Vestibular migraine: course of symptoms during a four-year follow-up

Data about the prognosis of vestibular migraine (VM) is scarce. VM patients on follow-up for at least 4 years were included in this multicenter study to evaluate the course of symptoms.

This is a cross-sectional study. A structured questionnaire was used inquiring demographic features, age of onset of migraine headaches and vertigo attacks, headache and vertigo attack frequency, severity, associated features and the presence of interictal dizziness and positional vertigo. Menopause, history of motion sickness, and family history of migraine were recorded. Answers of the first visit were compared with the answers of the last visit. In addition, variables considered were evaluated regarding their effect on the symptom course.

203 patients were studied. Median vertigo and headache attack frequency and severity had significantly dropped during follow-up (p < 0.01 for all comparisons). Complete resolution was reported by only 5.4%. Dizziness between the attacks was present in 67%, and positional vertigo was reported by 20.2%. Univariate analysis showed that aural symptoms (p = 0.013) and menopause (p = 0.016) were risk factors for ongoing frequent vertigo attacks. A history of motion sickness (p = 0.019) and a family history of migraine (p = 0.004) were associated with the risk of frequent migraine headaches. The presence of allodynia (p = 0.002) was associated with severe headache attacks while an early age of onset of vertigo attacks (p = 0.005) was a risk factor for continuing high-frequency vertigo attacks.

Though the frequency and severity of headache and vertigo attacks decrease, complete resolution is reported by a minority.