Sit-up dizziness and head-shaking dizziness may be diagnostic symptoms of vestibular migraine

Abstract

Background: Vestibular migraine (VM) frequently presents as a diagnostic challenge because objective neurological findings consistent with this entity have not been described. Certain patients with VM present with dizziness while sitting up or shaking their head, which we have designated as sit-up dizziness (SUD) and head-shaking dizziness (HSD) respectively. Objective: To study the prevalence of SUD and HSD in patients with acute VM and to evaluate their sensitivity and specificity for the diagnosis of acute VM. Methods: We examined 60 patients with VM and compared them to 61 patients with episodic migraine (EM), who were subsequently divided into 4 groups (acute-VM, symptom-free-VM, acute-EM, symptom-free-EM). SUD was induced by a positional change from lying to sitting, while HSD was induced by voluntary horizontal head-shaking. The prevalence of SUD and HSD was assessed in the patients during acute and asymptomatic periods. The sensitivity and specificity of SUD and HSD for identification of VM were assessed in an additional 85 patients with acute VM and 123 patients with acute EM. Results: The prevalence of SUD and HSD was 72% and 60% respectively in the acute-VM group, which was significantly higher than the symptom-free-VM, acute-EM and symptom-free-EM groups, and which was not related to sex, age, or symptom duration. SUD and HSD had a sensitivity of 80.0% and 81.2%, and specificity of 75.6% and 78.9%, respectively in diagnosing acute VM. The sensitivity and specificity for either test being positive was 91.8% and 71.5%, and 69.4% and 82.9%, when both tests were positive, respectively. Conclusions: SUD and HSD can be used as diagnostic indicators of acute VM that possess high sensitivity and specificity. This study suggests that SUD and HSD are useful diagnostic tests in patients with new dizziness of unknown cause.