What Lifestyle Changes Or Therapies Can Help With Vestibular Migraine
You may be able to reduce the number and intensity of your vestibular migraine attacks by keeping a consistent sleep routine, eating on a regular schedule , managing stress, and getting enough exercise, according to Johns Hopkins Medicine.
While its important to recognize migraine triggers, you dont want to avoid everything as a coping mechanism, says Mueller. Cognitive behavioral therapy can help people to learn manage stress and live with migraine and vertigo, she says.
Some people may benefit from vestibular rehabilitation , which is like physical therapy for people who have issues with vertigo and dizziness, says Mueller. VR is an exercise-based program that is designed to help train the nervous system to compensate for vestibular problems, according to the Vestibular Disorders Association.
Symptoms And Features Of Vestibular Migraine
Vestibular Migraine can manifest through alarming symptoms like lightheadedness, ataxia, and sensations of moving while sitting still. Because symptoms are not the same for every person, it is incredibly easy to misdiagnose VM.
There are few clinical studies available on VM. Specialists in this field find themselves learning more every day about how to distinguish this diagnosis from other vestibular disorders like Meniere’s disease and benign paroxysmal positional vertigo .
Healthcare providers diagnose VM based on universal criteria set forth by the Barany Society and the International Headache Society. General practitioners receive little education in headache types, including Vestibular Migraine, so many people with symptoms of VM end up seeing several different doctors before they are accurately diagnosed.
Some of the common symptoms of Vestibular Migraine are:
- Memory loss and brain fog
- Positional and/or spontaneous vertigo episodes
- Sensitivity to light and motion
- Nausea and vomiting
Emotional Symptoms And Comorbidities
We have only discussed the physical symptoms that occur with vestibular migraine, but there are also emotional consequences as well. Specifically, there has been a higher prevalence of anxiety, depression, as well reduced quality of sleep observed among those with migraine-associated vertigo.8 It is important to note that migraine and other headache disorders have long been connected with these emotional side effects, so there is no clear causal link. However, it does appear that these issues may be more severe even when compared with the general migraine population.
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How Does My Doctor Rule Out Something Else
Theyâll likely order an MRI to check your brain and run hearing and balance tests to look for problems with your ears.
- Meniere’s disease. Before you get dizzy, usually one of your ears feels full or stuffy, or hurts. During an attack, one or both ears may ring, or you might lose hearing. This doesn’t usually happen with a vestibular migraine.
- Brainstem stroke. Along with vertigo, you mayalso have numbness, weakness, trouble speaking, and other stroke symptoms. If you have any of these symptoms, or if you have new vertigo that has not been diagnosed, get immediate emergency help.
Recognition Of Migraine Syndromes
Most people associate migraine with severe head pain and a period of incapacitation. However, a large portion of people with migraine often have no accompanying pain, their predominant symptom instead being vertigo or dizziness/ disequilibrium , mental confusion, disorientation, dysarthria, visual distortion or altered visual clarity, or extremity paresis. This presentation may result in a visit to the emergency room and extensive laboratory, imaging, and other diagnostic evaluationsoften with normal results, which lead to increased confusion and anxiety on the part of the patient. In addition, anti-emetic medications are often given, which may have sedative side effects associated with increased postural instability and increased fall risks.
Clinicians are faced with the task of attempting to apply objective clinical testing methods to determine the etiology of a patients symptoms so as to optimize treatment. Often, a combination of etiologies exists, which can complicate or confuse the diagnostic process.
Physicians should be using the International Headache Societys International Classification of Headache Disorders in order to better diagnose patients with primary headache disorders. These criteria, used by neurologists and other headache specialists, are readily available in almost every library, either online or in print.
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Migraine And Vestibular Dysfunction
Approximately 40% of migraine patients have some accompanying vestibular syndrome involving disruption in their balance and/or dizziness at one time or another. This may be prior to, during, after, or totally independent of their migraine event. Some interesting parallels exist between migraine and non-migrainous vestibular dysfunction. Many of the food and environmental triggers for migraineurs are the same as those for patients with non-migrainous vestibular dysfunction. Hormonal fluctuations, foods, and weather changes often exacerbate both conditions. Finally, diet modifications and certain medications used in migraine management may ameliorate or prevent the vestibular component of the migraine.2,3 Interestingly enough, some of the analgesic medications for the pain do not resolve the dizziness and medications for the dizziness often do not resolve the painful headache.
The clinical presentation of vestibular symptoms that often correlate with migraine includesbut is not limited todizziness motion intolerance with respect to head, eyes, and/or body spontaneous vertigo attacks diminished eye focus with photosensitivity sound sensitivity and tinnitus balance loss and ataxia cervicalgia with associated muscle spasms in the upper cervical spine musculature confusion with altered cognition spatial disorientation and anxiety/panic.4
How Do Vestibular Migraines Differ From Classic Migraines
A migraine headache causes moderate to severe pain and tends to recur. The pain often begins on one side of the head and throbs or pulses. You may notice sensitivity to light, sound and odors. You may experience nausea and vomiting.
