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Vestibular Migraine

Aka: Vestibular Migraine
  1. Epidemiology
    1. Incidence: 1-2%
    2. Very common diagnosis in neurotology (tertiary centers)
    3. Common cause of episodic Vertigo in children
    4. More common in women (by 3 fold over men)
    5. Ages affected most commonly: 20 to 50 years old
  2. Risk Factors
    1. Family History
  3. Diagnosis: Definitive Criteria
    1. Current or previous history of Migraine Headaches (ICHD-II Criteria)
    2. Vestibular symptom episodes at least 5 times
      1. Vestibular symptoms of a least moderate severity lasting at least 1 minute
      2. Episodes persists for no more than 72 hours
    3. More than 50% of the attacks are accompanied by Migraine-type symptoms
      1. Migraine Headache
      2. Photophobia
      3. Phonophobia
      4. Visual aura
  4. Management
    1. See Vertigo Management
    2. Manage Migraine Headaches
    3. Avoid Migraine Headache Triggers
      1. Avoid Tyramine-Vasoactive Amines
      2. Avoid excessive stress
      3. Get adequate rest
    4. Magnesium Supplementation may be effective
    5. Consider Migraine Prophylaxis (e.g. Nortriptyline, Propranolol, Topiramate)
      1. Goal to reduce Vestibular Migraines by 50%
      2. See Migraine Headache Prophylaxis
  5. References
    1. Staab (2012) Mayo POIM Conference, Rochester
    2. Muncie (2017) Am Fam Physician 95(3): 154-62 [PubMed]

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