Meniere’s disease (MD) and vestibular migraine (VM) are two conditions with overlap in their symptoms. There is often a lack of understanding regarding symptom-based differentiation between them. MD presents with episodic vertigo, fluctuating hearing loss and tinnitus. MD has been classified into ‘probable MD’ and ‘definite MD’ categories by the American Academy of Otolaryngology - Head and Neck Surgery. VM has been jointly classified by the Barany Society and International Headache Society. It is based on recurrent vestibular symptoms, migraine history, a temporal association between vestibular symptoms and exclusion of other vestibular causes. The lack of objective measurements confirming one over the other condition adds to the diagnostic challenge. The authors’ aim was to evaluate complaints in people with MD with and without migraine and headache in order to study the association between MD and VM. A retrospective study was undertaken using data from the Finnish Meniere Federation database. A total of 911 patients, with a mean age of 60.2 years and mean duration of disease of 12.6 years, were identified. Questionnaires on both disease-specific and impact-related questions were sent to the patients. Migraine and headache was reported by 190 subjects (20.9%) and 391 subjects (42.9%) respectively.

Patients that would be classified as VM had more severe symptoms. They had reduced quality of life, more anxiety, neurological complaints and worse attitude towards illness compared to the non-migrainous patients with MD.

Neither decision tree analysis nor logistic regression analysis could reliably predict patients in the correct group of MD and VM, highlighting the heterogeneity of the disorder. This study demonstrates the significant association of MD with headache and migraine. Clinicians should be aware of the classifications of MD and VM in order to better diagnose and manage such patients, preferably in a joint otolaryngology and neurology balance clinic.

Association between Meniere’s disease and vestibular migraine.
Pyykko I, Manchaiah V, Farkkila M, et al.
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Praneta Kulloo

Lewisham and Greenwich NHS Trust, UK.

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