Timothy C. Hain, MD •
Page last modified:
September 7, 2019
There is some speculation that Meniere's and Migraine
are two faces of the same indistinguishable condition. The evidence is against this idea because they don't overlap most of the time. In our dizzy practice in Chicago, as of 9/2019, we had 1161 patients diagnosed with Meniere's disease, of whom 293 also carried a diagnosis of Migraine. Thus this works out to about 25%, including 89 men and 202 women. Note that 25% is a little larger than the population prevalence of Migraine (about 15%), so there are roughly more persons with migraine than would be expected in persons with menieres. To work this out more precisely one would have to adjust for age and gender.
In the literature, the published studies of Meniere/migraine generally contain far less subjects than our clinic database (see below).
There are some substantial methodological problems here as "migraine" is a condition "diagnosed" from subjective symptoms -- i.e. someone who reads the Wikipedia page on migraine, could in theory, have "migraine". Meniere's disease is rather similar, but it does include a requirement for hearing loss, which presumably narrows the field.
Another problem is that "Meniere's", may be a varying degrees of certainty (like Migraine).
Furthermore, there is almost certainly a sample bias - - individuals referred to our practice (we are oto-neurologists), likely have more neurological symptoms (i.e. headache), than patients seen in an otolaryology practice, and there are also many other potential biasing features.
Nevertheless, we think that 25% is "as good as it gets" in 2019, for the coincidence of migraine and Meniere's, mainly because of the large sample.
With respect to the entity called "vestibular migraine", defined by a committee called the "International Headache Society", we are not so sure that all of our Meniere's patients are a fit -- the criteria for "vestibular migraine" are so complex that it is difficult to know if any particular patient has "jumped through all of the hoops" and therefore qualified to be officially designated as "vestibular migraine". The term "migraine associated vertigo" would however still seem to be generally useful.
MD = Meniere's disease, MMD = Menieres +Migraine, VN = Vestibular Neuritis.
- Cha, Y. H., J. Brodsky, (2007) reported that concurrent bilateral aural symptoms and hearing loss were seen in 56% of MMD and 4% of MD patients. A family history of episodic vertigo was seen in 39% of MMD and 2% of MD patients. Only 50 patients with Meniere's were studied.
- Eklund, S. (1999). Reported that 60 MD patients (70%) and 26 VN patients (58%) reported headache.
- Gopen, Q., E. Viirre, et al. (2009). The incidence of migraine headache was calculated at 3.8%, and the incidence of Meniere syndrome was estimated at 0.14%. The incidence of migraine headache in patients with Meniere syndrome was estimated at 4.5%. The incidence of migraine headache was not substantially elevated in patients with Meniere syndrome when compared to the general population. Comment: [although this study included an immense number of surveys, the data seems very suspect. First, "incidence" means # of cases/year, while prevalence is % of cases in the entire population. Incidence figures are simply not relevant here. Second, the # of migraine headaches seems low to us, and it is well known that survey studies are a poor method of diagnosing Meniere's (e.g. Framingham study). Finally, this result is not at all consistent with our clinical experience at Chicago Dizziness and Hearing. (we have more than 1000 Meniere's patients in our database, as well as many thousands of Migraine patients)]
- Ghavami et al (2015) reported that in 37 patients with definite MD, 51% also had migraine headaches. They suggested that MD may be an atypical variant of migraine. [This seems to us to be overreaching -- correlation is not cause]
- Ibekwe, T. S., J. A. Fasunla, et al. (2008). This was a study of "a total of 25 patients" that met the criteria for Meniere's. They reported that there is a statistically significant difference between the prevalence of migraine in Meniere's patients and migraine in the overall population (32% vs. 5.3%, P = 0.000). As 14% of the population has migraine, this study appears to have underdiagnosed migraine.
- Neff, B. A., J. P. Staab, et al. (2012). They reported that symptoms of MD and Vestibular migraine overlapped. Comment: yes, this seems pretty clear.
- Radke and Lembert (2002) reported on 78 patients with Meniere's disease. The lifetime prevalence of migraine with and without aura was higher in the MD group (56%) compared to controls (25%; p < 0.001). Forty-five percent of the patients with MD always experienced at least one migrainous symptom (migrainous headache, photophobia, aura symptoms) with Meniere attacks. Comment: this paper in our opinion is the best on the subject, although it included only 78 patients. We would like to see a study of an order of magnitude more patients.
- Rassekh, C. H. and L. A. Harker (1992), in a survey based study of about 100 patients in total, they studied patients with classic Meniere's disease, patients with vestibular Meniere's disease, and a normal control group. The percentages of the respondents who met "predetermined criteria for migraine" in the three groups were 22%, 81%, and 33%. As only 14% of the entire population has Migraine in large studies, and this study reported 33%, this study's criteria were almost certainly too loose. Furthermore, survey studies perform very poorly in identifying Meniere's disease. Neverthless, it does point out a likely association between "vestibular Menieres", and Migraine.
- Taylor, R. L., A. S. Zagami, et al. (2012) reported that VEMPs and calorics, specifically the 0.5/1 kHz frequency ratio, 0.5 kHz asymmetry ratio and caloric test combined, separated MD from VM with a sensitivity of 90.0% and specificity of 70.0%. We are dubious -- we would think that VEMPs and calorics are covariates of ear damage.
- Ghavami et al (2018) reported in this study of 27 patients that Meniere's patients who failed duiretics responded very positively to migraine prevention medications. Comment: Although a small study, this work contributes to the general idea that when Meniere's patients are doing poorly, it makes sense to treat for Migraine before going to last resort type treatment.
- Cha, Y. H., J. Brodsky, et al. (2007). "The relevance of migraine in patients with Meniere's disease." Acta Otolaryngol 127(12): 1241-1245.
- Eklund, S. (1999). "Headache in Meniere's disease." Auris Nasus Larynx 26(4): 427-433.
- Ghavami, Y., H. Mahboubi, A. Y. Yau, M. Maducdoc and H. R. Djalilian (2016). "Migraine features in patients with Meniere's disease." Laryngoscope.
- Ghavami Y, Haidar YM, Moshtaghi O, Lin HW, Djalilian HR.Evaluating Quality of Life in Patients With Meniere's Disease Treated as Migraine. Ann Otol Rhinol Laryngol. 2018 Sep 9:3489418799107. doi: 10.1177/0003489418799107. [Epub ahead of print]
- Gopen, Q., E. Viirre, et al. (2009). "Epidemiologic study to explore links between Meniere syndrome and migraine headache." Ear Nose Throat J 88(11): 1200-1204.
- Ibekwe, T. S., J. A. Fasunla, et al. (2008). "Migraine and Meniere's disease: two different phenomena with frequently observed concomitant occurrences." J Natl Med Assoc 100(3): 334-338.
- Neff, B. A., J. P. Staab, et al. (2012)."Auditory and Vestibular Symptoms and Chronic Subjective Dizziness in Patients With Meniere's Disease, Vestibular Migraine, and Meniere's Disease With Concomitant Vestibular Migraine." Otol Neurotol.
- Radtke, A., T. Lempert, et al. (2002). "Migraine and Meniere's disease: is there a link?" Neurology 59(11): 1700-1704.
- Rassekh, C. H. and L. A. Harker (1992). "The prevalence of migraine in Meniere's disease." Laryngoscope 102(2): 135-138.
- Taylor, R. L., A. S. Zagami, et al. (2012). "Vestibular evoked myogenic potentials to sound and vibration: characteristics in vestibular migraine that enable separation from Meniere's disease." Cephalalgia 32(3): 213-225