Unravelling the Meniere’s vs. migraine conundrum – what does the mastoid contribute?
Reviewed by Victor Osei-Lah

This is an interesting observational study that attempts to classify subtypes of Meniere’s disease (MD) in relation to the coexistence of migraine. It is well known that the two conditions share common characteristics, making diagnosis and treatment challenging at times. Ninety-five patients with MD and an equal number of age-matched controls were recruited. The clinical symptoms, duration of disease and frequency of symptoms, demographics, average hearing thresholds, mastoid pneumatisation, and position of the sigmoid sinus on high-resolution CT (HRCT), were compared between the two groups. The sigmoid was said to be displaced anteriorly (ADSS) if the distance between the sigmoid sinus and the posterior wall of the external auditory canal is less than 10mm. The same data were used to divide the MD patients into two groups: MD with migraine (54 patients) and MD without migraine (41 patients). There were no demographic differences between MD and controls. However, the degree of mastoid pneumatisation was significantly poorer in the MD group (p <0.001). ADSS was found in a higher proportion of the MD patients compared to controls. In the two MD groups, those with migraine had a significantly higher female preponderance (39/54 vs. 9/41), had more attacks of vertigo per month (2.3 vs. 6.4) and had better 4-frequency pure tone average. Another interesting finding was that more frequent vertigo and longer duration of MD increased the susceptibility to migraine. This is certainly my personal observation as well. Although the MD patients had poor pneumatisation and greater ADSS, these changes were significantly greater in the MD patients with migraine. In summary, female sex, longer duration of MD and more frequent vertigo attacks, better low-frequency hearing, poorer mastoid pneumatisation and anteriorly displaced sigmoid sinus were more common in MD patients with migraine than without. The authors argue this proposed clinical subtyping might help with diagnosis and inform treatment.

The clinical characteristics and anatomical variations in patients with intractable unilateral Meniere’s disease with and without migraine.
Diao T, Han L, Jing Y, et al.
J VESTIB RES
2022;32(1):57-67.