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Dizziness, migrainous vertigo and psychiatric disorders

Published online by Cambridge University Press:  03 December 2009

R Teggi ,
D Caldirola ,
B Colombo ,
G Perna ,
G Comi ,
L Bellodi  and
M Bussi
R Teggi*
Affiliation:
Department of ENT, San Raffaele Hospital, Vita-Salute University, Milan, Italy
D Caldirola
Affiliation:
Anxiety Disorder Clinical and Research Unit (Istituto Scientifico HS Raffaele), San Raffaele Hospital, Vita-Salute University, Milan, Italy
B Colombo
Affiliation:
Department of Neurology, San Raffaele Hospital, Vita-Salute University, Milan, Italy
G Perna
Affiliation:
Anxiety Disorder Clinical and Research Unit (Istituto Scientifico HS Raffaele), San Raffaele Hospital, Vita-Salute University, Milan, Italy
G Comi
Affiliation:
Department of Neurology, San Raffaele Hospital, Vita-Salute University, Milan, Italy
L Bellodi
Affiliation:
Anxiety Disorder Clinical and Research Unit (Istituto Scientifico HS Raffaele), San Raffaele Hospital, Vita-Salute University, Milan, Italy
M Bussi
Affiliation:
Department of ENT, San Raffaele Hospital, Vita-Salute University, Milan, Italy
*
Address for correspondence: Dr Roberto Teggi, San Raffaele Hospital, via Olgettina 60, 20132 Milan, Italy. Fax: +39 2 26433508 E-mail: teggi.roberto@hsr.it
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Abstract

Objectives:

This study sought to establish the prevalence of vestibular disorders, migraine and definite migrainous vertigo in patients with psychiatric disorders who were referred for treatment of dizziness, without a lifetime history of vertigo.

Study design:

Retrospective study.

Setting:

Out-patients in a university hospital.

Materials and methods:

Fifty-two dizzy patients with panic disorders and agoraphobia, 30 with panic disorders without agoraphobia, and 20 with depressive disorders underwent otoneurological screening with bithermal caloric stimulation. The prevalence of migraine and migrainous vertigo was assessed. The level of dizziness was evaluated using the Dizziness Handicap Inventory.

Results:

Dizzy patients with panic disorders and agoraphobia had a significantly p = 0.05 regarding the prevalence of peripheral vestibular abnormalities in the group of subjects with PD and agoraphobia and in those with depressive disorders. Migraine was equally represented in the three groups, but panic disorder patients had a higher prevalence of migrainous vertigo definite migrainous vertigo. Almost all patients with a peripheral vestibular disorder had a final diagnosis of definite migrainous vertigo according to Neuhauser criteria. These patients had higher Dizziness Handicap Inventory scores. The Dizziness Handicap Inventory total score was higher in the subgroup of patients with panic disorders with agoraphobia also presenting unilateral reduced caloric responses or definite migrainous vertigo, compared with the subgroup of remaining subjects with panic disorders with agoraphobia (p < 0.001).

Conclusions:

Our data support the hypothesis that, in patients with panic disorders (and especially those with additional agoraphobia), dizziness may be linked to malfunction of the vestibular system. However, the data are not inconsistent with the hypothesis that migrainous vertigo is the most common pathophysiological mechanism for vestibular disorders.

Keywords

Vestibular DisordersVertigoPsychiatric DisordersMigraine
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 3 , March 2010 , pp. 285 - 290
Copyright
Copyright © JLO (1984) Limited 2009

