalent than nrmal (38% vs 24%)

5 Backgrund Pathphysilgy Diagnsis Furman et al. Annals f new yrk academy f sciences, 2015

6 Backgrund Diagnstic Criteria Diagnsis Vestibular symptms Migrainus symptms Crrelatin f symptms Rule ut thers

7 Diagnstic Criteria Backgrund Diagnsis Vestibular symptms Migrainus symptms Crrelatin f symptms Rule ut ther causes At least 5 episde f mderate t severe symptms (5 minutes t 3 days) Spntaneus vertig Psitinal vertig Visual induced vertig Head mtin induced vertig Head mtin induced dizziness with nausea (Spatial rientatin lss)

8 Backgrund Vestibular symptms Diagnstic Criteria Diagnsis Migrainus symptms Crrelatin f symptms Current r Previus histry f migraine (± aura) Rule ut ther causes

9 Backgrund Vestibular symptms Diagnstic Criteria Diagnsis Migrainus symptms At least 50% f vestibular episdes had ne f these features: Characteristic headache Crrelatin f symptms Phtphbia & Phnphbia Visual aura Rule ut ther causes

10 Diagnstic Criteria Backgrund Diagnsis Vestibular symptms Migrainus symptms Crrelatin f symptms Rule ut ther causes At least 50% f vestibular episdes had ne f these features: Characteristic headache at least 2 f these: ne sided lcatin pulsating quality mderate r severe pain intensity aggravatin by rutine physical activity Phtphbia & Phnphbia Visual aura

11 Backgrund Vestibular symptms Diagnstic Criteria Diagnsis Migrainus symptms At least 50% f vestibular episdes had ne f these features: Characteristic headache Crrelatin f symptms Phtphbia & Phtphbia sund induced discmfrt (transient & Rule ut ther causes bilateral). [vs recruitment: persistent & unilateral] Visual aura

12 Backgrund Vestibular symptms Diagnstic Criteria Diagnsis Migrainus symptms At least 50% f vestibular episdes had ne f these features: Characteristic headache Crrelatin f symptms Phtphbia & Phnphbia Visual aura Rule ut ther causes bright scintillating lights / zigzag lines (5 t 20 minutes) ften with sctma (interfere with reading)

13 Backgrund Symptms time table Diagnsis Stlte et al. Cephalalgia, 2014

14 Backgrund Vestibular symptms Diagnstic Criteria Diagnsis Migrainus symptms Crrelatin f symptms Rule ut ther causes Rule ut by histry and physical examinatin Rule ut by apprpriate investigatin Accept as cmrbidity with distinct features

15 Backgrund Diagnsis Vestibular symptms Migrainus symptms Diagnstic Criteria Crrelatin f symptms Meniere s disease Ear fullness r pain befre attack r at attack nset & accmpanying tinnitus and/r hearing lss during the episde (nt typical fr vestibular migraine) Audimetry Treatment trial may be helpful Rule ut ther causes Rule ut TIA Vascular risk factrs Other symptms Sudden nset Ttal duratin f less than ne year Imaging evidence f vascular disease

16 Patients with very brief attacks f vertig Patients with very brief attacks f vertig V e s t i b u l a r M i g r a i n e Backgrund Diagnstic Cnsideratins N cnclusive diagnstic tests Shuld be cnsidered a diagnsis f exclusin Diagnsis If a first episde lasts lnger than a few minutes, patients shuld underg MRI (DWI) & MRA Audimetry In brief psitinal attacks : assess BPPV Vestibular tests: in research level (develp)

17 Acute migraine treatments such as ergtamine and triptans may ffer benefi V e s t i b u l a r M i g r a i n e Backgrund Diagnsis Acute management Preventive management Acute migraine treatment + Vestibular suppressants

18 Acute Backgrund Acute migraine treatment + vestibular suppressants Diagnsis NSAIDs Aspirin (650 t 1000 mg) Ibuprfen (400 t 1200 mg) Naprxen (750 t 1250 mg) Diclfenac (50 t 100 mg) Ergtamine Triptan Abrtive treatments usually mre effective if given early A large single dse wrks better than repetitive small dses Many ral agents are ineffective because f pr absrptin secndary t migraine-induced gastric stasis.

19 Acute migraine treatments such as ergtamine and triptans may ffer benefi V e s t i b u l a r M i g r a i n e Backgrund Acute Acute migraine treatment + vestibular suppressants Diagnsis Antihistamines are the drugs f chice in mst patients

20 Backgrund Preventin Diagnsis Wetmre et al. Vestibular migraine, 1 st editin, 2015

21 Thanks a lt fr yur Attentin Current presentatin cntent is available at: h tt p : / / t u m s. a c. i r / fa c u l t i e s /s - d a b i r i