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Migraine and Ménière's disease

Study
Results
Comment


Text books are generally silent on the question of whether there is any link between migraine and Ménière's disease. Anecdotal accounts of headaches as an additional symptom of a typical Ménière attack go back to the original description in 1861. There is little of note in the literature, and what there is has been criticised.


A new study [1] using strict diagnostic criteria for both conditions in a case-control study is the best evidence yet available for such a link.


Study


The study population was 114 patients with Ménière's disease seen at a clinic. Diagnosis was based on standard criteria of the American Academy of Otolaryngology of recurrent spontaneous vertigo, with tinnitus or aural fullness, hearing loss, plus exclusion of other causes for the vertigo. Secondary causes like trauma or ear infection were exclusions.


All 114 patients were sent a letter to request their participation. Thirteen patients could not be found, and 78 of the remaining 101 consented to participate. They were 38 men and 40 women aged 29 to 81 years. An age and sex matched control group was selected from patients who had had surgery for orthopaedic problems or trauma.


All participants underwent a semi-structured interview by two neurologists, in which diagnosis of migraine was made using International Headache Society criteria.


Results


The lifetime prevalence of migraine in patients with Ménière's disease was higher than in controls (Figure 1). Prevalence was considerably higher in women than men, as is well known. The level of statistical significance overall was high (p<0.001) with lifetime prevalence of migraine of 56% in patients with Ménière's disease and 25% in controls. Migrainous headaches during a Ménière attack occurred in 28/78 patients, and photophobia was also common (52/78).



Figure 1: Relationship between lifetime prevalence of migraine in men and women with Ménière's disease, and controls





The mean age of onset of Ménière's disease was 46 years on average, some 14 years after the average age of onset of migraine, which was 32 years. Migraine onset preceded onset of Ménière's disease in 33 of 44 patients, was simultaneous in five and later in six.


Comment


This is an interesting study with a good discussion about the difficulties of dissecting the symptoms and classifications of migraine, vertigo and Ménière's disease. In the absence of other convincing evidence, it does make a strong association between migraine and Ménière's disease more likely. Diagnosis is still going to be problematical, because classical presentation of migraine or Ménière's disease will be relatively uncommon. It makes us think more about people with vertigo and headache, and whether Ménière's disease is a possible diagnosis, where before we would not.


Reference:

  1. A Radtke et al. Migraine and Ménière's disease. Is there a link? Neurology 2002 59: 1700-1704.

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