What Are The Symptoms
Vestibular migraines donât always cause headaches. The main symptom is dizziness that comes and goes. Vestibular refers to the inner ear, which controls your hearing and balance. If youâre having a vestibular migraine, you may feel:
- Dizziness that lasts more than a few minutes
- Extreme motion sensitivity — feeling sick or dizzy when you move your head, eyes, or body
- Feeling disoriented or confused
- Feeling unsteady, like youâre in a rocking boat
- Sensitivity to sound
You could get dizzy and have balance problems without having a migraine at all. Other times, the vertigo symptoms happen before, during, or after the headache. Sometimes, you might have migraines for years before the vertigo symptoms begin.
Pharmacologic And Other Therapies
Because most patients equate migraine with headache exclusively, convincing them that symptoms other than headache are due to migraine may be difficult. Dizziness secondary to migraine usually responds to the same treatment used for migraine headaches.
The 3 broad classes of migraine headache treatment include reduction of risk factors, abortive medications, and prophylactic medical therapy. Vestibular rehabilitation therapy may be of benefit in patients with movement-associated disequilibrium.
Migraine and vestibular disease can coexist. Patients who meet the clinical criteria for Ménière disease should be treated appropriately for Ménière disease, even if a history of migraine headache exists.
Living With Vestibular Migraine
Many people may find that lying down in a dark room or sleeping can help reduce migraine symptoms.
Taking over-the-counter pain or nausea-relief medication at the first sign of symptoms may also reduce the severity of the symptoms.
People who have vestibular migraine may experience periods in life with fewer occurrences, and other periods when there are more.
When symptoms happen with high frequency, it can impact a persons ability to live their day-to-day life. This may include a negative impact on a persons career, education, and relationships with family and friends.
Living with the condition can be isolating and discouraging. In addition to exploring treatments, looking for support from peers with the condition may also help.
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Finding The Right Treatment
I didnt have a good experience with my GP at first they just tried me on one drug after another that made no difference at all. They prescribed me antidepressants but these affected my head and I couldnt focus, and all they wanted to do was try me on a higher dose. Fortunately, I had a better experience with another doctor at a specialist ear, nose and throat centre in Brighton and finally found medication that helps me manage my symptoms.
I take a preventive called pizotifen everyday which has made a huge difference. While it hasnt completely stopped my bouts of migraine attacks, it has made them less frequent and less severe, although weight gain is a downside of it. I also take sumatriptan when I feel an attack coming on, but it doesnt always work which can be very frustrating.
While living with vestibular migraine is very challenging, something I would say to others is that finding the right medication can make a big difference so dont give up. Finding an effective preventive has helped me a great deal.
Nausea And Related Symptoms
Between 30%-80% of those with persistent migraine vertigo get the nasty side effects that come with those sensations, notably:1,6
- Motion sickness
Is is unclear if these are the result of experiencing vestibular disorientation or if they are a complication of migraine, but it does not make them any less unpleasant. Curiously, motion sickness has separately been identified as one of the two biggest precursors to the onset or diagnosis of vestibular migrainethe other being the prior existence of migraine attacks and/or a family history of headache disorders.2,5
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How Is Vestibular Migraine Treated
Migraine in general has been shown to be closely related to anxiety and depression and the most common cause is stress! Most patients have one or more specific triggers and treatment therefore centres on identifying and managing these triggers in individual patients.
The top 5 most common triggers for vestibular migraine are
Other external triggers can include certain forms of lighting and ventilation, weather changes, smoking and strong odours.
Initial treatment is education, with the systematic identification of trigger factors with a symptom diary. Regulation of lifestyle is often the key, but the good news is that simple lifestyle and dietary changes have been shown to help in 80-90% of patients! Medication is only needed in a minimal number of patients.
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!
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Vestibular Migraine: Progress In The Search For Treatments
- By William Renthal, MD, PhD, Contributor
Nearly 15% of the worlds population has migraine, a condition in which moderate-to-severe headache is associated with neurological abnormalities such as visual dysfunction, sensitivity to light, disordered speech, nausea, vomiting, or dizziness. While we now have many options to treat the head pain associated with migraine, we are often helpless in treating these other associated neurological symptoms.
