Clinical criteria of positional vertical nystagmus in vestibular migraine

Abstract

Objectives: The goal of this study was to identify key diagnostic criteria for positional vertical nystagmus caused by vestibular migraine (VM).

Materials and methods: The study group included a case series of 13 subjects with VM (10 females and three males with age 38.6 ± 8.9 years); they were complaining of positional vertigo. They were subjected to thorough audiovestibular examination and treated with cinnarizine or topiramate

Results: The entire study group demonstrated positional vertical nystagmus (eight patients had up-beating nystagmus and five patients had down-beating nystagmus). The vertigo and nystagmus were elicited in one or more of the following positions: the right & left Dix–Hallpike, supine with head center, head right, and head left positions. The nystagmus had no latency period. It was persistent, non-fatigable and markedly reduced by visual fixation. Prophylactic therapy of VM (topiramate or cinnarizine) cured the positional vertigo in 92% of the study group. Neither the positional vertigo nor the nystagmus recurred in a 3–6 months follow-up period.

Conclusions: VM can induce characteristic form of vertical positional nystagmus and vertigo, which would be treated by medications used for controlling the VM.

Chinese abstract

目的：本研究的目的是确定前庭性偏头痛（VM）引起的体位垂直性眼震的主要诊断标准。

材料与方法：研究对象为13例受试者（女10例, 男3例, 年龄38.6 ± 8.9岁）, 主诉体位性眩晕。他们接受了彻底的声前庭检查和桂利嗪或托吡酯治疗 。

结果：整个研究组均表现为体位垂直性眼球震颤（八例患上跳动性眼球震颤, 五例患下击性眼球震颤）。眩晕和眼球震颤引发于一个或多个位置 ：左右迪克斯-霍尔皮克、头中位、头偏右、和头偏左的仰卧位置。眼球震颤无潜伏期。它是持久的, 不易消退的, 会因视觉固定而明显减少。VM的预防性治疗（托吡酯或桂利嗪）治愈了92%的研究人群的体位性眩晕。无论是体位性眩晕或眼球震颤都没有在3 - 6个月的随访期间复发。

结论：VM可诱发垂直体位性眩晕和眼球震颤的特征性形式, 这些病症可通过控制VM的药物来治疗。

Keywords:

• Positional nystagmus
• vertical nystagmus
• vestibular disorder
• migraine therapy

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.