The interrelations of migraine, vertigo, and migrainous vertigo
MauricePreter, Assistant Professor of Psychiatry and Neurology, University of Mississippi Medical Centermpreter@psychiatry.umsmed.edu
Submitted June 10, 2001
To the Editor:
I read Neuhauser et al's study on "The interrelations of migraine,
vertigo, and migrainous vertigo" with interest. (1) . The authors
correctly point out the diagnostic and nosologic complexities of
“migrainous vertigo”. It was surprising however that their discussion did
not take into account the psychiatric comorbidity of migraine, namely
panic disorder. Simple inspection of the data presented in Table 2, and
adding up the number of patients comprised in the four most problematic
nosologic categories (psychogenic dizziness, vestibulopathy of unknown
origin, probable migrainous vertigo, and undetermined) shows that 75% of
all patients likely carried a “functional” diagnosis.
The association between migraine and panic disorder is epidemiologically
well–established and clinically relevant (2). Data recently published in
this journal show that this comorbidity of panic disorder may also apply
to severe headaches other than migraine (3). Bidirectionality suggests
that the migraine-panic association is unlikely to be merely coincidental
(4) and that shared environmental or genetic factors are involved. Any
diagnosis of migraine should heighten the suspicion of comorbid panic
disorder (3). Conversely, although classical panic disorder is
characterized by prominent dyspnea (5), a number of patients may present
with atypical symptoms, such as gastrointestinal and vestibular ones,
including true vertigo (6). These panic subtypes, especially if
undiagnosed are likely to contribute to the high chronic morbidity of
panic disorder, and of the possibly related condition, migraine headache.
References:
1. Neuhauser H, Leopold M, von Brevern M, Arnold G, Lempert T. The
interrelations of migraine, vertigo, and migrainous vertigo. Neurology
2001;56: 436-441.
2. Silberstein SD, Lipton RB, Breslau N. Migraine: association with
personality characteristics and psychopathology. Cephalalgia. 1995;15:358-
369.
3. Breslau N, Schultz LR, Stewart WF, Lipton R, Welch KM. Headache types
and panic disorder: directionality and specificity. Neurology 2001;56:350-
354.
4. Preter M, Klein DF: Panic disorder and the suffocation false alarm
theory: Current state of knowledge and further implications for
neurobiologic theory testing. In: Bellodi L, Perna G, eds. The panic
respiration connection. Milan 1998.
5. Klein DF. False suffocation alarms, spontaneous panics, and related
conditions. An integrative hypothesis. Arch Gen Psychiatry 1993;50:306-
317.
6. Jacob RG. Panic disorder and the vestibular system. Psychiatr Clin
North Am. 1988;11:361-374.
To the Editor: I read Neuhauser et al's study on "The interrelations of migraine, vertigo, and migrainous vertigo" with interest. (1) . The authors correctly point out the diagnostic and nosologic complexities of “migrainous vertigo”. It was surprising however that their discussion did not take into account the psychiatric comorbidity of migraine, namely panic disorder. Simple inspection of the data presented in Table 2, and adding up the number of patients comprised in the four most problematic nosologic categories (psychogenic dizziness, vestibulopathy of unknown origin, probable migrainous vertigo, and undetermined) shows that 75% of all patients likely carried a “functional” diagnosis. The association between migraine and panic disorder is epidemiologically well–established and clinically relevant (2). Data recently published in this journal show that this comorbidity of panic disorder may also apply to severe headaches other than migraine (3). Bidirectionality suggests that the migraine-panic association is unlikely to be merely coincidental (4) and that shared environmental or genetic factors are involved. Any diagnosis of migraine should heighten the suspicion of comorbid panic disorder (3). Conversely, although classical panic disorder is characterized by prominent dyspnea (5), a number of patients may present with atypical symptoms, such as gastrointestinal and vestibular ones, including true vertigo (6). These panic subtypes, especially if undiagnosed are likely to contribute to the high chronic morbidity of panic disorder, and of the possibly related condition, migraine headache.
References: 1. Neuhauser H, Leopold M, von Brevern M, Arnold G, Lempert T. The interrelations of migraine, vertigo, and migrainous vertigo. Neurology 2001;56: 436-441. 2. Silberstein SD, Lipton RB, Breslau N. Migraine: association with personality characteristics and psychopathology. Cephalalgia. 1995;15:358- 369. 3. Breslau N, Schultz LR, Stewart WF, Lipton R, Welch KM. Headache types and panic disorder: directionality and specificity. Neurology 2001;56:350- 354. 4. Preter M, Klein DF: Panic disorder and the suffocation false alarm theory: Current state of knowledge and further implications for neurobiologic theory testing. In: Bellodi L, Perna G, eds. The panic respiration connection. Milan 1998. 5. Klein DF. False suffocation alarms, spontaneous panics, and related conditions. An integrative hypothesis. Arch Gen Psychiatry 1993;50:306- 317. 6. Jacob RG. Panic disorder and the vestibular system. Psychiatr Clin North Am. 1988;11:361-374.