Migraine-anxiety related dizziness (MARD): a new disorder?

Dizziness is a common complaint that can result from abnormalities of the vestibular apparatus of the inner ear and of those portions of the central nervous system (CNS) that process information from the peripheral vestibular system and other senses, particularly vision and somatosensation. Recently, two CNS disorders, migraine and anxiety, have been recognised as being commonly associated with dizziness.1,2 These associations may be an expression of an aetiological relationship, for example, dizziness caused by migraine, or dizziness caused by anxiety; alternatively, migraine or anxiety may influence the presentation of a balance disorder. For example, chronic dizziness may become more disabling during the added stress of a migraine headache or panic attack. In addition, dizziness occurs comorbidly with both migraine headache and anxiety disorders.3,4 Finally, there is increased comorbidity between anxiety and migraine.5 Thus, it is not surprising that some patients with dizziness may suffer from a combination of a balance disorder, migraine, and an anxiety disorder, a symptom complex that we propose to name migraine−anxiety related dizziness (MARD) (fig 1). The general recognition of MARD may be limited because of the fragmented nature of our healthcare system, where specialists in one field, such as psychiatry or neurology, fail to recognise phenomena known to specialists in other fields, such as otoneurology. Figure 1  Venn diagram of the interfaces among migraine, anxiety, and balance disorders. The central sector, which denotes the three way interface, represents an hypothesised new ailment, migraine−anxiety related dizziness (MARD). This editorial will focus on the pathophysiology and clinical issues relating to MARD, including the interfaces among balance disorders, migraine, and anxiety. We use current epidemiological data and studies of pathogenesis to develop comorbidity models. These models serve as hypotheses that may lead to possible treatment options for many patients with dizziness, including those with MARD. …