Vestibular Migraine: Diagnostic Criteria 2012 (IHS)

Hi All,

A major paper was released (thanks Jen for alerting me) in the Journal of Vestibular Research that comes at a very good time given the recent discussion on the prevalence and diagnostic criteria for VM. So I hope you’re all sitting down because the International Headache Society (IHS) is going to publish diagnostic criteria for this, expected to be listed in their 3rd edition next year. Wow! This means that VM is now finally a recognised entity that all physicians will take seriously when one of us shows up dizzy and asks – is this migraine?

Full paper below. HIGHLY recommend that everyone read it. Some highlights for now:

– vestibular migraine is one of the most common vestibular disorders affecting up to 1% of the general population (that would be over 3 million Americans)
– a principle aim of the definition of VM is its broad acceptance within both the vestibular and headache communities
– these criteria will be included in the 3rd edition of the International Classification of Headache Disorders, expected to be published in 2014
– there are no biological markers for vestibular migraine
– caloric stimulation often triggers migraine attacks within 24 hours – this provocation is a diagnostic clue
– a chronic variant of VM has been reported; chronic vestibular migraine may become a formally recognised category of a revised classification

Journal of Vestibular Research 22 (2012) 167–172

Abstract:
This paper presents diagnostic criteria for vestibular migraine, jointly formulated by the Committee for Classification of Vestibular Disorders of the Bárány Society and the Migraine Classification Subcommittee of the International Headache Society (IHS). The classification includes vestibular migraine and probable vestibular migraine. Vestibular migraine will appear in an appendix of the third edition of the International Classification of Headache Disorders (ICHD) as a first step for new entities, in accordance with the usual IHS procedures. Probable vestibular migraine may be included in a later version of the ICHD, when further evidence has been accumulated. The diagnosis of vestibular migraine is based on recurrent vestibular symptoms, a history of migraine, a temporal association between vestibular symptoms and migraine symptoms and exclusion of other causes of vestibular symptoms. Symptoms that qualify for a diagnosis of vestibular migraine include various types of vertigo as well as head motion-induced dizziness with nausea. Symptoms must be of moderate or severe intensity. Duration of acute episodes is limited to a window of between 5 minutes and 72 hours.

Nice find Scotty!!

Wow - a MILESTONE!!
Barb

That is GREAT News. :smiley:

About time!

Good find Jen :slight_smile:

great news!!!

Can anyone outline what this will mean in terms of research / treatment possibilities in the coming years? does it mean there will be more dedicated research ongoing?

Possibly Richy. I don’t think there’s much money thrown at migraine though – we’re still relying on drugs from decades ago!

But now that it is a recognised entity at least physicians won’t think we’re barking mad when you ask “is this migraine?”

S

BTW, who here was completely wiped out after the caloric test?

I was a complete train wreck after that test back in 2003 first acutely for about 36 hours afterwards and then there was a long chronic nightmare that went on for about 3 weeks before returning to whatever baseline I had established then.

I could barely function for a few days after mine. It was rough for a couple of weeks after this.

— Begin quote from “scott”

BTW, who here was completely wiped out after the caloric test?

I was a complete train wreck after that test back in 2003 first acutely for about 36 hours afterwards and then there was a long chronic nightmare that went on for about 3 weeks before returning to whatever baseline I had established then.

— End quote

Hi Scott,

I had no issues after the Caloric. I felt a little dizzy which is normal for the test but no increase in MAV symptoms

Wow that is a great step forward towards progress!

Paper added. Maybe we need to change the name of this forum to be in line with the IHS? What do you guys think?

Vestibular migraine forums?

Wowzers, this is big news. Thanks for posting!

To answer your questions Scott,

a) Yes, I had massive spike in dizzies post calorics. Lasted about 2-3 weeks. Dr S said it was usual.

b) Chronic vestibular migraine? Or do we not particularly need the chronic tag?

P.S I find this interesting

More than 50% of
patients with vestibular migraine have comorbid psychiatric disorders [25].

Yes most of us here have Chronic Vestibular Migraine as opposed to the episodic form which they suggest lasts 5 mins to 72 hours.

The final paragraph suggests that chronic vestibular migraine may be something that is added in future:

In this classification, vestibular migraine is conceptualized
as an episodic disorder. However, a chronic
variant of vestibular migraine has been reported [10,
27]. A distinction between chronic vestibular migraine
and comorbid psychiatric dizziness syndromes seems
particularly challenging in these patients [28]. In the future,
following additional research, chronic vestibular
migraine may become a formally recognized category
of a revised classification.

This is a great paper, thank you for posting Scott. The calroics had no effect on me at all. I was so bad when I had them done though that perhaps I wouldn’t have noticed anyway!! x

I noticed a differnce after the caloric. I have taken it twice. I don’t remember anything the first time but the 2nd time it I took it, I was extra dizzy for several weeks after.

— Begin quote from ____

Wow! This means that MAV is now finally a recognised entity that all physicians will take seriously when one of us shows up dizzy and asks – is this migraine?

— End quote

Great paper–great news–and WONDERFUL STEPPING STONE–

But let’s not go hog wild…it took doctors over 60 years to fully embrace germ theory–and even then many only did so because not doing so would cost them their license. There will be a lot of doctors who still don’t have a clue what you are talking about when you ask if your dizzies are migraine related–the good news NOW is that there will be a publication in your back pocket and/or purse to show you know what the heck you are talking about as you walk out the door in search of the next doctor :wink:

— Begin quote from “Jem”

Yes most of us here have Chronic Vestibular Migraine as opposed to the episodic form which they suggest lasts 5 mins to 72 hours.

The final paragraph suggests that chronic vestibular migraine may be something that is added in future:

In this classification, vestibular migraine is conceptualized
as an episodic disorder. However, a chronic
variant of vestibular migraine has been reported [10,
27]. A distinction between chronic vestibular migraine
and comorbid psychiatric dizziness syndromes seems
particularly challenging in these patients [28]. In the future,
following additional research, chronic vestibular
migraine may become a formally recognized category
of a revised classification.

— End quote

thats a shame Jem… I guess we are on the right path though…

question:

why is this recognised by the International Headache Society when its not a headache?

As we all know, vertigo and dizziness can be a symptom of migraine and migraine is a neurological condition, not a headache.