(PP1311) Motion Sickness May Be a Contributing Factor for Migraine Associated Vertigo

Abstract: A retrospective medical record review found 60% of 165 patients with diagnosis of migraine associated vertigo (MAV) had a history of motion sickness (MOS).  Previous studies have also shown a positive correlation between MAV and MOS. Since MOS is known to occur in patients with normal peripheral vestibular function, and all 165 patients also had normal peripheral vestibular function, we propose that MOS may be one of the contributing factors for developing MAV and a common underlying central mechanism may explain both MOS and MAV.

Summary: Rationale:

To assess the relationship between motion sickness and migraine associated vertigo.

Background:

Prior studies suggest vestibular symptoms in MAV may signify dysfunction in either the peripheral or central vestibular system. In further investigations of peripheral or central involvement, researchers have found that motion sickness (MOS) can be an indicator for symptoms of MAV, whether MOS occurred before or after onset of MAV.  The vestibular system relies on visual, spatial, proprioceptive and nervous system stimuli to determine if an individual is accelerating or at rest. MOS occurs when there is a sensory mismatch in the detectors of the vestibular system. Previous findings reported that in order for MOS to occur, the peripheral vestibular system is normally intact. Feelings or episodes of motion sickness can co-occur with common peripheral vestibular disorders such as Meniere’s disease, benign paroxysmal positional vertigo or vestibular neuritis. However, this may be distinct from true MOS, which typically affects patients throughout their lifetime. Previous studies found MOS was notably more common among migraineurs than in normal controls. Therefore, the reciprocal relationship between MOS and MAV is consistent with the assumption of common central pathway involvement rather than peripheral.

Design:

This retrospective research study was completed for patients who visited the Dent Dizziness, Balance and Tinnitus Center between 2015 and 2021. Patients were included if they had a diagnosis of migraine variant (ICD 10-G43.809), which was used specifically for the diagnosis of MAV. MAV diagnosis was based on the 2012 Barany Society and International Headache Society Criteria:  at least 5 episodes of vestibular symptoms of moderate or severe intensity lasting 5 minutes to 72 hours; current or previous history of migraine with or without aura according to the International Classification of Headache Disorders (ICHD); one or more of the following migraine features with at least 50% of vestibular episodes: 1) Headache with at least two of the following characteristics: one sided location, pulsating quality, moderate or severe pain intensity; aggravation  by routine physical activity,  2) photophobia and phonophobia, 3) visual aura; and not better accounted for by another vestibular or ICHD diagnosis. MOS history was documented for all patients in the medical record or otherwise confirmed by phone interview. Patients were excluded if the above criteria were not met, if another diagnosis contributing to migraine headaches was present, or they had a diagnosis of Meniere’s disease, vestibular neuritis, benign paroxysmal positional vertigo or other peripheral deficits. 

Results:

One hundred sixty five patient charts were reviewed in which all subjects were diagnosed with migraine variant (ICD10-G43.809). In total, 66/165 (40%) of patients reported no history of MOS, while 99/165 (60%) reported a history of MOS. Our study also revealed that the onset of MAV was reported more commonly in adults with age ranging from age 30-59, with 60/99 patients falling into this category (60%).

Conclusion:

MOS may be one of the contributing factors for developing MAV. A common underlying central mechanism may explain both MOS and MAV.