Comparison of clinical features and associated comorbidities of vestibular migraine in Taiwan.

Abstract

Introduction: Vestibular migraine (VM) has become the most common diagnosis among patients with complicated dizziness in the last decade. Also, associated comorbidities such as sensory hyperreflexia may play an important role in affecting patient's quality of life. We reviewed a Taiwan series of patients diagnosed with VM to better understand the features and comorbidities associated with VM and also to determine whether there are regional differences in the presentation of VM.

Material and patients: We retrospectively reviewed medical records from all patients diagnosed with VM between 2020.04 and 2023.03 and extracted data on chief complaints, interview records, and physical, laboratory and imaging results. VM was re-categorized according to the International Headache Society-Bárány (IHS- Bárány) diagnostic criteria as definite or probable VM.

Results: Among 393 Taiwanese patients diagnosed with VM, 74.3 % had definite VM, and 25.7 % had probable VM. Dizziness was most frequently associated with recurrent migraine headaches (91.6 %) and phonophobia (60.3 %). Chronic cervicalgia (58.0 %) was the most common non-criteria symptom. While 36.6-54.5 % of patients had otologic symptoms suggestive of Meniere's disease, only 5.1 % had both "definite" VM and "definite" Meniere's disease by diagnostic criteria. Beyond the VM diagnostic criteria, symptoms like chronic cervicalgia, osmophobia, brain fog, and chronic or fluctuating tinnitus significantly correlated with "definite VM" in a multivariate regression model.

Conclusion: VM is not solely due to vestibular or central issues; it is closely linked to various systemic comorbidities that can worsen VM and significantly impact quality of life. This study aims to deepen understanding of VM symptoms in Taiwanese and identify potential gaps in interpreting diagnostic criteria, accounting for cultural and linguistic variations. By examining these aspects, we aim to gain insights into the complex nature of VM and advance more effective diagnostic and treatment approaches.