Familial Clustering of Migraine, Episodic Vertigo, and Ménière's Disease

OBJECTIVE: To evaluate the association between migraine, episodic vertigo, and Ménière's disease in families. STUDY DESIGN: Clinical report. SETTING: University Neurotology Clinic. PATIENTS: Index patients identified with Ménière's disease and migraine and their family members. INTERVENTION: Structured interview to assess a diagnosis of migraine, episodic vertigo, and Ménière's disease in 6 families. Genotyping was performed on 3 sets of twins to analyze monozygosity or dizygosity. MAIN OUTCOME MEASURES: Clinical history of migraine, episodic vertigo, and Ménière's disease. RESULTS: Six index patients and 57 family members were interviewed either by a senior neurologist in person or over the phone by a trained study coordinator. An additional 6 family members completed questionnaires by mail. All 6 index patients had Ménière's disease and migraine. Twenty-six (41%) of the 63 relatives met International Classification of Headache Disorders II criteria for migraine headaches. Thirteen (50%) of these 26 experienced migraine with aura. Three others experienced typical aura without headache. Seventeen (27%) of 63 family members experienced recurrent spells of spontaneous episodic vertigo. There was one twin pair in each of 3 families; 2 pairs were monozygotic and one was dizygotic. In each twin pair, one twin had migraine and Ménière's disease, whereas the other experienced migraine and episodic vertigo without auditory symptoms. CONCLUSION: The frequent association of episodic vertigo, migraine, and Ménière's disease in closely related individuals, including identical twins supports the heritability of a migraine-Ménière's syndrome, with variable expression of the individual features of hearing loss, episodic vertigo, and migraine headaches.