Migraine management for the otolaryngologist

Area of Science:

• Neurology
• Otolaryngology
• Neuroscience

Background:

• Migraine is a complex neurological disorder with diverse manifestations.
• Vestibulocochlear symptoms, including vertigo and tinnitus, are increasingly recognized as part of the migraine spectrum.
• The pathophysiology involves trigeminal innervation and calcitonin gene-related peptide (CGRP) in the inner ear.

Purpose of the Study:

• To review the pathophysiology, clinical presentation, and treatment of vestibulocochlear manifestations of migraine.
• To highlight the diagnostic challenges and therapeutic strategies for migraine-related otologic symptoms.

Main Methods:

• A narrative review of existing medical literature was conducted.
• The review focused on studies characterizing migraine's impact on the auditory and vestibular systems.

Main Results:

• Migraine can present with otologic symptoms like vertigo, tinnitus, and hearing loss, often without headache.
• Conditions such as Meniere's disease and benign paroxysmal positional vertigo may be associated with migraine.
• Migraine treatments, including abortive and prophylactic therapies (e.g., triptans, CGRP inhibitors), show promise for otologic symptom relief.

Conclusions:

• Migraine with primarily cochleovestibular symptoms poses diagnostic and management challenges.
• Patients with migraine-related vestibulopathies can benefit from targeted migraine treatments.
• Lifestyle modifications and prophylactic medications are crucial for managing migraine attacks and improving function.