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Furman, Joseph M.; Marcus, Dawn

CONTINUUM: Lifelong Learning in Neurology:
doi: 10.1212/01.CON.0000290483.03247.57

Migraine headache is often accompanied by dizziness or unsteadiness. For patients to be given a diagnosis of migraine-related dizziness (MRD), ie, dizziness attributable to migraine, they must meet International Headache Society criteria for migraine headache, have episodic or fluctuating symptoms highly suggestive of a balance disorder, have no recognized alternative otoneurological diagnosis, and experience migrainous symptoms during episodes of vertigo or imbalance. The pathophysiological basis for MRD may be related to interactions between pain pathways and vestibular pathways and abnormalities in the inner ear. MRD is treated by trigger avoidance, antimigrainous pharmaceutical agents, and physical therapy. MRD can occur as a comorbid disorder along with other, well-defined, neuro-otological disorders such as Ménière's disease. A subgroup of patients with MRD will manifest migraine, anxiety, and a balance disorder, a condition termed migraine-anxiety related dizziness. Motion sickness refers to autonomic and cognitive signs and symptoms that occur during exposure to certain moving environments. Although motion sickness is not a disease, it may result in disabling symptoms. The primary management of motion sickness is avoidance of the provocative stimuli. When motion sickness provocation cannot be avoided, antihistamines such as meclizine and benzodiazepines may provide significant relief.

© 2006 American Academy of Neurology