Curr Pain Headache Rep (2015) 19: 31 DOI 10.1007/s11916-015-0502-3
UNCOMMON AND/OR UNUSUAL HEADACHES AND SYNDROMES (J AILANI, SECTION EDITOR)
Headache and Dizziness: How to Differentiate Vestibular Migraine from Other Conditions Joshua M. Cohen 1 & Carlos A. Escasena 1
Published online: 7 June 2015 # Springer Science+Business Media New York 2015
Abstract Headache and dizziness are two of the most common symptoms prompting medical evaluation and may be seen in many primary and secondary headache and dizziness syndromes. Many of these disease processes share common characteristics making determination of the diagnosis extremely challenging. As more is understood about the concurrence of these symptoms, new diagnostic considerations have emerged, and the beta version of the latest edition of the International Classification of Headache Disorders describes a new entity termed vestibular migraine that may affect many patients presenting with headache and dizziness. This article examines the epidemiology of headache and dizziness, describes the presenting features of patients with conditions which often express these two symptoms, discusses recommendations for evaluation and testing for these patients, and serves to aid in the differentiation between vestibular migraine and other potential diagnoses.
Keywords Headache . Vestibular migraine . Ménière’s disease . Benign paroxysmal positional vertigo . Vestibular neuritis . Vestibular neuronitis
Introduction Headache and dizziness are both commonly reported symptoms and may coexist in a variety of conditions. A number of dizziness syndromes, including benign positional paroxysmal vertigo [1], syncope [2], and motion sickness [3], have been shown to be comorbid with migraine. Many secondary headache disorders, such as concussion or infection, will also produce dizziness, and both symptoms may improve as the underlying condition is managed. Dizziness may also be reported as a component of primary headache syndromes with vestibular symptoms ranging from imbalance to vertigo [4•]. In the beta version of the latest edition of the International Classification of Headache Disorders, a new entity named vestibular migraine is described. This diagnosis may explain many previously puzzling cases of concomitant headache and dizziness. This review will examine the epidemiology of headache and dizziness, describe the presenting features of patients with conditions which commonly express these two symptoms, discuss recommendations for evaluation and testing for these patients, and aid in the differentiation between vestibular migraine and other potential diagnoses.
Epidemiology This article is part of the Topical Collection on Uncommon and/or Unusual Headaches and Syndromes * Joshua M. Cohen [email protected] 1
The Headache Institute and Adolescent Headache Center, Mount Sinai Roosevelt Hospital, 425 W. 59th St, Suite 4A, New York, NY 10019, USA
Dizziness and headache are amongst the most frequently reported troubling symptoms motivating people to seek medical attention. Each year, nearly 4 million patients present to emergency departments complaining of dizziness or vertigo, accounting for 4 % of all patients and $4 billion in healthcare expenditures [5]. Over 4.3 million present to the emergency department complaining of headache annually, making it the 4th most common chief complaint and the 3rd most common in women age 15–64 [6]. While vertigo has annual incidence
31 Page 2 of 6
of 1.4 % in adults and a prevalence of 5 % in the general population [7], 16.6 % of adults age 18 or older report having migraine or other severe headache within the last 3 months [8]. When expanded to include those with mild symptoms, studies demonstrate that 46 % of adults suffer from headaches in general [9] and 23.2 % report some form of dizziness [10]. Headaches and dizziness also frequently occur together, with over 50 % of patients with headache also endorsing dizzy symptoms [11]. In the past 15 years, the number of papers published in PubMed on headache and vestibular symptoms has doubled every 5 years [12]; thus, our current knowledge about their comorbidity is considerably better than even the recent past. When dizziness is present, it increases both the disability and depression associated with headaches, emphasizing the importance of correct diagnosis and management [11]. When secondary syndromes are ruled out, the physician must consider which primary headache or dizziness syndrome can best explain the range of symptoms. Vestibular symptoms are much more common in migraine than in other headache syndromes, and a recent study of over 5000 patients with tension-type headache and migraine found significantly more vestibular symptoms in the patients with migraine (p
UNCOMMON AND/OR UNUSUAL HEADACHES AND SYNDROMES (J AILANI, SECTION EDITOR)
Headache and Dizziness: How to Differentiate Vestibular Migraine from Other Conditions Joshua M. Cohen 1 & Carlos A. Escasena 1
Published online: 7 June 2015 # Springer Science+Business Media New York 2015
Abstract Headache and dizziness are two of the most common symptoms prompting medical evaluation and may be seen in many primary and secondary headache and dizziness syndromes. Many of these disease processes share common characteristics making determination of the diagnosis extremely challenging. As more is understood about the concurrence of these symptoms, new diagnostic considerations have emerged, and the beta version of the latest edition of the International Classification of Headache Disorders describes a new entity termed vestibular migraine that may affect many patients presenting with headache and dizziness. This article examines the epidemiology of headache and dizziness, describes the presenting features of patients with conditions which often express these two symptoms, discusses recommendations for evaluation and testing for these patients, and serves to aid in the differentiation between vestibular migraine and other potential diagnoses.
