Vestibular Migraine in Children
Beck, Petrak, and Smith (2013) report migraine, Meniere’s Disease (MD), and vestibular migraine (VM) may share a common pathogenesis and (at this time) there is no single gold-standard lab-test which clarifies and identifies the differential diagnosis. Indeed, the audiologist, otolaryngologist, and neurologist (or other professional) is tasked with relying on and interpreting the case history, physical findings, and non-exclusive test results to establish the differential diagnosis. Unfortunately, confusing and overlapping diagnostic terms are used to indicate the same (or highly similar) phenomena, such as migraine associated dizziness (MAD), vestibular Meniere’s, migraine associated vertigo, benign recurrent vertigo, vertiginous migraine, and migraine-related vestibulopathy—all of which appear to be synonymous with vestibular migraine (VM).
Casselbrant (2013) states that "the terminology for migraine-related/associated vertigo/dizziness has previously been confusing…migraine-associated vertigo, migraine-related vestibulopathy and migrainous vertigo have been used…." Casselbrant reports that Neuhauser and Lempert (2009) advocate the term vestibular migraine (VM), as it stresses the vestibular manifestation of migraine (in agreement with Beck, Petrak, and Smith, 2013). Of note, the diagnosis term selected may be dependent on the profession and education of the individual practitioner, rather than specific criteria associated with a preferred diagnostic term.
Casselbrant reports "vestibular migraine is the most common vestibular/balance disorder in children." Indeed, the actual incidence of VM in children is unknown and difficult to objectively assess as children may not have the vocabulary to describe their symptoms. VM manifests without an aura and is more common in adolescent females (than males) and may be associated with menstrual periods. In many VM cases, vertigo is often associated with headache and may last for hours and may include nausea, vomiting and photophobia. Bright lights, intense smells and/or (loud) noise may precipitate an attack. Many children with VM report motion sickness or car sickness and many have a family history of migraine. Casselbrant reports that treatment should be individualized to the child and includes watchful waiting, stress reduction, appropriate sleep, rehabilitation therapy, and avoidance of food triggers and vestibular suppressants. Ophthalmologic evaluation and correction is recommended as visual problems may cause the same/similar symptoms.
For More Information, References, and Recommendations
Beck DL, Petrak MR, Smith AG. (2013) Overview 2013: Migraine, Meniere’s Disease and Vestibular Migraine. Audiology Today 25(2):54-56.
Casselbrant M. (2013) Vestibular Migraine, in Manual of Pediatric Balance Disorders. Editors; O’Reilly RC, Morlet T, Cushing SL. Plural Publishing, San Diego, California.
Neuhauser H, Lempert T. (2009) Vestibular Migraine. Neurol Clin 27:379-391.