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References

1Afzelius, L-E, Henriksson, NG, Wahlgren, L. Vertigo and dizziness of functional origin. Laryngoscope 1980;90:649–56CrossRefGoogle ScholarPubMed
2Nedzelski, JM, Barber, HO, McIlmoyl, L. Diagnoses in a dizziness unit. J Otolaryngol 1986;15:101–4Google Scholar
3Heckhardt-Henn, A, Dieterich, M. Psychiatric disorders in otoneurology patients. Neurol Clin 2005;23:731–49CrossRefGoogle Scholar
4Pollak, L, Klein, C, Stryjer, R, Kossich, V, Rabey, JM. Anxiety in the first attack of vertigo. Otolaryngol Head Neck Surg 2003;128:829–34Google Scholar
5Neuhauser, HK. Epidemiology of vertigo. Curr Opin Neurol 2007;20:40–6CrossRefGoogle ScholarPubMed
6Grunfeld, EA, Gresty, MA, Bronstein, AM, Jahanshai, M. Screening for depression among neuro-otology patients with and without identifiable vestibular lesions. Int J Audiol 2003;42:161–5CrossRefGoogle ScholarPubMed
7Furman, JM, Redfern, MS, Jacob, RG. Vestibulo-ocular function in anxiety disorders. J Vest Res 2006;16:209–15CrossRefGoogle ScholarPubMed
8Redfern, MS, Furman, JM, Jacob, RG. Visually induced postural sway in anxiety disorders. J Anxiety Disord 2007;21:704–16CrossRefGoogle ScholarPubMed
9Jacob, RG, Moiler, MB, Turner, SM, Wall, C 3rd. Otoneurological examination of panic disorder and agoraphobia with panic attacks: a pilot study. Am J Psychiatry 1985;142:715–20Google ScholarPubMed
10Sklare, DA, Stein, MB, Pikus, AM, Uhde, TW. Disequilibrium and audiovestibular function in panic disorder: symptom profiles and test findings. Am J Otol 1990;11:338–41Google Scholar
11Furman, JM, Jacob, RG. Psychiatric dizziness. Neurology 1997;48:1161–6Google Scholar
12Jacob, RG, Furman, JM, Durrant, JD, Turner, SM. Panic, agoraphobia and vestibular dysfunction. Am J Psychiatry 1996;153:503–12Google ScholarPubMed
13Tecer, A, Tukel, R, Erdamar, B, Sunay, T. Audiovestibular functioning in patients with panic disorder. J Psychosom Res 2004;57:177–82CrossRefGoogle ScholarPubMed
14Heckhardt-Henn, A, Best, C, Bense, S, Breuer, P, Diener, G, Tschan, R et al. Psychiatric comorbidity in different organic vertigo syndromes. J Neurol 2008;255:420–8CrossRefGoogle Scholar
15Reploeg, MD, Goebel, JA. Migraine-associated dizziness: patient characteristics and management options. Otol Neurotol 2002;23:364–71CrossRefGoogle ScholarPubMed
16Cass, SP, Ankerstjerne, JKP, Yetiser, R, Furman, JM, Balaban, C, Aidogan, B. Migraine related vestibulopathy. Ann Otol Rhinol Laryngol 1997;106:182–9CrossRefGoogle ScholarPubMed
17Lempert, T, Neuhauser, H. Migrainous vertigo. Neurol Clin 2005;23:715–30Google Scholar
18Felbinger, J, Reinisch, VM, Sostak, P, Wallasch, TM, Diener, HC, Straube, A. Anxiety and depression in headache patients: the example of managed care of chronic headache patients in Bavaria. Schmerz 2009;23:33–9 [in German]Google Scholar
19Torelli, P, Lambru, G, Manzoni, GC. Psychiatric comorbidity and headache: clinical and therapeutical aspects. Neurol Sci 2006;27:73–6CrossRefGoogle ScholarPubMed
20Furman, JM, Balaban, CD, Jacob, RG, Marcus, DA. Migraine-anxiety related dizziness (MARD): a new disorder? J Neurol Neurosurg Psychiatry 2005;76:1–8CrossRefGoogle Scholar
21Sheehan, DV, Lecrubier, Y, Janavs, J, Knapp, E, Weiler, E, Bonora, P. Mini International Neuropsychiatric Interview. Paris, Tampa: MINI-plus, 1994Google Scholar
22Staab, JP. Chronic dizziness: the interface between psychiatry and neuro-otology. Curr Opin Neurol 2006;19:41–8Google Scholar
