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Original Investigation
January 24, 2019

Association Between Migraine and Benign Paroxysmal Positional Vertigo Among Adults in South Korea

Author Affiliations
  • 1Department of Otorhinolaryngology–Head & Neck Surgery, Hallym University College of Medicine, Dongtan, South Korea
  • 2Department of Otorhinolaryngology–Head & Neck Surgery, Hallym University College of Medicine, Anyang, South Korea
JAMA Otolaryngol Head Neck Surg. 2019;145(4):307-312. doi:10.1001/jamaoto.2018.4016
Key Points

Question  Is migraine associated with increases in the risk of benign paroxysmal positional vertigo?

Findings  This cohort study in South Korea involving 40 682 individuals with a migraine diagnosis and 162 728 controls found that the incidence of benign paroxysmal positional vertigo was statistically significantly higher in individuals with migraine than in individuals without migraine.

Meaning  Migraine appears to be a risk factor for benign paroxysmal positional vertigo; future studies are needed to determine vertigo’s association with specific factors related to migraine.

Abstract

Importance  Patients with migraine often experience various types of vertigo, and several studies have suggested an epidemiologic and physiologic association of migraine and vertigo with vestibule. However, few researchers have investigated the association between migraine and benign paroxysmal positional vertigo (BPPV).

Objective  To determine the incidence of BPPV in individuals with migraine in a large national population-based sample.

Design, Setting, and Participants  This cohort study obtained data from the Korean Health Insurance Review and Assessment Service covering the period January 1, 2002, through December 31, 2013. These data included personal information, health insurance claim codes, diagnostic codes, death records, socioeconomic data, and medical examination data for each individual in the database. A 1:4 matching method was used to select individuals for the migraine group (n = 40 682) and the control group (n = 162 728). Individuals who had a history of BPPV before the index date, for whom a match could not be identified, and who received a migraine diagnosis before age 20 years were excluded from the analysis. Data analysis was conducted from September 1, 2015, to December 31, 2017.

Main Outcomes and Measures  The crude and adjusted (by age, sex, income, region of residence, and medical history [hypertension, diabetes, or dyslipidemia]) hazard ratios for migraine and BPPV were analyzed using the Cox proportional hazards regression model.

Results  Of the 40 682 individuals in the migraine group, 10 381 (25.5%) were male and 30 301 (74.5%) were female. Of the 162 728 controls, 41 524 (25.5%) were male and 121 204 (74.5%) were female. The incidence of BPPV was statistically significantly higher in the migraine group than in the control group (2431 [6.0%] vs 3677 [2.3%]). Migraine increased the risk of BPPV (adjusted hazard ratio, 2.54; 95% CI, 2.41-2.68). In a subgroup analysis, the incidence of BPPV in all age groups and in both men and women was statistically significantly higher in the migraine group than in the control group. The incidence of BPPV was the highest in men younger than 40 years (adjusted hazard ratio, 4.49; 95% CI, 3.05-6.62), and the HR decreased in both men and women as age increased.

Conclusions and Relevance  Migraine appeared to be statistically significantly associated with higher incidence of BPPV; future studies are needed to determine the association between BPPV and specific factors related to migraine.

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