Vestibuläre Migräne

ZUSAMMENFASSUNG

Die vestibuläre Migräne (VM) stellt die häufigste Ursache für spontan rezidivierende Schwindelattacken bei Erwachsenen und Kindern dar, wird aber immer noch zu spät und zu selten diagnostiziert. Sie betrifft häufiger Frauen und Personen mit positiver Eigen- oder Familienanamnese für Migräne. Für die Diagnose werden 5 Episoden mit vestibulären Symptomen von mittlerer bis schwerer Intensität mit einer Dauer von 5 Minuten bis 72 Stunden gefordert, die in mindestens 50 % der Fälle von Migränesymptomen wie typische Kopfschmerzen (einseitig, pulsierend, mittlere/starke Intensität, Verstärkung bei körperlicher Routineaktivität), Foto-/Phonophobie und/oder visuelle Aura begleitet sind. Die Symptomatik variiert intra- und interindividuell deutlich und viele VM-Patienten erfüllen diese Diagnosekriterien nicht. Bei Verdacht auf VM sollte daher gezielt nach Migränecharakteristika gefragt werden. Zeichen einer leichten zentralen Okulomotorikstörung in Kombination mit einer – trotz wiederholter Schwindelepisoden – regelrechten audio-vestibulären Funktionsdiagnostik stützen die Diagnose. Gute Therapiestudien liegen nicht vor, sodass die konservativen und medikamentösen Therapieempfehlungen den Grundsätzen zur Behandlung der normalen Migräne ohne Aura folgen; sie sind auch bei der VM erfolgreich.

ABSTRACT

Vestibular migraine (VM) is the most common cause of spontaneously recurrent vertigo attacks in adults and children, but is still diagnosed too late and too rarely. It is more common in women and patients with a positive personal or family history of migraine. Currently, 5 episodes with vestibular symptoms of moderate to severe intensity with a duration of 5 minutes to 72 hours are required for diagnosis. In 50 %, they have to be accompanied by migraine symptoms such as typical headache (one-sided, pulsating, medium/strong intensity, intensification during physical activity), photo/phonophobia and/or visual aura. Symptoms vary significantly within and between individuals and many VM patients do not meet these diagnostic criteria. If VM is suspected, patients should therefore be asked specifically about additional migraine characteristics. Signs of a mild central oculomotor dysfunction in combination with – despite repeated episodes of vertigo – normal audio-vestibular function support the diagnosis. There are no good therapeutic trials available so far, so the conservative treatment and medication recommendations follow the principles for the treatment of normal migraine without aura; they are also successful in VM.

Schlüsselwörter

Episodischer Schwindel - vestibuläre Migräne - Schwindelattacken - Okulomotorikstörung

Key words

Episodic vertigo - vestibular migraine - dizziness - vertigo attacks - ocular motor disorder

Publication History

Article published online:
13 February 2023

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