Vestibular migraine: perspectives of otology versus neurology.

OBJECTIVE To compare the attitudes and opinions of otologists and neurologists regarding the cause, diagnosis, and management of vestibular migraine. STUDY DESIGN Survey questionnaire. METHODS An 18-question survey designed to elicit opinions about the cause, diagnosis, pathophysiology, and management of migraine and dizziness was mailed to the entire memberships of the American Neurotology Society (ANS) and the International Headache Society (IHS). Survey participant responses were recorded for physician practice characteristics and for opinions on various clinical features of vestibular migraine. RESULTS Of the 917 surveys mailed, 146 were completed by ANS members and 110 by IHS members. The frequency of respondents listing symptom origin as central to a diagnosis of migraine was 43% for ANS members versus 62% of IHS members. Only 31% of ANS respondents thought that a sensory trigger was a major etiologic factor. Of the IHS respondents, 60% thought a triggering event was mediated by the Vth nerve and 28% by the VIIIth nerve. Opinions varied on the character of dizziness and cochlear symptoms associated with migraine. Compared with 26% of IHS members, 55% of ANS members were more likely to view hearing loss as a migraine symptom. IHS members expressed a greater tendency to use triptans and anticonvulsants when compared with ANS members. CONCLUSION The results suggested that ANS and IHS members have different perspectives on the clinical presentation, pathophysiology, and management of vestibular migraine. These differences can result in patient confusion and inadvertently have an adverse effect on patient care, thereby potentially affecting patient outcomes.