MAV: common but difficult to define - Terry Fife MD

Hi All,

This is an article that Caroline alerted me to. It’s nice and easy to digest and not dogmatic. Fife sheds a bit more light on the IHS. Some highlights:

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• MAV, which may be referred to by other terms such as vestibular migraine, migraine associated dizziness, migraine associated recurrent vertigo, benign recurrent vertigo, migraine-related vestibulopathy, migrainous vertigo, is a common cause of recurrent vertigo affecting about a third of all migraineurs. note: that would translate into one third of 11% of the US population = 12 million Americans.]

• The International Headache Society’s International Classification of Headache Disorders, Edition 2 (ICHD- 2) does not include vestibular migraine or migraine associated vertigo in its classification, per se. That does not mean its panel discounts the syndrome but the Classification is a work in progress achieved by con- sensus of many headache experts.

• MAV is a clinical diagnosis made by the combination of exclusion of other causes and by the presence of some features somewhat characteristic of MAV (Table 3).

• MAV is about five times more common than Meniere’s disease and the two conditions occur together more than expected. Among people with Meniere’s disease, 56% also have migraine headaches which is more than twice than seen in the general population.

• What may distinguish between those with migraine symptoms and those without them is the inborn threshold for developing symptoms and, to a lesser degree, our exposure to environmental stimuli that activate the cascade of neurobiological processes that leads to the condition we call migraine.

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Excellent, excellent!
This is a great article, and though I didn’t learn anything new per se, I like how succinctly it was put. Thanks!!

This is a very good article, covers me completely. I still cant find enough of the differences distinguishing menieres from mav though, I seem to fit the criteria for menieres as well as mav. I had 54% parasis in the caloric testing first time round, then not mentioned in testing at another hospital. I had right beating nystagmus on one of the tests, I have a very slight low level hearing loss, yet most of my symptoms fit mav, I get proper migraines with aura, had car sickness as a child, was diagnosed early on with basilar migraine at around the same time as the neurologist diagnosed me with menieres, it just goes on. It seems that they two overlap so much they are almost one.

Definitely an article worth keeping. One worth taking to a neurologist as a lot of them could learn from it.


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One worth taking to a neurologist as a lot of them could learn from it.

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Agree Christine – lays it all out quite clearly without getting too detailed about it. An easy read for all and one any GP could skim over and get the gist of it quickly to realise it’s a real entity.


I agree with the others… great article that I may consider giving to my doctors that are not the neuro treating me. One of my doctors just stared at me though he’s the chronic fatigue/fibro specialist so you’d think he’d be a BIT more open-minded considering the slippery mysterious nature of fibro etc. I think that he was skeptical that migraine treatment was actually treating my so-called “fibro” so successfully LOL.

Thank you! This is really helpful. Especially this comment at the very end: “Vestibular physical therapy is most helpful in those with gait difficulty disproportionate to their examination findings.”

The kid is still having difficulty walking normally, and the neuro and physical therapist both indicate that the difficulty is more than you’d expect, based on their examinations.

This seems almost like a residual effect – do you know what I mean? The migraine proper seems largely resolved. For the most part, he’s not dizzy, photophobia and phonophobia are pretty much resolved, but he still can’t walk properly.

The vestibular therapist wants to see him twice a week. Our insurance only covers that at 80%, so it’s going to add up. But what else can you do?

How common is the gait difficulty that seems to go on and on?


Mamabear – if the migraine is pretty much out of action now and he still shows signs of incomplete compensation then now is the time to use VRT. In that one study which is posted here somewhere (check the vault) people doing VRT for MAV while being treated for migraine made the biggest gains.