Two Cases of Successful Treatment With Topiramate in Patients With Meniere's Disease With Migraine

OBJECTIVE: To investigate the effects of topiramate on vestibular symptoms in patients with Meniere's disease and migraine CASE REPORTS: We present two patients with Meniere's disease and migraine, who did not respond to the salt reduction diet and diuretics. Topiramate was given and maintained for several months. Frequency and severity of headache and vestibular symptoms decreased after initiation of the topiramate. CONCLUSIONS: Topiramate can be used satisfactorily for the patients with Meniere's disease and migraine, who are refractory to regular conservative treatment for Meniere's disease, when vertigo attacks are accompanied by migraine.

Migrainous Vertigo

Patients with migraine frequently have hypersensitivity to light, sound, and smell. In addition to these hallmark features of migraine, patients often describe vestibular complaints ranging from true vertigo to less specific symptoms of dizziness, unsteadiness, and head motion intolerance. Over the last two decades a number of studies have stressed the association of migraine with vestibular and ocular motor disorders. Migraine may be a most common cause of various forms of episodic vertigo, but definite diagnostic criteria for migraine related vertigo are still lacking. As migrainous vertigo is an evolving entity, terminology is confusing and generally accepted diagnostic criteria are not established. The interrelations of migraine and dizziness can be classified into seven categories: (1) vertigo as an aura of migraine-basilar type migraine, (2) episodic vertigo attack without typical temporal relationship to migraine headache-migraine equivalent, (3) vertigo/dizziness during migraine attack, (4) susceptibility of motion sickness in migraine patients, (5) CACNA1A gene mutation and migraine-familial hemiplegic migraine, episodic ataxia type 2, (6) well defined vertigo syndromes that are not caused by migraine but show a statistical association with migraine-Meniere's disease, BPPV, (7) non-vestibular dizziness in migraine patients-psychiatric comorbidity, antimigraine medication. Each part of categories will be discussed.