One of the most bothersome neurological symptoms patients report is vertigo or dizziness-associated with migraine, a condition we call vestibular migraine, and in which patients feel as though they, or the environment around them, is spinning. At present, we have no adequate treatment for vestibular migraine.
How Is Vestibular Migraine Diagnosed
Vestibular migraine is a highly under-diagnosed condition with most medical professionals unfamiliar with this term. In some reports, as little as only 10% of vestibular migraine sufferers are actually properly diagnosed with this disorder.
One reason is that the headaches associated with migraine associated vertigo dont always accompany the dizziness. In fact, the headache portion of migraines usually occur first, sometimes even years before the vertigo symptoms begin. On average this difference is somewhere between 8-14 years.
Diagnosis of vestibular migraine is achieved through a careful review of a patients history, of their current symptoms and patterns and of ruling out of other causes for their episodes. Though a head scan such as an MRI or CT scan has a partial ability to show the lesions associated with general migraines, at this point these types of scans are not useful for diagnosing vestibular migraines.
Specific vestibular testing such as caloric tests and VEMPs can highlight problems with vestibular function, but generally cannot be used to specifically identify a vestibular migraine.
A diagnosis of vestibular migraine must involve the ALL of following:
1) A migraine history with or without migraine aura.
2) A minimum of 5 significant dizziness attacks that last for 5 min 72 hours.
3) At least half of the dizziness episodes must include one of the following:
- Migraine headaches that have a minimum of two of the following:
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Pearls And Other Issues
A vestibular migraine is an elusive diagnosis with variable presentation and without pathognomonic testing despite significant associated morbidity.
Familiarity with recently accepted Barany Society and the International Headache Society diagnostic criteria is important to make a diagnosis. See below:
- At least 5 episodes of vestibular symptoms of moderate or severe intensity lasting 5 minutes to 72 hours
- Current or previous history of migraine with or without aura according to the ICHD classification
- One or more migraine features with at least 50% of vestibular episodes: headache with at least 2 of the following characteristics: one-sided location, pulsating quality, moderate or severe pain intensity, or aggravation by routine physical activity photophobia or phonophobia visual aura
- Not better accounted for by another vestibular or ICHD diagnosis
Vestibular migraine can present at any age, although middle-aged women are most commonly affected.
One theory exists that a vestibular migraine may be caused by vestibular end-organ disease therefore, regular patient monitoring is merited to evaluate for possible contributing morbidity.
A vestibular migraine may be associated with other illnesses such as Meniere syndrome or BPPV. The verdict is currently out regarding the chronology of events/triggers. Do Meniere attacks trigger a vestibular migraine, or does a vestibular migraine give rise to Meniere syndrome features?
The Impact On My Life
Before I was prescribed effective medication, the impact of my migraine on my life was enormous. I had regular periods of migraine which lasted around a week.
During the first few days of an attack I was hardly able to get out of bed and, since I live alone, this meant I couldnt get food or look after myself. Even now I get occasional bouts when my life goes on hold. If I get a really bad attack, I feel terrible at the start and then it gradually improves over anything up to 10 days.
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Vestibular Migraine Treatment Near Me
Its commonly asked who treats vestibular migraines. The best outcomes involve a team approach in the management of this condition, including vestibular physiotherapists, neurologists, otolaryngologists, and family physicians among other healthcare professionals.
Cornerstone Physiotherapy has clinicians who are experienced in treating vestibular migraine at our clinics located in Toronto, North York, Burlington and Markham. We offer free phone consults if youre unsure that your condition is appropriate for our physiotherapists. Contact us today to learn more or to book an appointment.
What Causes Vestibular Migraines
Migraines are one of the most common medical issues in the United States. However, theres still a lot of confusion and misinformation surrounding migraines. For example, did you know that theres a type of migraine that often does not involve a headache at all? What causes vestibular migraines, and what can you do about them?
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Why Your Mental Health Matters With Migraine And Headaches
Missed days at work. So fatigued youre in bed all day. Blinded by the dimmest of lights. Is it any wonder that those battling chronic headaches also experience a blow to their mental health?
About 20% of people who experience migraine on 14 days or fewer each month may have depression and/or anxiety, according to the American Migraine Foundation. For people who experience migraine more days a month , depression and/or anxiety is even higher between 30% and 50% for anxiety.12 The same inherited brain chemistry that causes migraine may also be involved in anxiety and depression. Depression increases headaches, and headaches increase depression, so they both must be treated.
