(PP1503) Hormonal Changes May Be One of the Contributing Factors for Migraine Associated Vertigo

It is a common occurrence for patients to report initial migraine symptoms in early adulthood, and develop symptoms of migraine associated vertigo (MAV) later in life. Out of 267 female patients with MAV, onset of vertigo developed on average 13.4 years later than the migraine onset on average (30.8 years old). The peak age of vertigo onset occurred around 41-50 years old, the same time as perimenopause or menopause. Estrogen has been reported to inhibit the central nervous system neuronal activities; therefore, we hypothesized that declining estrogen levels related to perimenopause and menopause may contribute to the development of MAV.


Summary: 

Rationale:

The rationale for this study is to examine the relationship between the age of onset of migraines and migraine associated vertigo (MAV) and to explore the possible relationships of hormonal changes with age in women.

Background:

MAV can be described as a central nervous system (CNS) condition that causes recurrent dizziness and vertigo in patients with migraine headaches. MAV can occur before, during, or after a migraine. Females are three times more likely to have MAV than males. It was clinically observed that women experiencing MAV during perimenopause and menopause had initial onset of migraines in adolescence to early adulthood. It is hypothesized that estrogen, a natural systemic inflammatory inhibitor, blocks N-methyl-D-aspartate (NMDA) receptors in the cerebral cortex. Therefore, when the levels of estrogen are reduced, the neuronal activity of the cerebral cortex increases or becomes hyperactive, and ultimately leads to the development of MAV.

Design:

Per clinic procedure, MAV is diagnosed as migraine variants (ICD 10-G43.809) based on the 2021 Barany Society and International Headache Society Criteria. Using a retrospective study approach, electronic medical records of 618 patients with MAV who visited the Dent Dizziness, Balance and Tinnitus Center between January 2015 and August 2021 were reviewed. Onset age was considered to be the earliest age the patient clinically reported symptoms which led to a diagnosis of migraine and MAV. Only 267 female patients with documented both age onset of migraine and migraine associated vertigo were included in this study. Additional factors abstracted from the records included history of mental health diagnoses in the patient and their family, use of anti-anxiety medications, quality of sleep, body mass index, symptom frequency, and other factors known to trigger onset of MAV. Patients were excluded if the above criteria were not met, or if they had a diagnosis of Meniere’s disease, vestibular neuritis, benign paroxysmal positional vertigo, or other peripheral deficits. 

Results:

Of the 267 female patients who met the inclusion criteria, migraine onset most frequently occurred in adolescence to early adulthood (11-20 years old), while the peak MAV onset took place during the perimenopause and menopause age range (41-50 years old). Patients showed an average delay of 13.4 years between MAV onset (average = 44.2 years old) and migraine onset (average = 30.8 years old).

Conclusion:

The observed difference between onset of migraine and onset of MAV suggests that age may be a major contributing factor. In general, females 41-59 years old are in perimenopause or menopause. During this period of time, estrogen levels gradually decline. Estrogen is a CNS neuronal inhibitor and its receptors are found in the cerebral cortex. Therefore, we propose that reduction of endogenous estradiol levels may increase neuronal activity in the CNS vestibular center, which may subsequently lead to the development of MAV.