CHAPTER 15: Medical Management of Migraine, Ménière's Disease, and Motion Sensitivity

Introduction

Migraine is a common cause of episodic vertigo and disequilibrium in children and adults. In practices treating patients with headaches, 27% to 33% of patients out of a population of 700 patients with migraine report episodic vertigo.^1,2 Thirty-six percent of these patients experience vertigo during their headache-free period; the others experience vertigo either just before or during a headache. The occurrence of vertigo during the headache period is much higher in patients with migraine headaches with aura (classic migraine) as opposed to migraine without aura (common migraine).³ In this chapter, we describe the incidence of migraine; current classification and criteria used for diagnosing migraine, neuro-otological syndromes, and genetics related to migraine; and the management of migraine.

Incidence of Migraine

Migraine is an extremely prevalent disorder. An epidemiological study involving over 20,000 individuals between 12 and 80 years of age found that 17.6% of all adult females, 5.7% of all adult males, and 4% of all children had one or more migraine headaches per year.⁴ This study used the diagnostic criteria recommended by the International Headache Society⁵ (IHS, which is now referred to as ICHD⁶), which will be described later. Of those individuals with migraine, approximately 18% experienced one or more attacks per month. In both males and females, the prevalence of migraine was highest between the ages of 35 and 45 years. The type and severity of migraine often varies within the same individual. Migraine with or without aura frequently begins between 12 and 30 years of age. After the age of 50, migraine is much less common, and it frequently presents as migraine aura without headache.⁷

Migraine and International Classification of Headache Disorders (ICHD)

Migraine disorders are usually subdivided into several types. The classification of headache disorders was initially published by an Ad Hoc Committee of NIH.⁸ This included short descriptions of the headache disorder types without a description of the criteria. In 1988, an international committee developed a more comprehensive classification with criteria for each headache disorder termed the International Classification of Headache Disorders (ICHD).⁵ In most cases, the criteria for headache disorder was based on expert opinion. In 2004, the second version, the ICHD-II, was published, which was based on clinical research trials published since the 1988 study.⁶ The ICHD-III version should be published in 2013 and will be accessible on the IHS website (http://www.ihs-headache.org/). The classification and criteria for headaches pertinent to neuro-otological disorders is summarized in Box 15-1.