For some, depression and anxiety may appear months or years after living with the often-debilitating pain of migraine and headaches. It is not uncommon for migraineurs to say they spend several days a month in bed because of their migraine or headache attacks. For others, depression and anxiety, just like migraine, may run in the family.12
If you find yourself lying in bed day after day, even after your migraine or headache passes, you may be experiencing a residual mental health issue. Talk to your doctor or headache clinic about a referral to a psychologist for talk therapy and home-based strategies.
PPM recently held a video chat House Call on migraine and mental health. Check it out to get some common questions answered as well as a few self-help tips.
Vestibular Migraines / Migraine
You have been living with unbearable symptoms of dizziness, nausea and blurred vision for too long. When episodes hit, the dizziness is bad, and you might feel like everything around you is spinning, and that the ground is going to move out from under you. Each time you open your eyes you feel sick and off-balance. This feeling might last for several minutes or it could last for days. You might even get headaches. Youve been told these symptoms might be due to a nervous system issue called Vestibular Migraine or Migraine-Associated Vertigo.
You have tried everything to treat this condition from medications and changing your diet, to getting enough sleep, eliminating caffeine, exercising regularly, even learning how to manage your stress better. But no matter how much you try, your symptoms are still severe, and episodes keep occurring.
For those of you who have been wondering if there is something more that can be done, there is hope. You might not have vestibular migraines, but instead have a condition related to your eyes.
Since only 1 percent of the U.S. population has vestibular migraines / migraine-associated vertigo, it is quite possible that your symptoms could be due to a much more common condition called Binocular Vision Dysfunction , which impacts 10%-20% of the population.
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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.
Migraine And Headache Causes
Migraine and tension headaches usually have a genetic link just as some inherit asthma or another illness, you likely inherited a tendency to get these headaches from your family. Once inherited, several factors can trigger an attack.
The top FOUR migraine triggers are:
Less common migraine triggers are alcohol and MSG.
Tension Headache Common Triggers
Cluster Headache Common Triggers
Unlike migraine and tension headaches, cluster headaches tend to occur because of abnormalities in a region of the brain that connects the nervous system to the endocrine system . Once a person has clusters, alcohol or MSG may trigger an attack.
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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.
What Does A Vestibular Migraine Feel Like
Migraine is one of the most crippling chronic conditions for a reason. They bring about harsh headaches and neurological symptoms that can be unbearable to migraineurs. However, the experience can get even worse if you have vestibular migraines. To give you a clue what a vestibular migraine feels like, imagine dealing with a bout of migraine while having a vertigo attack at the same time. You definitely wouldnt wish vestibular migraines on anyone.
Also known as sick headaches, classic migraines can cause these symptoms:
- Unilateral head pain
- Pounding or throbbing headache
- Sensitivity to sound, light, or odors
- Nausea and vomiting
- Pain that disrupts a persons productivity
- Aura: sensory disturbances such as blind spots, flashing lights, vision changes, or tingling in the face or hand
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Triggers Of Vestibular Migraines
Migraines and vestibular conditions share a couple of similarities. Both can come about due to environmental or food triggers. Factors such as weather changes and hormonal imbalance also play a role in their progression. Heres a list of known triggers of vestibular migraines:
- Sleep disturbances
- Low blood sugar
- Changes in barometric pressure
- Aged cheeses parmesan, cheddar, feta, stilton, gouda, bleu
- Cured or processed meat hot dog, sausage, salami, ham, pepperoni, bacon
- Yogurt, sour cream, buttermilk
- Peanut butter and other nuts
- Peapods and broad beans
- Doughnuts, fresh bread, raised coffee cake
- Monosodium glutamate
- Some fruit avocado, banana, figs, papaya, red plums, citrus, passion fruit
- Alcohol gin, Scotch, bourbon, red wine, port, sherry
- Too much coffee, cola, or tea
A smart method to find out whether you have other migraines or vestibular migraines is to maintain a migraine diary. In this way, you can take note of your symptoms and other essential migraine factors, such as your feelings, the weather, and your activities before the attack. Doing so can reveal the patterns developing and help you prevent your triggers and potential future attacks.
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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