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Vestibular Migraine Diagnosis and Treatment
Built from Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
What’s inside
8 sections · 100 slides
Overview
- Scope of this presentation
Scale of the problem
- Definition of vestibular migraine
- Prevalence of migraine and vestibular migraine
- Temporal relationship of headache and vertigo
- Reasons the diagnosis is obscured
- Internal ear: bony and membranous labyrinth
- Planes of the semicircular canals
- Crista ampullaris and cupula
Diagnosing migraine
- International Headache Society classification
- Migraine without aura
- Migraine with aura
- Scintillating scotoma of visual aura
- Migraine with brainstem aura
- Brainstem: midbrain, pons and medulla
- Bickerstaff's original description
- Hemiplegic migraine
- Benign paroxysmal vertigo of childhood
- Selected migraine types: episodes, duration, headache
- Diagnostic criteria: Migraine without aura
- Diagnostic criteria: Migraine with aura
- Diagnostic criteria: Migraine with brainstem aura
- Diagnostic criteria: Hemiplegic migraine
- Diagnostic criteria: Vestibular migraine
Criteria for diagnosing vestibular migraine
- Why criteria were needed
- The Bárány Society consensus
- Vestibular migraine and probable vestibular migraine
- Criteria for definite vestibular migraine
- Criteria for probable vestibular migraine
- Status in the ICHD third edition
- Types of vestibular symptom recognised
- Duration of vestibular symptoms
- Severity grading of vestibular symptoms
- Limitations of vestibular and auditory testing
- Electronystagmographic findings in vestibular migraine
Vestibular migraine and Ménière disease
- Migraine prevalence in Ménière disease
- Two explanations for the association
- Neff series: cohort and groups
- Features favouring Ménière disease
- Features favouring vestibular migraine
- The combined MDVM group
- Audiometry and caloric testing in the differential
- Vestibular evoked myogenic potentials
Treatment: triggers and supplements
- Challenges in treating vestibular migraine
- Principles of management
- Modalities of treatment
- Trigger avoidance
- Elimination and reintroduction protocol
- Safe foods and the dietary journal
- Non-dietary triggers
- Trigger foods
- Trigger foods (continued)
- Vitamins and supplements
- Cautions with supplements
- Supplements and doses
- Oral supplement preparations
Pharmacotherapy
- Abortive versus prophylactic therapy
- Abortive migraine medication
- Zolmitriptan randomised trial
- Other abortive agent studies
- Sumatriptan molecule
- Classes used for migraine prophylaxis
- Choosing a prophylactic agent
- Beta blockers: mechanism
- Beta blockers: indications and contraindications
- PROVEMIG trial of metoprolol
- Calcium channel blockers
- Calcium channel blockers: safety profile
- Tricyclic antidepressants
- Tricyclics: adverse effects and contraindications
- Serotonin-norepinephrine reuptake inhibitors
- Valproic acid
- Lamotrigine and topiramate
- Topiramate: adverse effects
- Prophylactic drug therapy: class, agent and daily dose
- Prophylactic drug therapy: side effects
- Prophylactic drug therapy: contraindications
Newer and adjunctive therapies
- CGRP-targeted therapies
- Evidence for anti-CGRP monoclonal antibodies
- Reported benefits and acute gepant therapy
- Treatment strategy
- Instituting prophylactic therapy
- Vestibular physical therapy
- OnabotulinumtoxinA: longitudinal fMRI study
- OnabotulinumtoxinA: randomised controlled trial
- Botulinum toxin in practice
- Non-invasive vagus nerve stimulation
- Conclusion
- References (1 of 4)
- References (2 of 4)
- References (3 of 4)
- References (4 of 4)
- Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
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