How is Ménière disease differentiated from migraine-associated vertigo?

Updated: Jan 18, 2019
  • Author: Aaron G Benson, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

The principal differential is with Ménière disease. The overlapping symptoms of Ménière disease and migraine-associated vertigo include episodic vertigo, sensorineural hearing loss, and tinnitus. Differentiating migraine-associated vertigo from Ménière disease may be difficult, because of the overlapping nature of the symptoms of these diseases. However, often the patient’s history offers clues that may help to make the diagnosis. (See Table 2, below.)

Table 2. A Comparison of the Symptoms of Migraine-Associated Vertigo and Ménière Disease (Open Table in a new window)

Symptom

Migraine-Associated Vertigo

Ménière Disease

Vertigo

May last >24h

Lasts up to 24h

Sensorineural hearing loss

Very uncommon; when present, often low frequency; very rarely progressive; may fluctuate in cases of basilar migraine

Nearly always progressive; most often unilateral; may be bilateral; fluctuation is common

Tinnitus

May be unilateral or bilateral; rarely obtrusive

May be unilateral or bilateral; often of significant intensity

Photophobia

Often present; may or may not be associated with dizziness

Never present unless a concurrent history of migraine exists

When vertigo is present, it may be indistinguishable from the spontaneous vertigo of Ménière disease. One clue that the vertigo is not of the Ménière type is that the vertigo of migraine-associated vertigo may last longer than 24 hours. In fact, a rocking sensation may be a continuous feeling for many weeks to months. In contrast, the vertigo of Ménière disease typically does not last longer than 24 hours.

Symptoms that would support the diagnosis of migraine-associated vertigo as opposed to Ménière disease include photophobia, nonprogressive sensorineural hearing loss, vertigo of longer than 24 hours in duration, a long-standing history of motion intolerance, and dizziness occurring only during the menstrual cycle. Childhood benign positional vertigo is strongly related to migraine-related vertigo.

Migraine and vestibular disease can coexist. [24] Patients who meet the clinical criteria for Ménière disease should be treated appropriately for Ménière disease, even if a history of migraine headache exists.

Sensorineural hearing loss in Ménière disease and basilar migraine

Although unexplained sensorineural hearing loss has been reported in 0-31% of unselected patients with migraine, [25] such changes are rarely a significant feature of migraine-related vertigo and thus help to differentiate it from other causes of vertigo, especially Ménière disease.

Up to 80% of patients with basilar migraine have been reported to have sensorineural hearing loss, which often affects the lower frequencies and may be bilateral. [26] Fluctuation is also possible, similar to the sensorineural hearing loss of Ménière disease. However, unlike in Ménière disease, the sensorineural hearing loss of basilar migraines rarely progresses.


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