Vestibular Migraine Q& a With Christina Sun
I have had migraines since my teens. The headaches are pretty severe, and I always vomit during them. For a long time these headaches occurred only every few months, and if I went to sleep in a dark, quiet room, Id feel much better after a few hours. Lately Ive noticed that I also get really dizzy and unsteady during my migraines. If I dont hold onto the wall while trying to get to my bedroom to lie down, Ill just fall over. Sleep still helps for the headache, but when I wake up I still feel unsteady, like Im walking around on a soft mattress. This feeling can last for the whole day, and even part of the next day. In between my migraines Ive had a few other similar episodes of dizziness and unsteadiness. These can happen at any time, especially if I move my head quickly.
If dizziness and imbalance are a major part of your migraine attacks, you may be suffering from vestibular migraine.
What is vestibular migraine?
Vestibular migraine is a headache disorder in which typical migraine headaches occur with dizziness, vertigo and/or imbalance.
Other names for VM include migrainous vertigo, migraine-related vestibulopathy, and migraine-related dizziness.
Who gets vestibular migraine?
People who have had migraines for many years may develop VM. It seems to occur more often in women than men. While people with standard migraine have a tendency to have motion sickness, those with VM are even more likely to suffer from motion sickness.
How is vestibular migraine treated?
Vertigo And Other Vestibular Symptoms
Ongoing vertigo is the hallmark of vestibular migraine, but there are multiple types of vertigo that can manifest. These include:
a) spontaneous vertigo, characterized by a false sense of self-motion OR a spinning environmentb) positional vertigo, which stems from shifting of the head to a different positionc) visually-induced or visual vertigo that is triggered by complex moving stimulid) head motion-induced vertigo, which occurs during the actual movement of the heade) head motion-induced dizziness with nausea
Generally, spontaneous rotational vertigo and head motion intolerance were most frequently reported by patients with vestibular migraine attacks.1,3,6 In addition, the average duration of vestibular migraine vertigo is 3 hours and typically lasts longer on so-called headache daysalthough it can occur prior to attacks and during symptom-free periods as well.6 And no matter how it is experienced, it is no fun for a person who has to deal with these problems. Take Jamie for instance who described her vestibular migraine symptoms like this:
“I instantly become dizzy, get tunnel vision, basically cannot see what is in front of me, my cognitive processes slow way down, and I get many other neurological and vestibular symptoms. This has rendered it impossible for me to spend much time in stores at all. As a style blogger, I am invited to events, spend time in airports , and I like to shop . Hence, this makes normally fun activities quite stressful for me.”
My Current Treatment Plan
These days I have been under the care of a great neurologist here in Perth to treat my chronic migraine, I am on several preventative medications to manage my chronic migraine condition as well as getting occipital nerve blocks every 3 months to assist with the muscle contraction. I have gone from having over 15 migraine attacks a month to only having 4-5. I still experience a daily persistent headache, and managing my pain is tricky to ensure I do not go into a rebound headache cycle.
One month ago, I finally received my awaited vestibular migraine diagnosis. According to American Migraine Foundation, vestibular migraine affects up to 3% of the adult population. The diagnosis was finally the validation of my symptoms that I needed for many years. I can now focus on working on a vestibular rehabilitation therapy plan moving forward, something I am very eager to get started.
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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.
How Are Vestibular Migraines Diagnosed
Thereâs no blood or imaging test that can tell for sure. But the International Headache Society and other organizations recently set up the first criteria to help your doctor diagnose the disorder.
You could be having a vestibular migraine if:
- You have migraines or had them in the past.
- You have at least 5 episodes of vertigo that make you feel like you are spinning or moving. This isnât the same as motion sickness or feeling faint.
- These feelings last between 5 minutes to 72 hours.
- Your symptoms are moderate to severe. That means they stop you from doing everyday tasks or theyâre so bad you can’t do anything at all.
- At least half of the episodes happen with one of the following migraine symptoms:
- A headache that has two of these characteristics: is one-sided, pulsing, moderate to severe, or gets worse with activity
- Sensitivity to light or sound
- Seeing shimmering or flashing lights in your vision
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Persistent Postural Perceptual Dizziness
PPPD – formerly known as Chronic Subjective Dizziness – symptoms include non-vertiginous dizziness and unsteadiness that is increased by a persons own motion, exposure to environments with a complex or moving stimuli , and performance of tasks that required precise visual focus . PPPV is NOT a psychiatric disorder, but rather a neuro-otologic condition with behavioral elements.
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.
