Overlap btw Meniere’s and Vestibular Migraine

How dificult is to differentiate these two disorders? You can find some observation which may help you in practice:
Accompanying Symptoms Overlap during Attacks in Menière’s Disease and Vestibular Migraine

Few days ago I saw the pt (45yr wom) with few attacks (three) of strong vertigo accompanied with nausea, vomiting, and pulsating headache. Attacks lasted 48hours and she felt dizzy next 5 days. She hasn’t have any auditory symptoms. She has migraine since she was 20. Exam during last two attacks relieved left-beating Ny.
Vestibular Migraine Caloric Test

  • Calorics show no labyrinth function at the right side
  • VHIT reduced bilaterally
  • cVEMP: absent at right side
  • oVEMP: absent at both sides
  • tonal audiometry: normal hearing

The first attack was 6yr ago and other two this year. Regarding history and her vestibular testing results, one would assume recurrent neuritis at right sides. But pulsating headache, the same one which she has during migraine attacks would favor vestiblar migraine as diagnosis. I doubt Meniere’s disease whenever the attack of vertigo lasts more than 24hour and also, she didn’t have any audiological symptoms jet. The explanation for right vestibular deficit would be ischemic insult as result of vasospasm during the migraneous attacks.

One thought on “Overlap btw Meniere’s and Vestibular Migraine

  1. Dr Dusan

    Six month later, control exam:
    She takes Topiramate 25mg per day.
    She had vertigo attack each month on the 8th or 10th day of her menstrual cycle. Attacks are strong but lasted shorter, for 2-3h, without headache. On one month she didn’t have vestibular migraine attack, but classic migraine attack like she had before, but this time with much stronger headache than before.
    So, this clinical picture more likely favorizes Vestibular Migraine as diagnosis.

    Reply

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