Meniere’s Plus Migraine

 A few weeks ago, I gave an example of a young lady that seemed to have a prolonged reaction to simple posterior canal BPPV that I suspected was the result of her history of migraine. I have been suspicious for years that migrainuers experience vestibular disorders with more extreme symptoms and recover with more difficulty than non-migrainuers.

A recent study explored recovery from treatment for Meniere’s disease in two groups. Group 1 had Meniere’s disease without migraine. Group two had both Meniere’s and migraine. The treatment consisted of intra-tympanic gentamicin injections, which have been shown to effectively reduce recurrent vertigo in definite Meniere’s disease.

The researchers found that both groups reported a reduction in episodes of vertigo, but that the patients that also had migraine had substantially poorer long term functional outcomes. The majority of the Meniere’s plus migraine patients continued to have complaints of disequilibrium, head movement associated dizziness, or dizziness associated with headaches, while less than 10% of Meniere’s only patients had similar levels of residual symptoms.

The authors hypothesize that the gentamicin injections treat the peripheral labyrinth aspect of Meniere’s disease, but would not have any effect of symptoms generated from migraine. They consider whether disrupting the vestibular inputs may actually trigger migraine activity. I wonder whether migrainuers have more difficulty compensating to their stable vestibular weakness induced by the gentamicin injection.

It seems that when we discuss migraine, there is much in the way of theory and less in the way of evidence. This is just one more piece of information demonstrating that migraine plays a role in recovery from vestibular injuries. Have others noticed that migrainuers seem to experience vestibular disorders more severely? I would love to hear some others thoughts on this topic.


About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.