Evaluating associations of migraine-related vertigo.

OBJECTIVE

We set out to examine detailed phenotypic data from our clinic for associations of vertigo in chronic migraine.

BACKGROUND

Vertigo is a non-canonical, common symptom of migraine. Little is known about its associations with other symptoms within the migraine phenotype. There is significant methodological heterogeneity and therefore inadequate overall evidence about the potential differences in efficacy of any migraine treatments in patients with problematic vertigo associated with migraine, compared to those without vertigo. Enhancing understanding of migraine-related vertigo could help guide treatment and inform on mechanisms of vestibular migraine, a poorly understood diagnostic entity.

METHODS

Chronic migraine extended phenotypes of patients seen within the adult headache service at King's College Hospital Tertiary Headache Service between January 2014 and December 2021 (n = 589) were extracted from the first documented clinic consultation letter retrospectively. For those with information about vertigo (n = 562), potential associations of interest for the presence of vertigo (gender, allodynia, aura, photophobia, phonophobia and osmophobia, baseline headache frequency, number of premonitory symptoms, presence of cranial autonomic symptoms, and age) were analyzed using a regression model (IBM SPSS v 29). Missing data were excluded (final n = 435).

RESULTS

The total sample size for analysis in the regression model was n = 435, after excluding missing data (n = 126) and outliers (n = 1). Patients were 16-92 years old (median, 47; interquartile range, 37-55), and the majority (83.4%) were female. Vertigo associated with migraine was present in 275 of 562 (49%) patients. Within the regression model, the presence of aura (odds ratio, 2.13; 95% confidence interval, 1.4-3.23, P < 0.001) and allodynia (odds ratio, 2.74; 95% confidence interval, 1.76-4.26, P < 0.001) were positively associated with vertigo.

CONCLUSIONS

Vertigo in chronic migraine is common and may be associated with a more enriched phenotype independent of baseline headache frequency. Future treatment strategies should be evaluated for their effects on this often under-recognized yet disabling symptom.