Timothy C. Hain, MD Page last modified: January 30, 2018 You may also be interested in our many other pages on migraine on this site
Benign recurrent vertigo of adults
BRV, Essentially a vertiginous migraine aura without headache, was described first by Slater (1979) but his observations have been confirmed by others (e.g. Lee et al, 2002; Cha et al, 2009). It consists of spells of vertigo, which can include tinnitus, but without hearing loss (were hearing loss allowed, this disorder would become very difficult to distinguish from Menieres disease ). Vertigo lasts from minutes to hours. According to Cha et al, sensory amplifications such as photophobia or auditory symptoms were uncommon in patients without headache, but were common in patients with headache. Not all authors agree that BRV is caused by migraine however, and Leliever and Barber suggested that it is caused by peripheral vestibular lesions (Leliever and Barber, 1981). At this writing (2012), this idea seems to have been discarded. Brantberg and Baloh (2011) reported that the vertigo in BRV overlaps substantially with vertigo in Meniere's. They also noted that many patients with BRV never develop headaches.
Another example of a similar recurrent vertigo, without headache, attributed to migraine is the Benign Paroxysmal Vertigo syndrome of children, as described in this page under the heading of familial syndromes, where headache does not occur. With respect to timing, Cutrer and Baloh (1992) also observed that dizziness and headaches are not necessarily closely associated. In fact, in their 91 patients, only 5 had a consistent recurring dizziness with headache. In 30%, dizziness was consistently independent of headache. In most, spells sometimes occurred with and sometimes independently.
BRV is nearly identical to cyclic vomiting of adults, but in CV, the vomiting dominates.
A middle aged woman provided a history of having 1-2 spells per year, of dizziness lasting a day. She called for an urgent appointment. She was "due" for her period, as she was on a birth control pill., and taking the "blanks". The vertigo began when she awoke in the morning. She had taken meclizine and found it just put her to sleep and did not help her dizziness. She did not have any substantial headache. On her exam, she had no nystagmus in the dark, upright. Lying down, she had a complicated positional nystagmus that was right-beating on head left, and downbeating on head right. The nystagmus gradually built up over seconds, and became rather uncomfortable after about 10 seconds. She had a similar downbeating nystagmus, that also built up with her head forward looking down at the floor. The rest of her examination was normal.
Comment: This woman clearly has an objectively verifiable nystagmus, that does not fit into the usual criteria for BPPV of any canal. Her dizziness occured when her estrogen levels were low.
Adapted from lecture handout given for the seminar "Recent advances in the treatment of Dizziness", American Academy of Neurology, 1997 and "Migraine Vs Meniere's", at the American Academy of Otolaryngology meeting, 1999-2001.