Study Compares Vertigo’s Effects on Patients With Vestibular Migraine, BPPV

The emotional, functional and physical effects of vertigo on patients with vestibular migraine (VM) were more significant compared with the experiences of patients with benign paroxysmal positional vertigo (BPPV), according to study results published in Medicine.

Dizziness, or vertigo, is one of the most commonly reported complaints in clinical medicine while BPPV is one of the most commonly occurring peripheral vestibular disorders, the researchers explained. BPPV, which has a lifetime prevalence of 2.4%, is defined as acute, short attacks of severe dizziness brought on by sudden head movements.

Apart from BPPV, VM is the most common cause of spontaneous vertigo attacks. VM’s clinical manifestations “mainly include paroxysmal vestibular symptoms, which are accompanied by various types of migraines.”

Previous studies have shown high rates of mood or anxiety disorders in patients with BPPV, but “the reciprocal role played by degree of dizziness handicap in vertigo and psychological conditions remains unclear,” the authors wrote.

To assess the impact of dizziness, anxiety, or depression on patients with VM and BPPV, the researchers conducted a prospective cohort study of patients recruited from a single hospital in Beijing, China. All participants had either BPPV (n = 131) or VM (n = 45) diagnosed between September 2016 and December 2017. Any patients presenting with additional primary or secondary headaches or those with cerebral infraction, cerebral hemorrhage, and multiple sclerosis were excluded.

Before and after a 3-month period (during which patients received treatment), participants completed the Dizziness Handicap Inventory Scale (DHI) and Hospital Anxiety and Depression Scale (HADS) and were asked about the frequency of vertigo attacks. Demographic data and medication history were also collected. The researchers used the Mann-Whitney U test to compare test scores between the 2 cohorts.

Prior to treatment, the researchers found:

• Median DHI scores of BPPV and VM were 34 and 60, respectively (Z  =  −5.643; P =  .001)
• Median HADS scores were 6 and 14, respectively (Z  =  −4.807; P  =  .001)

In comparison, after 3 months:

• Median DHI scores of BPPV and VM were 0 and 22, respectively (Z  =  −8.425; P  =  .001)
• Median HADS scores were 6 and 14, respectively (Z  = −7.126; P  =  .001)
• 51.11% of patients with VM and 12.21% of patients with BPPV exhibited anxiety and depression

Spearman correlation showed “the change of DHI scores in BPPV patients was positively correlated with changes in the anxiety and depression in the HADS (r  =  .591; 95% CI ,  0.385-0.762; P < .001),” while “the change of DHI scores in VM patients was positively correlated with changes in the anxiety and depression in the HADS (r  =  .556; 95% CI =, 0.303-=0.751; P < .001).”

Overall, patients with VM had DHI and HADS scores that were significantly higher than those of patients with BPPV, and patients with VM were more likely to suffer from dizziness, depression, and anxiety.

The results show more attention ought to be paid to the clinical manifestations and psychological evaluations of patients with VM, the researchers argued.

The lack of structured interviews to diagnose depression and anxiety, in addition to the relatively small sample sizes, mark limitations to this study.

Reference:

Zhu C, Li Y, Ju Y, Zhao X. Dizziness handicap and anxiety depression among patients with benign paroxysmal positional vertigo and vestibular migraine. Medicine. Published online December 24, 2020. doi:10.1097/MD.0000000000023752