Background Vestibular Migraine (VM) and the migraine variant Benign Paroxysmal Vertigo of childhood (BPV) are the commonest causes of vertigo in childhood (Langhagen et al., 2016). Studies suggest VM and BPV are the cause in between 24–56% of childhood vertigo (Brodsky et al., 2016). Between 2–10.6% of school age children are affected by VM/BPV (O’Reilly et al, 2012).
VM is a clinical diagnosis with no specific vestibular diagnostic features or other biomarkers (Langhagen et al, 2016). Whilst there are numerous studies on VM in adult patients, there is a paucity of evidence in paediatric patients, particularly on clinical characterisation. Currently diagnosis and management strategies are largely based on evidence from adult populations (Kacperski and Bazarsky, 2017).
Objectives This study aims to describe a large cohort of patients diagnosed with VM at a tertiary Audiovestibular Medicine unit, describing clinical presentation, examination, diagnosis, and management. We hope to raise awareness of this common and treatable condition in children and young adults.
Methods This is a retrospective electronic case note review of all patients presenting to Audiovestibular Medicine clinics in a tertiary unit between January and December 2018. All patients who were given a diagnosis of vestibular migraine/migraine variant during this time, or who were patients being followed up with a known diagnosis of vestibular migraine/migraine variant, were identified. Clinical letters were reviewed looking specifically at: presenting symptoms (including headache and vertigo, other symptoms, medical comorbidities and impact of symptoms); clinical examination findings; diagnostic test findings (including vestibular diagnostics, blood tests and neuroimaging); treatment and overall outcome.
Results 81 children were identified with a mean age at presentation of 10.3 ±3.8 years (range 2–17). 53% were female. 65% reported episodes beginning ≥2 years ago. No headache was reported in 29 children, however photophobia and phonophobia were common (68 and 54 children respectively). Otological symptoms were not uncommon with tinnitus present in 22 children. Comorbidities often included neurodevelopmental difficulties. Impact on schooling and extra-curricular activities was high for a subgroup of children. 31 children had episodes weekly or more frequently.
Clinical examination showed abnormal oculomotor signs in 5/77 children tested (2 central and 3 peripheral) and abnormal neuro-vestibular findings in 14/78 children tested. Videonystagmography showed abnormalities in 30/75 patients tested (8 central and 8 peripheral oculomotor; 28 neuro-vestibular). Video Head Impulse Test showed significant saccades in 11/94 tests. 37% of children showed normal examination and diagnostic findings.
Treatment included lifestyle measures, medication (for acute treatment or for migraine prophylaxis) and vestibular rehabilitation. The most commonly used medications in this cohort were Pizotifen (44), Propranolol (29) and Topiramate (10). Symptoms fully resolved or improved in most patients (79%) with treatment.
Conclusions VM and migraine variants are a common diagnosis in children. Early recognition of clinical symptoms, appropriate diagnosis and treatment are important for effective management of these children.
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