This is a very nice little paper which shows just how well MAV mimicks or is even possibly behind (a trigger?) for Meniere’s disease (MM). In these two women they presented with what any physician and probably a good bunch of neurologists would nail down as MM, yet look at what happened:
Recent reports have focused on a possible association between migraine and Menière’s disease (MM); patients suffering from MM present a higher rate of migraine. In some cases, the clinical features of migraine-associated vertigo (MAV) may mimic the presentation of MM. The present report focuses on two cases of females with recurrent episodes of rotational vertigo, fluctuating hearing loss and tinnitus lasting from a few minutes to several hours; both cases also presented migrainous attacks. As a result of repeated cochleo-vestibular attacks, both patients presented a permanent low frequency sensorineural hearing loss. Preventive therapies for MM did not reduce vertigo attacks, while Topamax and aspirin treatment resulted in a significant reduction of both migraine and vertigo. Both the diagnosis of MM and of MAV rely on clinical history and both disorders lack a specific diagnostic test. In the early stages, differential diagnosis between MM and MAV is often very difficult; previous investigations focused on the possibility that subjects with migraine may experience all symptoms of MM, including sensorineural fluctuating hearing loss. In conclusion, a trial with prophylactic drug treatment for migraine might be suggested in patients with clear symptoms of migraine and recurrent cochleovestibular disorders.
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• Prosper Menière himself observed the association between MM and migraine.
• a higher prevalence of migraine in MM patients, variously reported at between 43% and 56%, while in the normal population it is 10%.
• epidemiology of both MM and MAV may underline a possible pathogenetic link between the 2 diseases.
• MAV is the main disorder capable of mimicking MM in its early stages. There is clinical evidence that migraine can damage the inner ear, causing permanent hearing loss or impairment of vestibular function. Some authors have hypothesised that MM may develop in an ear previously damaged by vasospasm induced by migrainous mechanisms.
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• 42-year-old female, suffering from migraine with aura according to IHS criteria. The final diagnosis was made by a senior neurologist. The patient reported the first attack of migraine at the age of 20 years, which more typically occurred before menstruation, at a frequency of 1-2/month. Her family history was positive for migraine (mother and one of three sisters).
• patient reported recurrent episodes of rotational vertigo (about 1/month) lasting from a few minutes to 1-2 hours, often with a right ear fluctuating hearing loss. Migraine and vertigo never occurred together.
• She also reported the presence of tinnitus which increased before vertigo attacks.
• Caloric tests demonstrated a right sided unilateral weakness (26%) during caloric stimulation according to Freyss and the Head Impulse Test was positive on the horizontal plane with refixation saccades towards the left side.
• 59-year-old female with a long history of migraine which began at the age of 23 and ceased at the age of 50, immediately after onset of menopause.
• Over the last year, she reported various episodes of rotational vertigo normally lasting for 2-3 hours with hearing loss on the left side. She reported increased hearing loss during vertigo. Audiometric examinations demonstrated a low frequency sensorineural hearing loss.
• Preventive therapy of md with betahistine 24 mg twice a day, salt restriction and increased water intake did not prevent vertigo attacks, which remained unchanged in frequency and duration in a 6-month follow-up.
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Drug prophylaxis of migraine with Topamax 100 mg a day and aspirin (100 mg a day) produced a clear decrease in vertigo attacks, in both patients, in a 1-year follow-up.
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How bizarre that daily aspirin helped to fix them up (with Topamax) which is in contrast to what Nick Silver would say about a painkiller. Now I wonder if my head would feel any better on 100 mg daily?
So the take home messgae folks is that quite clearly a dx of Meniere’s has to be closely examined to rule out either a problem completely or maybe partially based on migraine. They offer the following for help in differential diagnosis:
• In the patient’s history, the report of only very short (seconds to less than 15 minutes) or prolonged (more than 24 hours) vertigo spells are more likely due to migraine rather than MM. Moreover, if the spontaneous spells of vertigo are associated with migraine features (phono- or photo-phobia), migraine is the probable source.
• In MAV, audiometric and vestibular anomalies are more typically mild in magnitude and stable over time rather than fluctuating.
Full text article here: