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Neurotology of migraine
1Department of Neurology, UCLA School of Medicine 90095-1769, USA.
Abstract:
Neurotologic symptoms are common with migraine, yet relatively little is known about the pathophysiology of such symptoms. Motion sensitivity with bouts of motion sickness occurs in about two thirds of patients with migraine. Episodes of vertigo occur in about one fourth of patients and, in some, vertigo is the only symptom (so-called "migraine equivalent"). Phonophobia is the most common auditory symptom, but fluctuating hearing loss and acute permanent hearing loss occur in a small percentage. Migraine can mimic Meniere's disease and so-called "vestibular Meniere's disease" is usually associated with migraine. The recent discovery of a mutation in a brain calcium-channel gene in families with hemiplegic migraine and in families with episodic vertigo and ataxia suggests a possible mechanism for neurotologic symptoms in patients with more common varieties of migraine. A defective calcium channel, primarily expressed in the brain and inner ear, could lead to reversible hair cell depolarization and auditory and vestibular symptoms. This hypothesis is currently being investigated in other families with migraine headaches and neurotologic symptoms. Hopefully, such studies will lead to improved diagnosis and better treatments in the future.
Insights
Migraine is linked to common neurotologic symptoms like vertigo and motion sickness. A potential cause involves brain calcium channel gene mutations, impacting auditory and vestibular functions.
Area of Science:
- Neurology
- Otolaryngology
Background:
- Neurotologic symptoms are frequently observed in migraine patients, but their underlying pathophysiology remains poorly understood.
- Common symptoms include motion sensitivity, motion sickness, vertigo, phonophobia, and less frequently, hearing loss.
- Migraine can present similarly to Meniere's disease, with
- vestibular Meniere's disease
- often associated with migraine.
Purpose of the Study:
- To explore the potential mechanisms behind neurotologic symptoms in common migraine varieties.
- To investigate the role of genetic factors, specifically calcium channel gene mutations, in migraine-related vestibular and auditory dysfunction.
Main Methods:
- Review of existing literature on neurotologic symptoms in migraine.
- Analysis of genetic studies identifying mutations in brain calcium-channel genes in families with hemiplegic migraine and episodic vertigo/ataxia.
- Hypothesis generation based on the potential impact of defective calcium channels on inner ear hair cells.
Main Results:
- Motion sensitivity and sickness affect about two-thirds of migraine patients.
- Vertigo occurs in about a quarter of patients, sometimes as the sole symptom (migraine equivalent).
- A mutation in a brain calcium-channel gene has been identified in specific migraine and vertigo/ataxia patient groups, suggesting a potential shared mechanism.
Conclusions:
- Defective calcium channels, particularly those expressed in the brain and inner ear, may explain reversible hair cell depolarization leading to auditory and vestibular symptoms in migraine.
- This hypothesis provides a potential pathophysiological link between migraine and neurotologic symptoms.
- Further research is ongoing to validate this hypothesis and improve diagnosis and treatment for migraine patients with neurotologic issues.