Vestibular migraine and benign paroxysmal positional vertigo, close presentation dilemma

Abstract

Background: Not only an association between benign paroxysmal positional vertigo (BPPV) and migraine have been recognized in the literature, but also, there are close similarities between BPPV and vestibular migraine (VM) presentations as both can be presented by very similar positional nystagmus.

Aims/objectives: To prescribe relatively uncommon cases of positional nystagmus caused by VM that mimics positioning nystagmus of BPPV.

Material and method: 12 patients were reviewed retrospectively in this study. All were subjected to full history taking, videonystagmography testing (VNG) and brain magnetic resonance imaging (MRI) with contrast. Provisionally, they were diagnosed with BPPV. After three attempts of repositioning sessions none of them improved. After exclusion of central insults using brain MRI, trial of anti-migraine medical treatment (50-100 Topiramate tablets once per day) for at least one month was prescribed to them.

Results: 10 patients were completely cured on medical treatment and finally were diagnosed VM. Only 2 patients did not improve on medical treatment (for one month), were managed again by repeated repositioning maneuvers till finally improved and were diagnosed as resistant BPPV.

Conclusions/significance: VM positional nystagmus can mimic BPPV nystagmus in some patients.

Chinese abstract

背景：良性阵发性位置性眩晕（BPPV）和偏头痛之间存在关联, 这已在文献中得到认可。BPPV和前庭偏头痛（VM）之间也有相似之处, 两者都可以通过非常相似的位置性眼球震颤呈现。

目的：描述由VM引起的相对罕见的位置性眼球震颤病例, 这种病例模仿BPPV位置性眼球震颤。

材料与方法：本研究回顾性回顾了12例患者。所有患者都有完整的历史记录、视频眼震描记测试（VNG）和脑磁共振成像（MRI）。他们暂时被诊断出患有BPPV。在尝试重新定位三次之后, 他们没有一个得到改善。使用脑MRI排除中部受损后, 给予抗偏头痛医药治疗（50–100 mg托吡酯）处方至少一个月。

结果：10例患者完全治愈, 最终被确诊为VM。经药物治疗1个月未改善的两位患者通过反复的重新定位操作, 最终得到改善, 并被诊断为耐药性BPPV。

结论/意义：一些患者的VM位置性眼球震颤可模仿BPPV眼球震颤。

Keywords:

• Migraine
• BPPV
• vertigo
• positional nystagmus

Disclosure statement

No potential conflict of interest was reported by the author.