Some people notice a warning signal or aura before a migraine.
They tend to run in families, but there are other triggers emotional stress, sensitivity to chemicals and preservatives in food, caffeine, and sleep deprivation.
Vestibular migraines mirror many of these symptoms along with dizziness . Dr. Cherian says he looks for the absence of signs of an inner ear problem or other possible sources of dizziness to help make a diagnosis.
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Why Is Tyramine Important
Tyramine is an amino acid that is found in aged foods and foods that have been stored for an extended period . Tyramine is well known as a substance that can easily trigger a migraine, especially when there is a build up in your system. Tyramine builds up in food when it is stored in the fridge or pantry, especially in high protein foods like the leftovers you stored from dinner last night.
It is important to avoid Tyramine as those who experience migraine have a difficult time breaking the chemical down. This will cause your brain to release norepinephrine, and the imbalance between the chemical itself, and norepinephrine will cause neurons to incorrectly fire, causing a headache.
Patient History And Physical Examination
As with any type of dizziness evaluation, the history is the most important means to diagnose migraine-associated vertigo. Patients with migraine-related vestibulopathy typically experience a varied range of dizzy symptoms throughout their life and even within individual attacks. These symptoms may be solitary or may be a combination of vertigo, lightheadedness, and imbalance.
A thorough headache history is also important when evaluating patients for possible migraine-associated vertigo. Many patients with recurrent headaches are unaware that their headaches may be from migraine. Therefore, the examining physician should have a thorough knowledge of the strict diagnostic criteria for migraine diagnosis.
A study by Bruss et al found that in persons with recurrent benign paroxysmal positional vertigo, those with migraine headache and those without did not show a statistically significant difference in the rate at which the majority of migraine-related symptoms in the study occurred. The investigators stated that these results may indicate a link between recurrent benign paroxysmal positional vertigo and migraine and suggested that this form of vertigo may be a manifestation of otologic migraine.
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Tips To Relieve A Migrainous Vertigo Attack
If youve never been hit by a migrainous vertigo attack before, its downright terrifying. Many times patients dont understand what is happening or why and we immediately start to panic. Often the dizziness or vertigo is so severe, we end up in the ER searching for a way to make it stop. In this post well talk about my favorite ways to relieve vestibular migraine dizziness and stay calm during a vertigo attack.
My First Time Traveling With Vestibular Migraine
The first trip we took after I was diagnosed with Vestibular Migrainewas to Las Vegas. Talk about going all in! This was a trip we usually went on annually, but that year was not the best choice. Between the heat, loud noises, and smoky atmosphere, I did not do well. I could have let this bad experience prevent me from trying again, but I refused. The next opportunity I had to travel was to go on a business trip to Florida, but I ended up leaving my company right before and had to cancel the trip. I have a huge connection with Florida because I grew up in Tampa, and every time I go back it still feels like home.
My husband and I decided we would buy our own tickets and go to St Pete Beach. Theres a big, pink hotel I always loved there called the Don Cesar. When I was a child we would sometimes go there to get ice cream and I always thought it was so magical. Since it was a short trip, we decided to go all in and book a room there. It was the first time we were able to have fun together in months. We felt so far away from all the torturous doctors appointments and FMLA fights. It gave me renewed hope that maybe I could live a normal-ish life with vestibular migraine.
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Vestibular Test Results Commonly Observed In Migraine
During video-oculography, a prevalent feature is poor gaze stability with ocular drift, often accompanied by spontaneous up or downbeating directional nystagmus, which does not suppress with fixation-suppression testing added. Unilateral or bilateral gaze induced lateral nystagmus is commonly observed. There may also be a reduced ability to cancel or inhibit the vestibulo-ocular reflex function, used for attaining simultaneous head and eye tracking maneuvers. These results may be due to the fact that the cerebellum, which is responsible for coordinating gaze-fixation functions, is thought to be involved in the vascular and neural changes associated with migraine.
Testing of other cerebellar functions may give normal results, with no postural instability or ataxia/apraxia evident, but postural instability is often evident as well. Smooth pursuit tests often give abnormal results . Thus, it may be that only those neural processes of the cerebellum associated with coordinated eye motions are affected in migraine, and not the neural connections involving postural stability.
Computerized dynamic posturography may give positive results for postural instability, especially when used in combination with head motions for dual tasking and otolithic system involvement. Alterations in balance strategies are commonly measured, and need to be addressed with the specific balance exercises in accord with test measures.
How To Travel With Vestibular Migraine
Traveling with vestibular migraine can be incredibly challenging. Not only are you afraid of easily triggering an episode, but its also scary to not be around all your comforts of home.
Because my chronic vestibular migraine disorder started after a trip around Asia, flying terrified me for a long time. My husband and I loved to travel, and it was always a huge part of our lives before this neurological illness began. We havent had children, and its probably the #1 thing we save up for every year. I decided I could only let this fear hold me back for so long. The worst that could happen was my VM would get more intense, and I would spend the whole trip in bed. The best that could happen was knowing that I could travel again, and continue to live my life as normal as possible.
