title: Investigation of the coherence of definite and probable vestibular migraine as distinct clinical entities.
abstract: OBJECTIVE
  To investigate the following: 1) associations between vestibular symptoms and migraine in a well-characterized cohort of tertiary neurotology patients, 2) effects of comorbidity on clinical presentations, and 3) validity of proposed definitions of definite (dVM) and probable vestibular migraine (pVM).
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Tertiary neurotology center.
  
  
  METHODS
  All 228 subjects with headache were selected from a larger investigation of 410 patients with vestibular symptoms who underwent comprehensive medical, surgical, and behavioral neurotologic consultations. Subjects had at least one of 4 diagnoses: dVM/pVM, Ménière's disease, benign paroxysmal positional vertigo, or chronic subjective dizziness.
  
  
  METHODS
  Subjects were divided into migraine (n = 164) and nonmigraine headache (n = 64) groups by International Headache Society criteria, then subdivided by those with vestibular symptoms related or unrelated to headache. Subjects meeting proposed criteria for dVM (n = 46) and pVM (n = 42) were identified. Statistical analyses investigated discriminating features and cohesiveness in each group, with or without comorbidity.
  
  
  METHODS
  Characteristics of dVM and pVM.
  
  
  RESULTS
  Migraine, particularly migraine with aura, was more often related to vestibular symptoms than nonmigrainous headache. dVM and pVM groups did not differ in demographics, clinical histories, examinations, or vestibular testing. Numerous differences existed between dVM/pVM subjects with and without comorbid Ménière's disease, benign paroxysmal positional vertigo, or chronic subjective dizziness. The pVM group contained 4 subtypes.
  
  
  CONCLUSIONS
  These results support an association between vestibular symptoms and migraine but not proposed distinctions between dVM and pVM. pVM does not appear to be a coherent diagnostic entity. Comorbid conditions are important causes of vestibular symptoms in patients with migraine.
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA. eggers.scott@mayo.edu
authors.forename: Scott D Z
authors.initials: SD
authors.lastname: Eggers
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Staab
authors.forename: Brian A
authors.initials: BA
authors.lastname: Neff
authors.forename: Adam M
authors.initials: AM
authors.lastname: Goulson
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Carlson
authors.forename: Neil T
authors.initials: NT
authors.lastname: Shepard
mesh_terms: D000328:Adult; D000368:Aged; D004244:Dizziness / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008575:Meniere Disease / Q000150:complications / Q000175:diagnosis*; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications / Q000175:diagnosis*; D012189:Retrospective Studies; D015837:Vestibular Diseases / Q000150:complications / Q000175:diagnosis*