Horizontal Direction-Changing Positional Nystagmus and Vertigo: A Case of Vestibular Migraine Masquerading as Horizontal Canal BPPV

Headache
Shin C Beh

Abstract

Episodic positional vertigo is typically due to benign paroxysmal positional vertigo (BPPV) but may also be a manifestation of vestibular migraine. Distinguishing vestibular migraine from BPPV is essential since the treatment of each disorder is markedly different. The 31-month clinical course of a 41-year-old woman with vestibular migraine causing recurrent positional vertigo is described. During vestibular migraine attacks, she developed left-beating nystagmus in the upright position with removal of fixation, and geotropic horizontal nystagmus during the supine roll test. Interictally, her exam demonstrated positional apogeotropic horizontal nystagmus with the supine roll test, more intense in the supine head left position. Her vestibular migraine was successfully controlled with topiramate and eletriptan.

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Citations

Dec 19, 2018·Current Opinion in Neurology·Michael StruppJose A López-Escámez
May 17, 2019·Journal of Neuro-ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society·Shin C Beh
Dec 7, 2019·Current Treatment Options in Neurology·Marco MandalàDaniele Nuti
Nov 25, 2020·Journal of Neurology·Hyo-Jung KimJi-Soo Kim
Jun 30, 2021·Journal of Clinical Neurology·Seong Hae Jeong, Ji Soo Kim
Jan 12, 2022·Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology·Youjin Shen, Xiaokun Qi

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