title: Vestibular migraine: long-term follow-up of clinical symptoms and vestibulo-cochlear findings.
abstract: OBJECTIVE
  The aim of the study was to assess the evolution of clinical symptoms and vestibulo-cochlear function in patients with definite vestibular migraine (dVM).
  
  
  METHODS
  We reassessed 61 patients (54 women, 7 men, aged 24-76 years) with dVM according to validated diagnostic criteria after a median follow-up time of 9 years (range, 5.5-11). Assessment comprised a clinical interview and neurotologic examination, including pure-tone audiometry and caloric testing.
  
  
  RESULTS
  The majority of patients (87%) had recurrent vertigo at follow-up. Frequency of vertigo was reduced in 56%, increased in 29%, and unchanged in 16%. Impact of vertigo was severe in 21%, moderate in 43%, and mild in 36%. Eighteen percent reported mild persistent unsteadiness. Interictal ocular motor abnormalities had increased from 16% initially to 41% of patients at follow-up. The most frequent finding was positional nystagmus (PN), in 28%, including definite central-type PN in 18%. However, only 1 of 9 patients with ocular motor abnormalities at initial presentation showed similar findings on follow-up. Concomitant cochlear symptoms with vertigo had increased from 15% initially to 49%. Eleven patients (18%) had developed mild bilateral sensorineural hearing loss, which also involved the low-frequency range.
  
  
  CONCLUSIONS
  The majority of patients continue to have recurrent vertigo in the long-term evolution of VM, and the impact of vertigo may remain severe. Whereas interictal ocular motor abnormalities may show some variation over time, vestibulo-cochlear dysfunction progresses slowly in some patients with VM. Interictal central-type PN may help distinguish VM from peripheral vestibular disorders such as Ménière disease.
authors.affiliation: Department of Neurology, Charité, University Freiburg, Berlin, Germany. andrea.radtke@charite.de
authors.forename: Andrea
authors.initials: A
authors.lastname: Radtke
authors.forename: Michael
authors.initials: M
authors.lastname: von Brevern
authors.forename: Hannelore
authors.initials: H
authors.lastname: Neuhauser
authors.forename: Tilman
authors.initials: T
authors.lastname: Hottenrott
authors.forename: Thomas
authors.initials: T
authors.lastname: Lempert
mesh_terms: D000328:Adult; D000368:Aged; D002150:Caloric Tests; D003051:Cochlea / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis* / Q000503:physiopathology; D014717:Vertigo / Q000175:diagnosis* / Q000503:physiopathology; D015837:Vestibular Diseases / Q000175:diagnosis* / Q000503:physiopathology; D014722:Vestibule, Labyrinth / Q000503:physiopathology*