Articles: vertigo.
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Vestibular migraine (VM) designates recurrent attacks of vertigo that are caused by migraine. VM presents with attacks of spontaneous or positional vertigo, lasting seconds to days, accompanied by migrainous symptoms. ⋯ In contrast, vestibular testing serves mainly for the exclusion of other diagnoses. Treatment is targeted at the underlying migraine.
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Both migraine and vertigo are common in the general population with lifetime prevalences of about 16 % for migraine and 7 % for vertigo. Therefore, a concurrence of the two conditions can be expected in about 1.1 % of the general population by chance alone. However, recent epidemiological evidence suggests that the actual comorbidity is higher, namely 3.2 %. ⋯ During acute attacks one may find central spontaneous or positional nystagmus and, less commonly, unilateral vestibular hypofunction. In the symptom-free interval, vestibular testing adds little to the diagnosis as findings are mostly minor and non-specific. In the absence of controlled studies, treatment of VM is adopted from the migraine sphere comprising avoidance of triggers, stress management as well as pharmacotherapy for acute attacks and prophylaxis.
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Understanding three peripheral vestibular disorders--vestibular neuritis, benign paroxysmal positional vertigo, and Meniere's disease--is the key to the evaluation and management of vertigo and dizziness presentations in the emergency department. Each of these benign disorders is a common cause of a broad category of dizziness presentation. ⋯ An effective strategy for "ruling-out" a serious disorder, such as stroke, is "ruling-in" a peripheral vestibular disorder. In this article a focus is on the key features of these disorders.
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Dizziness is a common complaint among patients seen by primary care physicians, neurologists, and otolaryngologists. The most common causes of dizziness are peripheral vestibular disorders, but central nervous system disorders must be excluded. This article provides an overview of the epidemiology of dizziness, differentiating between central and peripheral vertigo, and central causes of dizziness. ⋯ Epidemiologic studies indicate that central causes are responsible for almost one-fourth of the dizziness experience by patients. The patient's history, neurologic examination, and imaging studies are usually the key to differentiation of peripheral and central causes of vertigo. The most common central causes of dizziness and vertigo are cerebrovascular disorders related to the vertebrobasilar circulation, migraine, multiple sclerosis, tumors of the posterior fossa, neurodegenerative disorders, some drugs, and psychiatric disorders.
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Otolaryngol Head Neck Surg · Nov 2008
Review Practice GuidelineClinical practice guideline: benign paroxysmal positional vertigo.
This guideline provides evidence-based recommendations on managing benign paroxysmal positional vertigo (BPPV), which is the most common vestibular disorder in adults, with a lifetime prevalence of 2.4 percent. The guideline targets patients aged 18 years or older with a potential diagnosis of BPPV, evaluated in any setting in which an adult with BPPV would be identified, monitored, or managed. This guideline is intended for all clinicians who are likely to diagnose and manage adults with BPPV. ⋯ This clinical practice guideline is not intended as a sole source of guidance in managing benign paroxysmal positional vertigo. Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgement or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.