Abstract
Dizziness and vertigo are frequently reported by patients with migraine. In migrainous vertigo (MV), vertigo is causally related to migraine. Patients of MV usually have an attenuated or absent headache with their vertigo as compared with their usual headache of migraine. Here we report three female patients of MV in which administration of triptan was associated with induction (two patients) or exacerbation (one patient) of headache with disappearance of vertigo. We suggest that headache and vertigo of migraine may be inversely related to each other and suppression of one may induce or aggravate the other.
Keywords: Dizziness, Vertigo, Migraine, Triptans, Migrainous vertigo
Full Text
The Full Text of this article is available as a PDF (109.0 KB).
Acknowledgments
Source of support/funding: No grant or support was required.
Conflicts of interest
None.
References
- 1.Neuhauser H, Lempert T. Vertigo and dizziness related to migraine: a diagnostic challenge. Cephalalgia. 2004;24:83–91. doi: 10.1111/j.1468-2982.2004.00662.x. [DOI] [PubMed] [Google Scholar]
- 2.Neuhauser HK, Radtke A, Brevern M, Feldmann M, Lezius F, Ziese T, Lempert T. Migrainous vertigo: prevalence and impact on quality of life. Neurology. 2006;67(6):1028–1033. doi: 10.1212/01.wnl.0000237539.09942.06. [DOI] [PubMed] [Google Scholar]
- 3.Vukovic V, Plavec D, Galinovic I, Lovrencic -Huzjan A, Budišic´ M, Demarin V. Prevalence of vertigo, dizziness, and migrainous vertigo in patients with migraine. Headache. 2007;47:1427–1435. doi: 10.1111/j.1526-4610.2007.00939.x. [DOI] [PubMed] [Google Scholar]
- 4.Brandt T, Strupp M. Migraine and vertigo: classification, clinical features, and special treatment considerations. Headache Current. 2006;3(1):12–19. doi: 10.1111/j.1743-5013.2006.00027.x. [DOI] [Google Scholar]
- 5.Evans RW, Baloh RW. Episodic vertigo and migraine. Headache. 2001;41:604–605. doi: 10.1046/j.1526-4610.2001.041006604.x. [DOI] [PubMed] [Google Scholar]
- 6.Saxena PR, Tfelt-Hansen P. Triptans, 5 HT1B\1D receptors agonists in the acute treatment of migraines. In: Olesen J, Goadsby PJ, Ramadan NM, Tfelt-Hansen P, Welch KMA, editors. The headaches, 3rd edn. Baltimore: Lippincott Williams & Wilkins; 2006. pp. 469–503. [Google Scholar]
- 7.Diamonds S, Bkind A, Jackson T, Ryan R, DeBussey S, Asghamejad M. Multiple-attacks efficacy and tolerability of sumatriptan nasal spray in the treatment of migraine. Arch Fam Med. 1998;7:234–240. doi: 10.1001/archfami.7.3.234. [DOI] [PubMed] [Google Scholar]
- 8.Burstein R, Jakubowski M, Levy D. Anti -migraine action of triptans is preceded by transient aggravation of headache caused by activation of meningeal nociceptors. Pain. 2005;115:21–28. doi: 10.1016/j.pain.2005.01.027. [DOI] [PubMed] [Google Scholar]
- 9.Dodick DW, Martin V. Triptans and CNS side effects: pharmacokinetics and metabolic mechanisms. Cephalalgia. 2004;24:417–424. doi: 10.1111/j.1468-2982.2004.00694.x. [DOI] [PubMed] [Google Scholar]
- 10.Goadsby PJ, Dodick DW, Almas M, Diener H-C, Tfelt-Hansen P, Lipton RB, Parsons B. Treatment-emergent CNS symptoms following triptan therapy are part of the attack. Cephalalgia. 2007;27:254–262. doi: 10.1111/j.1468-2982.2007.01278.x. [DOI] [PubMed] [Google Scholar]
- 11.Kolev O. How caloric vestibular irritation influences migraine attacks. Cephalalgia. 1990;10(4):167–169. doi: 10.1046/j.1468-2982.1990.1004167.x. [DOI] [PubMed] [Google Scholar]
- 12.Baloh RW. Migraine and vertigo: epidemiology, genetics, and mechanism(s) Headache Curr. 2006;3(1):1–7. doi: 10.1185/174234305X75216. [DOI] [Google Scholar]
- 13.Post J, Schram MT, Schoemaker RC, Pieters MSM, Fuseau E, Pereira A, et al. CNS effects of sumatriptan and rizatriptan in healthy female volunteers. Cephalalgia. 2002;22:271–281. doi: 10.1046/j.1468-2982.2002.00344.x. [DOI] [PubMed] [Google Scholar]
- 14.Marano E, Marcelli V, Di Stasio E, Bonuso S, Vacca G, Manganelli F, et al. Trigeminal stimulation elicits a peripheral vestibular imbalance in migraine patients. Headache. 2005;45:325–331. doi: 10.1111/j.1526-4610.2005.05069.x. [DOI] [PubMed] [Google Scholar]
- 15.Elhusseiny, Hamel E. Sumatriptan elicits both constriction and dilation in human and bovine brain intracortical arterioles. Br J Pharmacol. 2001;132:55–62. doi: 10.1038/sj.bjp.0703763. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Hargreaves R. New migraine and pain research. Headache. 2007;47(suppl-1):26–43. doi: 10.1111/j.1526-4610.2006.00675.x. [DOI] [PubMed] [Google Scholar]