Migraine and Vertigo: Epidemiology, Genetics, and Mechanism(s)

Abstract

Both migraine and vertigo are highly prevalent in the general population, but the co-occurrence of migraine and vertigo is much higher than would be expected by chance alone with a lifetime prevalence of migrainous vertigo in the range of 1%. Genetic factors are important for determining the threshold for migraine symptoms but so far, mutations have been identified in only two genes for the relatively rare syndrome of familial hemiplegic migraine. Numerous genetic loci and candidate genes have been identified for the more common syndromes of migraine with aura and migraine without aura, but the results are conflicting and largely unreplicated. Recently, a susceptibility locus for familial benign recurrent vertigo was identified on chromosome 22q, but as with the susceptibility loci for migraine syndromes, this will need to be replicated in other patient populations. How migraine leads to recurrent vertigo is poorly understood; there may be multiple mechanisms affecting both peripheral and central vestibular pathways. Vasospasm involving the labyrinthine arteries is an intriguing possibility since vasospasm has been identified with retinal migraine. An ion channel mutation shared by ear and brain could explain the combination of central and peripheral vestibular signs and the common triggers for migraine symptoms. Finally, in some patients with migrainous vertigo, the inner ear may be damaged resulting in a form of Meniere's disease.