Vestibular Migraine under Updated Migraine Classification System

With the International Headache Society's release of an update to the International Classification of Headache Disorders, the ICHD-III (beta), comes a variety of changes and proposed changes to classification of Migraine and other headache disorders. Classification of Migraine-Associated Vertigo (MAV) is one such proposed change.

The IHS reclassification committee has added a classification for Vestibular Migraine to the appendix in ICHD-III (beta). The committee uses the appendix to make tentative additions to the classification system for further exploration and discussion.

Adding a classification for Vestibular Migraine would actually make a great deal of sense.

Vertigo is a condition related to the vestibular system, which is comprised of parts of the inner ear and brain that control balance and eye movement. Vertigo can involve a variety of symptoms, including:

• Imbalance
• Dizziness
• Lightheadedness
• Sensitivity to motion
• Sense of spinning, whirling, tilting, rocking, falling or motion
• Experiencing nausea and dizziness after watching something move
• Nausea
• Vomiting
• Pressure or stuffiness in ears

Under the ICHD-III (beta) appendix, Vestibular Migraine is defined by the following diagnostic criteria:

A. At least five episodes that fulfill C and D.
B. A current or past history with Migraine without Aura or Migraine with Aura.
C. Vestibular symptoms of moderate or severe intensity lasting between five minutes and 72 hours.
D. At least 50% of episodes are associated with at least one of the three following Migrainous features:

1. Headache with at least two of the following four characteristics:

a. unilateral location (one sided)
b. pulsating quality
c. moderate or severe intensity
d. aggravation by routine physical activity

2. photophobia and phonophobia
3. visual aura

E. Not accounted for by another vestibular disorder.

In contrast to this new proposed category under the ICHD-III (beta) appendix, under ICHD-II, vertigo associated with Migraine attacks (MAV), was loosely dealt with under the Basilar-Type Migraine category. This category was the only Migraine classification that specifically dealt with vertigo associated with Migraine.

Many researchers believed Basilar-Type Migraine was at the severe end of the spectrum of Migraine-Associated Vertigo, making it unnecessary to classify the two conditions separately.

Under ICHD-III (beta), Basilar-Type Migraine is now called Migraine with Brainstem Aura.