الفهرس 
Overview of MigraineOnly 14 pages are availabe for public view
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Abstract
Vestibular migraine (VM), also known as migraine-associated vertigo, is a common cause of dizziness in adults. We performed a comprehensive literature search regarding treatment for VM or migraine-associated vertigo during the period of 1990–2008 and used, individually or in combination, the search terms VM, migraine-associated vertigo, migraine-associated dizziness, migrainous vertigo, migraine and vertigo, migraine and disequilibrium, and headache and vertigo. We found nine publications that address treatment strategies for VM. One small randomized clinical trial found some benefit from the use of zolmitriptan for abortive treatment of VM. The other eight observational studies showed marginal improvement with migraine prophylactic medications such as nortriptyline, verapamil, or metoprolol. Until more specific treatment options become available, patients with VM need to be managed with similar prophylactic and abortive strategies as those used for migraine in adults.
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Introduction
Vertigo, dizziness, and migraine are quite common in the general population, and in some patients, they may be inter-related [6, 7, 10, 13, 15]. The prevalence of migraine, according to the criteria of the International Headache Society (IHS) [1], is at least three times higher in those with vertigo [7, 15]. Patients with various forms of disequilibrium and some manifestations of migraine may have a condition known as vestibular migraine (VM), also known as migraine-associated vertigo or migrainous vertigo [7].
Savundra et al. [17] retrospectively analyzed 363 patients who presented to a neurotology clinic with vertigo and found 116 patients (32%) with migraines. Of those, 85% had no other explanation for their vertigo in contrast to only 51% of nonmigraineurs with idiopathic vertigo, suggesting that in a large proportion of patients with vertigo, VM is under-diagnosed. This underdiagnosis may be due to several factors, including the wide variability in presentation of patients with VM, lack of a widely accepted pathophysiologic model linking migraine and
vertigo, and significant overlap with depression or anxiety. In some patients, the history of vertigo may be seen as a nonspecific manifestation of panic attacks.
Given the high prevalence of VM, we performed a review of the literature to determine the optimal prophylactic and abortive treatment options for this condition.
Methods
A literature search was performed via PubMed, Ovid, and MD Consult using the following search terms: VM (209 papers), migraine-associated vertigo (82), migraine-associated dizziness (7), migrainous vertigo (49), migraine and vertigo (281), migraine and disequilibrium (31), headache and vertigo (1,215). The search was performed exclusively for
articles in English for the period of 1990–2008. After reviewing the abstracts, we focused on nine articles that addressed specific therapeutic interventions and their outcomes for VM.
Results
Only one small randomized, double-blinded, placebo-controlled study addressed treatment of VM (Table 1). Neuhauser et al. [14] found improvement of vertigo symptoms at 2 h in eight patients treated with zolmitriptan, as compared to the response in nine patients treated with placebo. The inclusion criteria were episodic vestibular symptoms of at least moderate severity, current or previous history of migraine according to IHS criteria [1], migrainous symptoms during at least two of the vertiginous attacks, and no other identifiable cause of vertigo. These researchers found that 38% of patients treated with zolmitriptan had a positive response (CI 9–76%) compared to 22% of patients taking placebo (CI 3–60%). Results were deemed inconclusive due to the limited power of the study.