Comparing Benign Recurrent Vertigo With Vestibular Migraine, Menière's Disease

In an effort to discriminate benign recurrent vertigo (BRV) from vestibular migraine (VM) or Menière's disease (MD), researchers conducted a prospective cohort study assessing vertigo attacks, vertigo medication use, and mental health limitations among patients with any of the 3 diagnosedvconditions during 3 years of follow-up.

Findings were published in Frontiers in Neurology, and they showed patients with BRV had favorable outcomes as by the end of the study window, 71% of patients were free of attacks.

BRV is defined as multiple episodes of vertigo lasting 5 minutes to 24 hours, and it is accompanied by nausea and vomiting. Although the syndrome occurs with recurrent vertigo attacks but without hearing loss, tinnitus, or aural fullness, its etiology remains unknown.

In addition, “some claim the involvement of VM, while others believe that MD is related to this vertigo syndrome,” the authors wrote, adding “BRV is frequently diagnosed, and the majority of the cases show spontaneous resolution of vertigo attacks.”

All patients included in the current study were recruited from the Apeldoorn Dizziness Center in the Netherlands between January 2015 and November 2016 and had either BRV, definite VM (dVM), probable VM (pVM), or MD. Those with dVM and pVM were combined into 1 cohort.

Participants completed a follow-up survey at 3, 6, 12, 18, 24, 30, and 36 months after the baseline assessment, until December 2019.

Of the 121 individuals surveyed, 44 patients had BVR, 34 had VM, and 43 had MD.

Analyses showed:

• For the total follow-up period, no statistically significant differences between the 3 diagnosis groups were observed for being attack free in the past 6 months: VM had an odds ratio (OR) of 0.86 (95% CI, 0.34-2.17; P = .745), and MD had an OR of 1.06 (95% CI, 0.44-2.51; P = .902) compared with BRV
• 19 patients (43.2%) with BRV, 13 (38.2%) with VM, and 35 (81.0%) with MD used medication to prevent vertigo attacks at any point during their 3-year follow-up
• At 36 months, the difference in medication use between the groups was statistically significant (Chi-square test, P < .001)
• 10 patients (23.3%) with MD received 1 or more intratympanic injections during follow-up

Throughout the observation period, patients with MD showed an average of 3.37 points (95% CI, 0.68-6.07; P = .014) higher Hospital and Depression Scale scores relative to patients with BRV

After 3 years of follow-up, 67% to 70% of the patients were free of vertigo attacks

“Like in most other studies, our BRV patients showed a favorable course with a strong reduction of frequency of attacks. As a result, in patients with BRV, the course of the disease does not differ from the course in VM and MD,” the authors concluded.

Debate continues as to whether BRV can be described as a separate clinical entity compared with the other 2 conditions, they explained, adding BRV can be considered as a subgroup within “recurrent vestibular symptoms not otherwise specified.”

Due to the strict application of criteria for the 3 diagnoses, the study samples were not very large, marking a limitation to these findings.

“The practical significance of our findings is that, in our view, patients who are diagnosed with BRV can be informed that their prognosis in terms of vertigo attacks is rather favorable, and also that it is unlikely that it will further develop into MD,” the researchers said.

Reference

van Leeuwen RB, Colijn C, van Esch BF, Schermer TR. Benign recurrent vertigo: the course of vertigo attacks compared to patients with Menière's disease and vestibular migraine. Front Neurol. Published online March 2, 2022. doi:10.3389/fneur.2022.817812