23Headache Classification Committee of the International Headache Society. The international classification of headache disorders. Cephalalgia 2004;24:1–60Google Scholar
24Neuhauser, H, Lempert, T. Diagnostic criteria for migrainous vertigo. Acta Otolaryngol 2005;125:1247–8CrossRefGoogle ScholarPubMed
25Torok, N. Quantitative parameters in nystagmography. ORL J Otorhinolaryngol Relat Spec 1974;36:37–45Google Scholar
26Barber, HO, Stockwell, CW. Manual of Electronystagmography. St Louis, Missouri: Mosby, 1980Google Scholar
27Jacobson, GP, Henry, KG. Effect of temperature on fixation suppression ability in normal subjects: the need for temperature and age-dependent values. Ann Otol Rhinol Laryngol 1989;98:369–72CrossRefGoogle Scholar
28Brandt, T. Positional and positioning vertigo and nystagmus. J Neurol Sci 1990;95:3–28Google Scholar
29Jacobson, GP, Newman, CW. The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg 1990;116:424–7CrossRefGoogle ScholarPubMed
30Jacob, RG, Redfern, MS, Furman, JM. Space and motion discomfort and abnormal balance control in patients with anxiety disorders. J Neurol Neurosurg Psychiatry 2009;80:74–8Google Scholar
31Piker, EG, Jacobson, GP, McCaslin, DL, Grantham, SL. Psychological comorbidities and their relationship to self-reported handicap in samples of dizzy patient. J Am Acad Audiol 2008;19:337–47Google Scholar
32Staab, JP, Ruckenstein, MJ. Which comes first? Psychogenic dizziness versus otogenic anxiety. Laryngoscope 2003;113:1714–18CrossRefGoogle ScholarPubMed
33Inada, Y, Yoneda, H, Koh, J, Sakai, J, Himei, A, Kinoshita, Y et al. Positive association between panic disorder and polymorphism of the serotonin 2A receptor gene. Psychiatry Res 2003;118:25–31Google Scholar
34Schuerger, RJ, Balaban, CD. Organization of coeruleo-vestibular pathways in rats, rabbits and monkeys. Brain Res 1999;30:189–217Google Scholar
35Halberstadt, AL, Balaban, CD. Serotonergic and nonserotonergic neurons in the dorsal raphe nucleus send collateralized projections to both the vestibular nuclei and the central amygdaloid nucleus. Neuroscience 2006;140:1067–77CrossRefGoogle ScholarPubMed
36Furman, JM, Marcus, DA, Balaban, CD. Migrainous vertigo: development of a pathogenetic model and structured diagnostic interview. Curr Opin Neurol 2003;16:5–13Google Scholar
37Buisseret-Delmas, C, Compoint, C, Delfini, C, Buisseret, P. Organisation of reciprocal connections between trigeminal and vestibular nuclei in the rat. J Comp Neurol 1999;409:153–683.0.CO;2-#>CrossRefGoogle ScholarPubMed
38Dos Santos, L, de Andrade, TG, Zangrossi, H Jr. Serotonergic neurons in the median raphe nucleus regulate inhibitory avoidance but not escape behavior in the rat elevated T-maze test of anxiety. Psychopharmacology (Berl) 2005;179:733–41CrossRefGoogle Scholar
39Dehbandi, S, Speckmann, EJ, Pape, HC, Gorji, A. Cortical spreading depression modulates synaptic transmission of the rat lateral amygdala. Eur J Neurosci 2008;27:2057–65CrossRefGoogle ScholarPubMed
40Zanoveli, JM, Ferreira-Netto, C, Brandão, ML. Conditioned place aversion organized in the dorsal periaqueductal gray recruits the laterodorsal nucleus of the thalamus and the basolateral amygdala. Exp Neurol 2007;208:127–36CrossRefGoogle ScholarPubMed
41DaSilva, AF, Granziera, C, Tuch, DS, Snyder, J, Vincent, M, Hadjikhani, N. Interictal alterations of the trigeminal somatosensory pathway and periaqueductal gray matter in migraine. Neuroreport 2007;18:301–5CrossRefGoogle ScholarPubMed