Vestibular migraine: Diagnostic criteria - JVR: Journal of ...

1 Journal of Vestibular Research 22 (2012) 167 172167 DOI PressVestibular migraine : Diagnostic criteriaConsensus document of the B ar any Society and the International Headache SocietyThomas Lemperta, , Jes Olesenb, Joseph Furmanc, John Waterstond, Barry Seemungale, John Careyf,Alexander Bisdorffg, Maurizio Versinoh,StefanEversiand David Newman-TokerjaDepartment of Neurology, Schlosspark-Klinik, Berlin, GermanybDanish Headache Center and Department of Neurology, University of Copenhagen, Copenhagen, DenmarkcDepartments of Otolaryngologyand Neurology, University of Pittsburgh, Pittsburgh, PA.

2 USAdDepartment of Neurology and Monash University Department of Medicine, Alfred Hospital, Melbourne, AustraliaeDepartment of Clinical Neuroscience, Charing Cross Hospital, London, UKfDepartment of Otolaryngology, Head and Neck Surgery, Johns Hopkins University Schoolof Medicine, Baltimore,MD, USAgDepartment of Neurology, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, LuxembourghDepartment of Neurological Sciences University of Pavia, HSC and BCC National Neurological Institute IRCCSC. Mondino Foundation, Pavia, Lombardy, ItalyiDepartment of Neurology, University of M unster, M unster, GermanyjDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USAR eceived 20 June 2012 Accepted 29 July 2012 Abstract.

3 This paper presents Diagnostic criteria forvestibular migraine , jointly formulated by the Committee for Classification ofVestibular Disorders of the B ar any Society and the migraine Classification Subcommittee of the International Headache Society(IHS). The classification includesvestibular migraineandprobable Vestibular migraine . Vestibular migrainewill appear in anappendix of the third edition of the International Classification of Headache Disorders (ICHD) as afirst step for new entities,in accordance with the usual IHS Vestibular migrainemay be included in a later version of the ICHD,when further evidence has been accumulated.

4 The diagnosis ofvestibular migraineis based on recurrent Vestibular symptoms, ahistory of migraine , a temporal association between Vestibular symptoms and migraine symptoms and exclusion of other causesof Vestibular symptoms. Symptoms that qualify for a diagnosis ofvestibular migraineinclude various types of vertigo as well ashead motion-induced dizziness with nausea. Symptoms must be of moderate or severe intensity. Duration of acute episodes islimited to a window of between 5 minutes and 72 : migraine , vertigo, dizziness, Vestibular , Diagnostic criteria , B ar any Society, International Headache Society1.

5 IntroductionThe link between migraine and vertigo was recog-nized by some of the early neurologists in the 19thcentury [1], but systematic studies of vertigo causedby migraine started only a hundred years later [2,3]. Corresponding author: Thomas Lempert, Department of Neu-rology, Schlosspark-Klinik, Berlin, Germany. E-mail: the past three decades Vestibular migraine has takenshape as a Diagnostic entity that may affect up to 1% ofthe general population [4]. Despite this recognition, thelack of a universally accepted definition of vestibularmigraine has hampered patient identification in clinicaland research settings.

6 In response, the B ar any Society,which represents the international community of ba-sic scientists, otolaryngologists and neurologists com-mitted to Vestibular research, mandated a classificationgroup to develop Diagnostic criteria for Vestibular mi-graine. The definition of Vestibular migraine is part ofISSN 0957-4271/12/$ 2012 IOS Press and the authors. All rights reservedThis article is published online with Open Access and distributed under the terms of the Creative Commons Attribution Non-Commercial License168T. Lempert et al. / Vestibular migraine : Diagnostic criteriaa larger endeavor for classification of neuro-otologicaldisorders steered by the Committee for Classificationof Vestibular Disorders of the B ar any Society.

7 Indi-vidual disorders are defined by classification groupswhich include otolaryngologists and neurologists fromat least three continents. The format of the classifica-tion is modeled on the International Classification ofHeadache Disorders. As afirst step and prerequisite forthe classification of Vestibular disorders, the Classifica-tion Committee of the B ar any Society published a con-sensus on the definitions of Vestibular symptoms [5].A principal aim of the definition of Vestibular mi-graine is its broad acceptance within both the vestibu-lar and headache communities.

8 Therefore, drafts of thisclassification were discussed with the migraine Clas-sification Subcommittee of the Classification Commit-tee of the International Headache Society (IHS). Con-troversies centered on the balancing of the sensitivityand specificity of the criteria . This conflict is inher-ent to all medical classification efforts, because high-ly specific criteria will inevitably exclude patients af-fected by the condition (false negatives), while high-ly sensitive criteria will include patients who do nothave the condition (false positives).

9 As a result of thesediscussions, a proposed category,possible vestibularmigraine, was eliminated while the categoriesvestibu-lar migraineandprobable Vestibular migrainewereretained. Other changes that resulted from discussionsbetween the B ar any Society and the IHS includeda nar-rower definition of the duration of acute episodes and asharpened focus on the careful exclusion of approved Diagnostic criteria were the prod-uct of an accord between the IHS Classification Com-mittee and the Committee for Classification of Vestibu-lar Disorders of the B ar any Society.

10 These criteria willbe included in the 3rd edition of the International Clas-sification of Headache Disorders, expected to be pub-lished in 2014, where it will appear in the appendix fornew disorders that need further research for addition, the classification of Vestibular migraine ispart of the evolving Classification of Vestibular Disor-ders of the B ar any Society. The new ICHD-3 will onlyincludevestibular migraine , while the B ar any classifi-cation also will containprobable Vestibular Diagnostic criteria for Vestibular migrainePreviously used terms: migraine -associated vertigo/dizziness, migraine -related vestibulopathy, migrainousvertigo.