Clinical criteria of positional vertical nystagmus in vestibular migraine

Acta Otolaryngol. 2017 Jul;137(7):720-722. doi: 10.1080/00016489.2017.1318220. Epub 2017 Apr 27.


Objectives: The goal of this study was to identify key diagnostic criteria for positional vertical nystagmus caused by vestibular migraine (VM).

Materials and methods: The study group included a case series of 13 subjects with VM (10 females and three males with age 38.6 ± 8.9 years); they were complaining of positional vertigo. They were subjected to thorough audiovestibular examination and treated with cinnarizine or topiramate Results: The entire study group demonstrated positional vertical nystagmus (eight patients had up-beating nystagmus and five patients had down-beating nystagmus). The vertigo and nystagmus were elicited in one or more of the following positions: the right & left Dix-Hallpike, supine with head center, head right, and head left positions. The nystagmus had no latency period. It was persistent, non-fatigable and markedly reduced by visual fixation. Prophylactic therapy of VM (topiramate or cinnarizine) cured the positional vertigo in 92% of the study group. Neither the positional vertigo nor the nystagmus recurred in a 3-6 months follow-up period.

Conclusions: VM can induce characteristic form of vertical positional nystagmus and vertigo, which would be treated by medications used for controlling the VM.

Keywords: Positional nystagmus; migraine therapy; vertical nystagmus; vestibular disorder.

MeSH terms

  • Adult
  • Female
  • Humans
  • Male
  • Middle Aged
  • Migraine Disorders / complications*
  • Nystagmus, Pathologic / diagnosis
  • Nystagmus, Pathologic / etiology*
  • Vertigo / diagnosis
  • Vertigo / etiology*
  • Vestibular Diseases / complications*
  • Young Adult