Migrainous Vertigo Unresponsive to Antimigraine Therapy in a Child with ‘Asymptomatic’ Cerebellar Lesion: Casual or Causal Association?

Abstract

Migrainous vertigo (MV) is a new type of headache that has not yet been recognized by the International Classification of Headache Disorders (ICHD-2) (1, 2). In MV patients, vertigo is an independent migrainous symptom that does not usually correspond to aura and may be dissociated from headache. These episodes of spontaneous or positional vertigo last from a few seconds to several hours, sometimes even for days: attacks that last less than migraine aura are not unusual (20–30%), those lasting hours or days occur in 20–50%, while those that last as long as typical migraine aura (5–60 min) occur in 10–30% of patients. Benign paroxysmal childhood vertigo often precedes by months or years MV symptoms in affected patients. Although there are as yet no internationally approved MV diagnostic criteria, symptoms which may help make a diagnosis (Table 1) and a structured diagnostic interview (3) have recently been proposed (4). Numerous hypotheses have been suggested in an attempt to clarify the pathophysiology of MV, but the underlying mechanisms remain unclear (4). To our knowledge, a lesion-related origin of MV has not previously been suggested. We describe a child with MV, a normal neurological examination, no family history of headache nor personal history of benign paroxysmal childhood vertigo, in whom MRI revealed a right cerebellar arachnoid cyst adjacent to the flocculo-nodular region.