Anterior inferior cerebellar artery (AICA) aneurysms are rare pathologies that may present with hearing loss, facial paralysis, vertigo, and tinnitus. Otologic symptoms at the time of presentation may prompt physicians to order an MRI, which can lead to the misdiagnosis of AICA aneurysms as vestibular schwannomas. We discuss the case of a 27-year-old female who presented with sudden-onset vertigo and right-sided hearing loss. She was found to have a right homogeneously enhancing internal auditory canal (IAC) mass abutting the vestibular nerve on post-gadolinium T1 MRI two hours after the presentation, which was initially diagnosed as a vestibular schwannoma. Serial T1 MRI highlighted the evolution of blood products within this mass by presenting as bright at two days and dark at two months after presentation. Profound ipsilateral sensorineural hearing loss and absent vestibulocochlear function were confirmed on audiometry and vestibular testing, respectively. The diagnostic cerebral angiogram was complicated by an iatrogenic right mid-cervical vertebral artery dissection, and the patient ultimately underwent successful embolization two months after presentation with the resolution of all presenting symptoms except right-sided hearing loss. Early recognition and treatment of an AICA aneurysm may help prevent associated vascular complications, and they should be considered as part of the differential diagnosis for IAC lesions despite their rarity.

Purpose of review

The purpose of this narrative review is to discuss current literature about vestibular migraine and other cochleovestibular symptoms related to migraine.

Recent findings

Vestibular migraine affects 2.7% of the US population. Misdiagnosis is common. The pathophysiology is currently unknown but new research shows that calcitonin gene-related peptide, which is implicated in migraine headaches, is expressed in the audiovestibular periphery. A recent large-scale placebo-controlled trial looking at metoprolol for vestibular migraine was terminated early due to poor recruitment; however, at study completion, no differences were seen between treatment arms. Many other audiovestibular symptoms have been shown to be associated with migraine, including tinnitus, hearing loss, aural fullness, otalgia, and sinus symptoms. Migraine is also associated with risk for developing numerous otologic conditions, including Meniere's disease, vestibular loss, Benign Paroxysmal Positional Vertigo, and sudden sensorineural hearing loss. There is now some evidence that patients may experience fluctuating hearing loss and aural fullness without vertigo in association with migraine, which is called cochlear migraine.

Summary

Migraine can cause a variety of audiologic and vestibular symptoms, and further research is required to understand how migraine affects the inner ear.