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What Are Treatment Options And Ways To Lessen The Impact Of Symptoms
If you are affected by vestibular migraine, its important to notice your triggers. In other words, know what experiences or situations seem to come before an attack. Most of them are very similar to migraineweather changes, not enough sleep, stress, menstrual cycle, bright light, flashing lights, missing meals, food-type triggers like caffeine, chocolate or alcohol, says Dr. Beh. Your triggers can be very unique and sometimes difficult to pinpoint, so it is important to keep track of them.
Consider what happens before, during and after a migraine attack. How do you feel? Is there something in particular that seems to come along with your migraine symptoms? Keeping a headache journal is a good way to identify patternsand to share this information with your doctor. Note specific examples of all your symptoms, such as dizzy spells or visual disturbances. Tracking your symptoms, noting possible triggers and discussing treatment options with a doctor can help prevent and relieve vestibular migraine attacks.
Vestibular Migraine Is A Common Cause Of Headaches And Dizziness But It Can Occur Without Pain Discover The Evidence Behind Vestibular Migraine Treatments
When I began to experience the strange sensations that come with Vestibular Migraine, I thought I was losing my mind. Some days I felt as though the car would be moving forward and I had to slam on my brakes, even though it was still in park.
Other days I would have daily background dizziness that made it hard to walk or think clearly. The worst days included a terrifying spinning sensation, and that’s when I knew I needed to pursue a diagnosis.
After seeing 7 different physicians who got it all wrong, I was finally diagnosed with Vestibular Migraine . I sat there in disbelief. How on earth could these symptoms be Migraine?
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Further Information About Vestibular Migraine
Please contact us for further information about vestibular migraine or to chat with a member of our team. Further information about vestibular migraine is also available at vestibularmigraine.co.uk .
If you have found our information helpful, why not become a member. As well as supporting our work, we’ll keep you informed about the latest management/treatment options for vestibular disorders and what research is taking place. Find out more about membership.
If membership isnt for you, please consider making a donation towards our work so we can continue supporting people affected by endolymphatic hydrops and other vestibular disorders, as well as funding vital research into these conditions. Donate Now!
Treatment Options For Vestibular Migraine
Treatment of vestibular migraine is similar to that of other types of migraine, with special focus on standard migraine preventive medications such as amitriptyline, propranolol, candesartan and flunarizine. Flunarizine is not available through the GP but is available from headache clinics and often a preventive of choice in this setting. Greater Occipital Nerve blocks may also be used in this setting.
The acute treatment of the headache attacks is the same as the usually recommended for migraine. This is based on migraine-specific medications, triptans or non-specific such as non-steroidal anti-inflammatory drugs and acetaminophen . Opioids should be avoided. For the vertigo attacks a short course of prochlorperazine may be beneficial as a potential vestibular sedative, and antiemetic medications such as ondansetron and domperidone may also be useful.
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Abortive Medication And Risk
In general, drugs used to abort migraine headaches have not been found effective in treating dizziness secondary to migraine. Reduction of risk factors includes an attempt to avoid certain conditions that can trigger migraine. Elimination of birth control pills or estrogen replacement products may be helpful.
Supplements For Vestibular Migraine
Nutritional supplements are a great option for those looking for a Vestibular Migraine natural treatment. Generally, the supplements given for all types of Migraine, such as riboflavin, magnesium, and ginger, can also be effective for Vestibular Migraine. Magnesium for Migraine is also helpful for VM, specifically Magnesium Glycinate and Magnesium Threonate.
Magnesium Glycinate elevates levels of serotonin, promoting relaxation, cognitive function, and anxiety relief, while Threonate is helpful for memory retention and cognitive impairment. Because this type of Migraine can cause significant brain fog and anxiety over instability, these two supplements could be beneficial.
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Positional Vertigo With Vestibular Migraine
With vestibular migraine, both rotational and non-rotational vertigo can occur with position changes as well. A large survey in 2006 by Neuhauser found that the rate of spontaneous rotatory vertigo is 67% while the rate of positional vertigo is 24%. The research agrees that migrainous vertigo is a lot more common than diagnosed.
What Other Conditions Can Have Vertigo As A Symptom
Vertigo can sometimes be a symptom of other conditions, and so doctors try to rule those things out before diagnosing vestibular migraine, says Mueller. Its worth noting that having one condition that causes vertigo doesnt necessarily exclude the others its possible for a person to have both vestibular migraine and Ménières disease, for example, according to John Hopkins Medicine.
Other conditions that cause vertigo include the following.
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Definitions Of Migraine And Vertigo
Migraine headaches are recurrent headaches that are often accompanied by nausea and light sensitivity and that are separated by symptom-free intervals. The headaches typically have a throbbing quality, are relieved after sleep, and may be accompanied by visual symptoms, dizziness, or vertigo. Patients often have a family history of migraine.
Migraine can be divided into 2 categories: migraine without aura and migraine with aura .
Vertigo is an illusion of movement of the environment or of the patient in relation to the environment.