Migraine predisposes individuals to developing benign paroxysmal positional vertigo (BPPV) earlier in life than those without migraine, according to a UCSF study.
“Migraine damages the inner ear in ways that we don’t fully appreciate,” said lead author Jeffrey D. Sharon, MD, otologist, neurotologist and skull base surgeon and director of the UCSF Balance and Falls Center. “In my view, the migraine mechanism causes crystals to dislodge from their normal location in the inner ear. That’s why people with a history of migraine have BPPV earlier in life.”
Screening recommendations
Of the 255 patients with BPPV in the study, 44.7% had a history of migraine. Those with migraine were an average of five years younger than individuals without migraine when they first experienced BPPV. Migraine was not associated with greater severity of functional impairment, an increased risk for dizziness-related falls or recurrence of symptoms.
“Migraine affects about 10 to 15% of people worldwide,” Sharon said. “In this cohort of patients with BPPV, migraine was incredibly common – nearly 45% of them had a history of it. That’s much higher than you’d expect by chance. Clearly, migraine and BPPV are related.”
Based on the study’s findings, Sharon has screening recommendations.
“When a patient comes in with vertigo, the best approach is to perform the Dix-Hallpike maneuver to check for BPPV and also screen for migraine history,” he said. “That way, you’re most likely to get the complete picture of what’s going on, because these aren’t entirely separate diseases.”
Provider and patient resources
At the UCSF Balance and Falls Center, experts across multiple specialties assess patients to determine potential causes of vertigo, dizziness and balance problems, and then recommend treatments. The center’s website features provider and patient resources, such as:
3D anatomic models of hearing and balance structures
The center also focuses on research. Sharon and other UCSF investigators developed and validated a patient-reported outcome measure for vestibular migraine (VM) called VM-Patient Assessment Tool and Handicap Inventory (VM-PATHI). The team is now conducting a double-blind, placebo-controlled clinical trial on the use of galcanezumab for VM.
“To date, there have been no randomized clinical trials comparing a drug to placebo for treating vestibular migraines,” Sharon said. “This study will help people who suffer from dizziness due to migraines begin to find a solution.”
To learn more
Phone: (415) 353-2101 | Fax: (415) 353-2883
Otology, Neurotology and Skull Base Surgery
Phone: (415) 353-2757 | Fax: (415) 353-2603