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The Impact Of Vestibular Migraine
Vestibular migraine affects up to 3% of the adult population and affects up to 5 times more women than men. Most patients have a personal history of migraine headache and/or motion sickness, as well as a family history of migraine or similar episodic vertigo or dizziness.
Dr. Beh describes his typical patient with vestibular migraine as a woman in her late 30s or 40s with a history of migraine and motion sickness. While migraine may improve with age, vestibular symptoms often increase. These symptoms can affect a patients daily life, including their ability to drive, work and travel.
There isnt a cure for vestibular migraine. But with the help of an experienced headache specialist, many patients learn to manage their triggers. That can help them live a normal life.
Vestibular Migraine: The Effects Of Migraine Vertigo And Dizziness
Written by Greg Bullock Scientific promiseFirst published on November 15, 2017 last updated September 8, 2019
Have you ever experienced recurring vertigo as part of a migraine attack? If the answer is frequently yes, you may be dealing with a very specific subtype of the headache disorder known as vestibular migraine. It has also been previously labeled ‘migraine-associated vertigo’ and ‘migrainous vertigo’ in clinical literature, although vestibular migraine more accurately encompasses other symptoms such as nausea, lightheadedness and balance instability. But regardless of how researchers and doctors describe it, vestibular migraine is a very real and often disrupting diagnosis for patients.
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Migraine With Brainstem Aura And Menieres Disease
It should not shock you to learn that vertigo and dizziness is not unique to vestibular migraine, although it is one of the most common underlying conditions that causes it. Migraine with brainstem aura and Menieres disease are two other conditions that present similar symptoms but also have key differences as well.
Migraine with brainstem aura has vertigo as its primary symptom, but it also typically includes ringing in the ears and other auditory issues, speech dysfunction , and double vision. In addition, these symptoms are shorter in duration, between 5-60 minutes, most commonly occur during the aura or pre-attack stage of a migraine, and almost always are followed by headache.
On the other hand, Menieres disease is a disorder of the inner ear that results in vertigo and other vestibular symptoms such as nausea and vomiting. Tinnitus, hearing loss, and congestion of the ear are also common for this condition and key signs for diagnosis. One of the main diagnostic impediments for medical professionals is that Menieres disease can present with headache in as many as 40% of patients, meaning they often have to look for other migraine-related indicators during examination.
Labyrinthitis And Vestibular Neuritis
Labyrinthitis and vestibular neuritis are disorders resulting from an infection that inflames the inner ear or the vestibulo-cochlear nerve , which connects the inner ear to the brain. Neuritis affects the vestibular branch of the vestibulo-cochlear nerve, resulting in dizziness or vertigo but no change in hearing. Labyrinthitis occurs when an infection affects both branches of the nerve, resulting in hearing changes as well as dizziness or vertigo.
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Superior Semicircular Canal Dehiscence
Superior semicircular canal dehiscence syndrome results from an opening in the bone overlying the superior semicircular canal within the inner ear. With this dehiscence, the fluid in the membranous superior canal can be displaced by sound and pressure stimuli, creating certain vestibular and/or auditory signs and symptoms.
What It’s Like To Have Chronic Vestibular Migraines
I have a chronic illness that not many people know about, or that some doctors dont accept as an actual medical condition. I have what is called chronic vestibular migraine, and when people see the term migraine they associate it with a painful headache. However, vestibular migraine is a unique kind of migraine whose main symptom is not pain, but instead dizziness/vertigo.
If people were more observant, they would realize that when I walk, I cant walk in a straight line, or that when I stand I never stand with my feet together, or else I will fall over. These are the only physical side effects of vestibular migraine that I show, but most of its effects happen internally. Vestibular migraine affects people in many different ways. Some people may have it for a duration of minutes, hours or days. The duration of my vestibular migraine is a little wonky. The easiest way of explaining it is that one week I have a vestibular migraine and then the next week I wont have it, and then the cycle repeats itself over and over again. So essentially, two weeks out of the month I would have a vestibular migraine, while the other two weeks I dont have a vestibular migraine.
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How Are They Treated
Thereâs no specific medication for vestibular migraines. Your doctor will prescribe different drugs to stop an attack when it happens. This is called abortive therapy.
- Triptans. Take these migraine meds at the first sign of headache symptoms.
- Vestibular suppressant. It can ease your dizziness and motion sensitivity. This type of drug works on the balance center in your inner ear. Your doctor might prescribe benzodiazepines like lorazepam , anti-nausea drugs like promethazine and antihistamines like meclizine.
