Elsevier

American Journal of Otolaryngology

Volume 29, Issue 5, September–October 2008, Pages 295-299
American Journal of Otolaryngology

Original contribution
Migraine and audiovestibular dysfunction: is there a correlation?

https://doi.org/10.1016/j.amjoto.2007.09.004Get rights and content

Abstract

Purpose

To study the audiovestibular functions in cases of migraine with or without vertigo.

Materials and methods

This was a prospective study involving 50 cases of migraine who were divided into 2 groups: patients with vertigo and those without. All patients underwent a detailed otological and neurootological examination followed by full audiological and vestibular investigation including pure tone audiometry, speech reception threshold, speech discrimination score, tone decay, short increment sensitivity index, auditory brainstem-evoked responses, and electronystagmography (ENG).

Results

Thirty-eight (76%) of 50 patients had vertigo on presentation, of which rotatory nonpositional vertigo (22/38) was the most common. Phonophobia was the most common auditory symptom (35/50, 70%) followed by tinnitus (25/50, 50%). Only 17 patients (34%) reported hearing loss, of whom only 7 had documented hearing loss on pure tone audiometry. However, the auditory brainstem-evoked responses of all these patients showed some abnormalities in the form of prolonged absolute latency or prolonged interwave peak latencies or both. Electronystagmography revealed canal paresis in 13 patients (26%), although there was no statistical difference between patients with or without vertigo on various electronystagmographic parameters.

Conclusion

Auditory brainstem-evoked response abnormalities may be the earliest indicator of impending auditory involvement in migraine.

Introduction

Migraine is a benign and recurring syndrome of unilateral throbbing headache, associated with nausea, vomiting, and phonophotophobia. Migraine is more common in females than in males with a ratio of 2.5:1 [1]. Various authors have studied the neurootological aspects of migraine such as its manifestations [2] including vertigo, unsteadiness, tinnitus, pitch distortion, phonophobia, and hearing loss. Sudden onset sensorineural hearing loss in migraine has also been reported [3], [4]. It was postulated that spasm of cochlear vessels led to reversible hypoxic injury and temporary hearing loss.

Thakar et al [5] studied the association of vertigo with migraine in which 344 cases of vertigo were reviewed. They identified 19 cases of vertigo with headache characteristic of migraine. Parker [6] reported a strong association between migraine and vertigo based on the results of his study. It has been opined that defective calcium channels, primarily expressed in the brain and inner ear, could lead to reversible hair cell depolarization, leading to auditory and vestibular symptoms [7]. The present study is a prospective analysis of the audiovestibular functions in patients diagnosed with migraine. The aim of the study was to explore the relationship between migraine and audiovestibular functions.

Section snippets

Materials and methods

This was a prospective observational study. The study was approved by the ethical justification committee of our institute. The study group consisted of 50 cases of migraine that fulfilled the IHS 1988 [8] criteria for migraine. The patients were divided into 2 groups: cases of migraine with vertigo and cases of migraine without vertigo. The patients were referred from the Neurology Services after an initial evaluation and were later worked up in the Department of Otolaryngology and Head and

Results

Fifty patients fulfilling the IHS 1988 criteria of diagnosis of migraine were taken up for study. The age of the patients ranged between 18 and 60 years, the majority of whom were between 18 and 30 years (ie, 21/50, 42%). There were 21 males (42%) and 29 females (58%). In the younger age group (ie, 18–30 years), there were 14 females (out of 21).

The duration of migrainous headache was divided into 4 groups as shown in Table 1.

Thirty-eight (76%) of 50 patients presented with vertigo, majority of

Discussion

The association of migraine and vertigo is frequently described [9]. However, a causal link between the two remains elusive. It is not uncommon for individuals with migraine to experience some sort of cochleovestibular symptoms, such as tinnitus, hearing loss, or dizziness. Although neurootological manifestations are common in migraine, only a limited number of studies have been done in this regard.

The literature quotes the incidence of vertigo in migraine patients from 55% to 69% [2], [10]. We

Conclusion

It can thus be said that patients with migraine with vertigo are more likely to have cochleovestibular affection. However, the type of migraine has no bearing on cochleovestibular abnormality. This study is another step toward understanding audiovestibular changes in patients with migraine. This has helped us to know the effects of migraine on both cochlear and vestibular apparatus, so that a detailed diagnostic evaluation can be undertaken in patients with migraine.

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