Dizziness and orthostatic intolerance in pediatric migraine

ABSTRACT

Pediatric migraine is followed by more frequent episodes of dizziness or vertigo than tension-type headaches. Just as children with migraine show a high sensitivity to light and noise, they are also susceptible to vestibular stimuli, resulting in vertigo or dizziness. Previous studies have found vertigo to be more common among patients with migraine. Vestibular migraine and benign paroxysmal vertigo of childhood have been identified as the most common causes of vertigo in children without ear disease. Benign paroxysmal vertigo of childhood is also thought to be a precursor of later episodes of migraine. The term vestibular migraine was included as a part of the appendix in the International Classification of Headache Disorders 3rd edition beta version, as an increasing number of studies have shown a positive relationship between migraine and vertigo. However, vertigo cannot be easily identified by parents or pediatricians, as young children are unable to explain their vertigo- or migraine-related symptoms. This is also applicable to specialists such as pediatric neurologists and otolaryngologists, as they often do not know the exact definition of vertigo in such patients and cannot make the correct differential diagnosis. Consequently, the inadequate evaluation and treatment of these patients can lead to a high socioeconomic cost. This review article discussing vertigo in pediatric migraine will help more medical doctors to effectively examine, accurately diagnose, and promptly treat young children suffering from migraine or vertigo.