- If you have frequent or disabling vestibular migraines, your doctor may try drugs similar to traditional migraine prevention meds. You take these regularly to reduce the severity or frequency of the headaches. These include seizure medicines, blood pressure medicines , and some antidepressants. CGRP inhibitors are a new class of preventive medicine that your doctor may recommend if other medicines donât help.
If you have frequent or disabling vestibular migraines, your doctor may try drugs similar to traditional migraine meds. They include:
Articles On Migraine Types
There are many names for this type of problem. Your doctor might also call it:
- Migraine-associated vertigo
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What Does A Vestibular Migraine Feel Like
People’s experiences of vertigo vary, says Mueller. They can report feeling like they are walking on air, light-headedness, spinning, or feeling off-balance, like they are pulling to the right or the left, she says.
Some people with vestibular migraine can experience vertigo as a to-and-fro sensation, according to a review published in 2021 in StatPearls.
The vertigo may or may not come with a headache often a vestibular migraine attack doesnt include head pain, according to the American Migraine Foundation.
Less-common symptoms include brain fog, fatigue, dry mouth, sweating, diarrhea, excessive yawning, tingling, scalp tenderness, and visual blurring.
Persistent Perceptual Postural Dizziness
PPPD is common and can occur with migraine, says Mueller. Its a chronic dysfunction of the vestibular system that makes people feel dizzy or unsteady all the time, according to a review published in Practical Neurology in December 2017.
People may have a vertigo episode or a vestibular migraine attack, and then something happens that makes them feel that perception of dizziness all the time it never really goes away. Its mild, but its always there, says Mueller.
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Nonmedical Treatment Options For Vm
VR is a therapeutic approach to treat dizziness and balance dysfunction and is based on central mechanisms of neuroplasticity, which includes adaptation, habituation, and substitution that facilitate vestibular compensation. Because of the availability, VR treatment should be considered for all VM patients.
Researchers arent certain what causes VMs, but some believe that the abnormal release of chemicals in the brain plays an important role. Some of the same factors that trigger other kinds of migraines can also trigger a VM, including stress, lack of sleep, dehydration, weather changes, or changes in barometric pressure, menstruation. Meanwhile, certain foods and drinks can trigger a VM attack as well. These foods and drinks include chocolate, red wine, aged cheeses, monosodium glutamate, processed meats, coffee, and sodas with caffeine. Therefore, some researchers propose that it is of great significance to establish regular sleep patterns, stress reduction, a migraine diet , and eliminate caffeine or habitual analgesic use.
Epidemiology Of Vestibular Migraine
VM is more prevalent than other vestibular disorders and its prevalence is different in the various study population and clinical context. Stolte et al. in a population-based study found that the lifetime prevalence of migraine and vertigo was approximately 16% and 7%, respectively in Western industrial nations taking Germany as a representative. Neuhauser et al. performed similar research and found that a 1-year prevalence was 0.9% and the lifetime prevalence was 1%. Meanwhile, many people, young or old, might suffer from VM in any period of life. However, it has been proved that women are to a greater extent subjected to VM compared with men, and the female-to-male predominance is about 5:1, with a mean age of onset of 37.7 years for women and 42.4 years for men. Familial occurrence has been reported in some patients with an autosomal dominant pattern of inheritance and decreased penetrance in men.
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Lets Talk About My Symptoms
The worstsymptom for me was that I felt too much motion every time I moved. That soundslike no big deal but I cant begin to explain how terrible it feels. Walkingfelt like whirling and the ground felt unsteady below me, like walking on aboat or on a floor made of marshmallows. It was so uncomfortable I mostlystayed as still as possible but, even that didnt relieve my dizziness. Whilesitting perfectly still, I had the feeling I was rocking and swaying. Whilestanding perfectly still Id suddenly feel a dropping sensation. You know thefeeling you sometimes get right as youre falling asleep where you feel likeyoure falling? Thats the dropping sensation that would continually come outof nowhere.
Have you ever been sitting in a row of buses and one bus begins to move and for a moment your brain cannot distinguish if your bus is moving or if its the bus next to you? I was in that constant state of confusion when I moved and when I saw something moving. My brain couldnt determine if I was moving or if it was the object I was looking at. Feeling like I was moving while I was sitting still made me have to constantly react and have to brace myself from falling when it wasnt really happening at all. I had difficulty focusing on and visually tracking objects and had increased dizziness from seeing moving objects like ceiling fans, trees swaying, water rippling, computer scrolling and tv screens. Moving objects appeared to have a stop start, glitchy, robotic motion.