Keywords Headache . Vestibular migraine . Ménière’s disease . Benign paroxysmal positional vertigo . Vestibular neuritis . Vestibular neuronitis
Introduction Headache and dizziness are both commonly reported symptoms and may coexist in a variety of conditions. A number of dizziness syndromes, including benign positional paroxysmal vertigo [1], syncope [2], and motion sickness [3], have been shown to be comorbid with migraine. Many secondary headache disorders, such as concussion or infection, will also produce dizziness, and both symptoms may improve as the underlying condition is managed. Dizziness may also be reported as a component of primary headache syndromes with vestibular symptoms ranging from imbalance to vertigo [4•]. In the beta version of the latest edition of the International Classification of Headache Disorders, a new entity named vestibular migraine is described. This diagnosis may explain many previously puzzling cases of concomitant headache and dizziness. This review will examine the epidemiology of headache and dizziness, describe the presenting features of patients with conditions which commonly express these two symptoms, discuss recommendations for evaluation and testing for these patients, and aid in the differentiation between vestibular migraine and other potential diagnoses.
Epidemiology This article is part of the Topical Collection on Uncommon and/or Unusual Headaches and Syndromes * Joshua M. Cohen [email protected] 1
The Headache Institute and Adolescent Headache Center, Mount Sinai Roosevelt Hospital, 425 W. 59th St, Suite 4A, New York, NY 10019, USA
Dizziness and headache are amongst the most frequently reported troubling symptoms motivating people to seek medical attention. Each year, nearly 4 million patients present to emergency departments complaining of dizziness or vertigo, accounting for 4 % of all patients and $4 billion in healthcare expenditures [5]. Over 4.3 million present to the emergency department complaining of headache annually, making it the 4th most common chief complaint and the 3rd most common in women age 15–64 [6]. While vertigo has annual incidence
31 Page 2 of 6
of 1.4 % in adults and a prevalence of 5 % in the general population [7], 16.6 % of adults age 18 or older report having migraine or other severe headache within the last 3 months [8]. When expanded to include those with mild symptoms, studies demonstrate that 46 % of adults suffer from headaches in general [9] and 23.2 % report some form of dizziness [10]. Headaches and dizziness also frequently occur together, with over 50 % of patients with headache also endorsing dizzy symptoms [11]. In the past 15 years, the number of papers published in PubMed on headache and vestibular symptoms has doubled every 5 years [12]; thus, our current knowledge about their comorbidity is considerably better than even the recent past. When dizziness is present, it increases both the disability and depression associated with headaches, emphasizing the importance of correct diagnosis and management [11]. When secondary syndromes are ruled out, the physician must consider which primary headache or dizziness syndrome can best explain the range of symptoms. Vestibular symptoms are much more common in migraine than in other headache syndromes, and a recent study of over 5000 patients with tension-type headache and migraine found significantly more vestibular symptoms in the patients with migraine (p
