Association Between Benign Positional Vertigo and Migraine in Indian Population

DOI: https://doi.org/10.1007/s12070- 020- 02192- 2

Abstract-Summary 100 diagnosed patients of BPV, aged more than 20 years, were evaluated for pres- ence of headache specifically migraine based on International Headache Classification 3rd Edition, beta version.

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2 Mechanisms

We also compared the success of epley’s manoeuvre in patients having BPV &

headache as compared to patients with complaints of vertigo alone.

Seventy-four patients had successful epley’s manoeuver and the rest did not

show improvement even after four trials.

Thirty-four patients reported headache and migraine was diagnosed in only ten

patients.

67.6% of patients with headache had successful epley’s maneuver however fifty-

one of the 66 patients without headache had successful epley’s manoeuver.

Prevalence of migraine was only 10% in patients with BPV in our population and we observed that presence of headache does not suggest success or failure of epley’s manoeuvre.

Introduction Patient with migraine often report dizziness, photophobia and phonophobia [417, 418].

Migrainous vertigo is a frequent cause of recurrent vertigo [419, 420]. Latest classification of migraine is given by International Classification of

Headache Disorders (ICHD) which classifies BPV as ‘migraine equivalent’.

The spectrum of headache disorders in patients presenting to the vertigo clinic of

our ENT department was determined.

Materials and Methods The present study was undertaken in department of ENT & Neurology, Atal Bihari Vajpayee institute of medical sciences and Dr Ram Manohar Lohia Hospital New delhi, to observe the association and frequency of headache disorders, specifically migraine, among patients with BPV.

All patients underwent epley’s manoeuvre, which was repeated either up to a maximum of 4 times (after a minimum interval of 7 days when required) or until the positional nystagmus & vertigo disappeared.

All Patients were referred to neurology department, for evaluation and classifica- tion of headache based on International Headache Classification 3rd Edition, beta version.

All the patients were analyzed using descriptive statistics.

Results Seventy-four patients had successful epley’s manoeuver and the rest did not show improvement even after four trials.

We did not observe any significant gender difference for success of epley’s

manoeuver.

We did not observe any significant gender and age differences in success of

epley’s manoeuvre among migraine patients.

We compared the success rates of epley’s manoeuvre between patients with & without headache and found that 67.6% of patients, with headache, had successful epley’s maneuver however fifty-one of the 66 patients without headache had suc- cessful epley’s manoeuver.

2.3 Comorbidities

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Discussion The observation of migraine in only 10 of the 100 patients with BPV might be under representation of the number of patients having migraine.

Almost all our patients with migraine were between 31 and 40 years. We observed that 7 patients with migraine successfully responded to Epley’s

maneuver which is similar to the observation in all patients with BPV in general.

Ischiyama and others [421] studied 247 patients and found that the age of onset of vertigo in patients of BPV with migraine was different as compared to patients without migraine.

About half of patients, who had onset of BPV under the age of 50 years, met the diagnostic criteria for migraine however only 15% of patients with onset of BPV after the age of 50 years had migraine.

Brantberg and others [422] conducted interview with 40 patients who presented in their neurology clinic with BPV and met the diagnostic criteria of ICHD for migraine.

Conclusion The present study was undertaken in department of ENT & Neurology, Atal Bihari Vajpayee institute of medical sciences and Dr Ram Manohar Lohia Hospital New delhi, to observe the association and frequency of headache disorders, specifically migraine, among patients with BPV.

There was female preponderance amongst both BPV and migraine patients. We found that the success of epley’s manoeuvre, according to age & gender in patients with BPV without headache and according to gender in patients with BPV & headache, was not statistically significant however the same was significant in patients with BPV & headache, according to age groups.

We conclude that in Indian context, the prevalence of migraine in BPV patients is only 10% and overall there is no statistical difference in improvement of symp- toms of BPV patients with or without headache subjected to Epley’s maneuver.

Acknowledgement A machine generated summary based on the work of Gupta, Ankur; Kushwaha, Ajeet Kumar; Sen, Kanwar; Bajaj, Bhupender Kumar. 2020  in Indian Journal of Otolaryngology and Head & Neck Surgery.

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