Vestibular Migraine

Question 1

what are 7 differential dx to r/o before dx vestib migraine

Answer 1

1. vestib hypofunction
2. BPPV
3. meniere’s
4. anxiety
5. TIA
6. migraine
7. central path: MS, CVA

Question 2

vestib migraine vs meniere’s

pt age

Answer 2

migraine: 20-60yo
meniere’s: 35-60yo

Question 3

vestib migraine vs meniere’s

duration of attacks

Answer 3

migraine: sec to days
meniere’s: 20min to hrs

Question 4

vestib migraine vs meniere’s

visual auras?

Answer 4

migraine: frequent
meniere’s: infrequent

Question 5

vestib migraine vs meniere’s

tinnitus?

Answer 5

migraine: non-specific tinnitus
meniere’s: (+) tinnitus

Question 6

vestib migraine vs meniere’s

phono/photophobia

Answer 6

migraine

Question 7

vestib migraine vs meniere’s

ear fullness

Answer 7

meniere’s

Question 8

vestib migraine vs meniere’s

hearing loss?

Answer 8

migraine: none associated
meniere’s: progressive hearing loss

Question 9

vestib migraine vs meniere’s

sleep?

Answer 9

migraine: sleep helps
meniere’s: sleep not helpful

Question 10

vestib migraine vs meniere’s

spontaneous n/v?

Answer 10

migraine: rare
meniere’s: common (min-hrs)

Question 11

vestib migraine vs meniere’s

motion sensitivity?

Answer 11

migraine: correlation to motion sensitivity
meniere’s: less frequent

Question 12

vestib migraine vs meniere’s

family hx?

Answer 12

migraine: more likely
meniere’s: possible

Question 13

what are the main 3 s/sx of meniere’s

Answer 13

(+) tinnitus
ear fullness
progressive hearing loss

Question 14

migraine w/ or w/o aura: which is more common?

Answer 14

w/o aura (75%)

Question 15

what is the dx criteria for migraine w/o aura

Answer 15

at least 5 attacks w the following:
HA attacks >4-72hrs
HA w at least 2:
- U/L location
- pulsating quality
- mod or severe pain intensity
- aggravated by specific activity
during HA w at least 1:
- n/v
- photophobia and phonophobia

Question 16

what is the dx criteria for migraine w/ aura

Answer 16

at least 2 attacks w the following:
1+ of these reversible aura sx:
- visual, sensory, speech
- motor, brainstem, retinal

at least 3 of 6:
- 1 aura sx over >5min
- 2+ aura sx in succession
- each aura sx lasts 5-60min
- at least 1 aura sx is U/L
- at least 1 aura sx is (+)
- aura is accompanied or followed w/i 60 min by HA

Question 17

what is the dx criteria for vestib migraine

Answer 17

current or past hx of migraine w or w/o aura

5 episodes with the following:
vestib sx lasting 5min to 7hrs
at least 50% of episodes associated w at least 3 of the following features:
1. HA w at least 2 of the following 4
– U/L location
– pulsating quality
– mod to severe intensity
– aggravated by routine physical activity
2. photophobia and phonophobia
3. visual aura”

Question 18

describe the etiology of a migraine per the current model of a neurochemical event w neurovascular consequences