Migraine and PPPD: how can we differentiate between these entities?

<h3>Background</h3> Migraine and Persistent Postural Perceptual Dizziness (PPPD) are two diagnostically challenging causes of episodic vertigo. We aim to describe and compare the Niigata PPPD Questionnaire (NPQ) and the Visual Vertigo Analogue Scale (VVAS) in patients with headache. <h3>Methodology</h3> Data collected using a questionnaire from 112 patients with headache in a neurology clinic and analysed using non-parametric tests. <h3>Results</h3> Median age was 47 years and 75% (n=84) were females. 68.75% fulfilled criteria for migraine. Migraine group had a median VVAS of 18.5 and NPQ of 24, compared to a median VVAS of 7 and NPQ of 6.5 in non-migraine group. Mann-Whitney-U test was significant for both VVAS (<i>U</i>=1211.5, <i>p</i>=0.002) and NPQ (<i>U</i>=1258.5, <i>p</i>=0.009). A statistically significant moderate positive correlation existed between NPQ and VVAS; <i>rs</i>=0.650, <i>p</i>&lt;0.001. Movement sensitivity resulted in significantly higher VVAS (median=22, <i>U</i>=975, <i>p</i>&lt;0.001) and NPQ (median=34, <i>U</i>=994, <i>p</i>=0.003). Both median VVAS (21) and NPQ (36) were significantly higher with phonophobia (<i>U</i>=1031, <i>p</i>=0.005). Photophobia was only associated with a higher VVAS (median=19, <i>U</i>=1264.5, <i>p</i>&lt;0.001) while only NPQ was higher with nausea (median=34, <i>U</i>=1007.5, <i>p</i>=0.038). <h3>Conclusion</h3> Migraine is associated with higher VVAS and NPQ. If the patient presents with headache and they fulfil the migraine criteria the latter should be considered before PPPD is diagnosed.