Could My Vestibular Migraine Be Something Else
Vestibular migraines have symptoms that overlap with other medical conditions. In fact, at least 20% of vestibular migraine cases are misdiagnosed. A condition called Menieres disease causes dizziness. This disease, however, will often be accompanied by a stuffed ear sensation or ear ringing.;Referral to an ENT doctor to evaluate for inner ear disorders should always be part of the evaluation plan, along with possible neuroimaging with brain MRI or CT, and possibly some blood work.;A brainstem stroke can also cause dizziness before more severe symptoms set in. MRIs and other medical tests can help rule conditions like these out. Therefore, vestibular migraine should always be a diagnosis of exclusion, meaning it can be considered only after other causes of dizziness and vertigo have been tested for and ruled out.
How Do I Know If I Have A Vestibular Migraine
To make a reasonable diagnosis of vestibular migraine requires a conversation with your doctor to review your medical history. However, a positive diagnosis is likely if you have at least five episodes of moderate to severe symptoms lasting between five minutes and 72 hours, and at least half of your episodes include at least one of the following three features:
- Headache with at least two of the following four characteristics: unilateral location, pulsating quality, moderate or severe intensity, and/or aggravation by routine physical activity
- Fear of or sensitivity to light and sound
- Visual aura
What Diets Didn’t Work
Originally I tried to do Whole30 thinking it was a great way to find food sensitivities and eat healthier. But Whole30 isn’t really meant for someone with a specific chronic illness, like migraine. What I didn’t realize is that most nuts were a huge trigger for me, and I only found this through doing Heal Your Headache. So with Whole30 or even Paleo, I was constantly eating nuts and drinking nut milks thinking I was helping myself.;
I also tried to go dairy and gluten free for about 4-6 months to see if it had any effect on my migraine symptoms. I had been tested multiple times for sensitivities to these, especially with my previous gut issues, and nothing was ever found. However, I saw a functional doctor for a short period who encouraged this so I gave it a try. I think this works much better for those with known sensitivities or allergies, but it’s also possible to improve without going gluten and dairy free. I’m complete proof of that.;
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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!
Current And Emerging Treatments
Patients who suffer from recurrent migraine episodes may need to be provided with a treatment strategy that includes preventative care as well as a plan for abortive therapy. Neurologists generally use the same 2-pronged approach when taking care of patients who experience recurrent vestibular migraines. When patients have frequent, unpredictable, or disabling symptoms, prevention is certainly an important consideration.
Prevention remains key, and I find antiepileptic drugs or venlafaxine to be most effective, Watson said. If the vestibular symptoms are part of migraine, the prognosis is pretty good. However, not all preventative medications are accessible for each patient, and some treatments that are FDA-approved for migraine prophylaxis are not approved for vestibular migraine, making payer authorization for off-label use in vestibular migraine another impediment.
I generally treat patients who have vestibular migraine prophylactically just like I do regular migraine patients, and it depends what their insurance will approve. Options for prophylaxis include amitriptyline, propranolol, and topiramate. My preferencebut often not approved up-front by insurancewould be 1 of the 3 anticalcitonin gene-related peptide injectables: erenumab , fremanezumab , or galcanezumab , Rebovich said. Other treatments used for prevention of vestibular migraine include flunarizine and cinnarizine, AEDs , beta blockers , antidepressants , and magnesium and clonazepam.4
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A New Look At Studies On Benign Recurrent Vertigo
The term vestibular Menière was not included in the second revision of the American Academy of Otolaryngology Head and Neck Surgery Committee on Hearing and Equilibrium criteria for Menières disease and the differential diagnosis of vestibular migraine was not discussed in their document . The terms vestibular Menières, recurrent vestibular vertigo and benign recurrent vertigo are used interchangeably. Recent studies show that benign recurrent vertigo is very strongly associated with migraine and usually does not evolve to become Menières disease and so many of these cases might now be considered to be vestibular migraine.
Controlled studies have extensively investigated betahistine, a histamine analogue, and flunarizine, a calcium antagonist, to treat recurrent vertigo and shown them to be efficient . The observations on flunarizine are consistent with those for vestibular migraine, whereas betahistine is still considered a classical drug for Menières disease, but it might also relieve the vestibular symptoms of migraine.
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?
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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.
The Vestibular Migraine Treatment Plan That Got My Life Back
Is it possible to recover from vestibular migraine? This is a question I get often and one Ive asked to my neurologist many times. The answer is yes, its completely possible to be free of dizziness and feel 100% on most days. I’m total proof this can happen with an effective vestibular migraine treatment plan.;
While it did take me about two to three years to completely have dizzy-free days, now it’s more common for me to not have any symptoms. Is this remission? It’s tough to say as I think remission looks different for everyone. But any dizzy days are so much more manageable now and this is even after going through infertility and IVF treatments. My goal with this post is not to say this is exactly what you should be doing, but to provide some hope that finding the right doctorand getting on the right plan can make all the difference when battling a migraine or vestibular disorder. I also want to manage expectations that these treatments take time to work, and it’s definitely not a quick fix.;
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Cut Out The Environmental Poison
We have to understand that our environment and its rapid change in the past 100 years has huge effects on our bodies, brains and health.
One of these changes is the huge influx of chemicals that we have never before been exposed to in our millions of years of evolution.
This has created many issues. One of them is multiple chemical sensitivity.
Among the population, 12.8% report medically diagnosed MCS and 25.9% report chemical sensitivity. Of those with MCS, 86.2% experience health problems, such as migraine headaches, when exposed to fragranced consumer products; 71.0% are asthmatic; 70.3% cannot access places that use fragranced products such as air fresheners; and 60.7% lost workdays or a job in the past year due to fragranced products in the workplace.
This is huge and vestibular migraines are not exempt.
We have to reduce the load our bodies are taking because of the different chemicals in our environments.
This means we need to:
- Switch hygiene products to natural sources
- Change makeup brands to find non toxic and chemical free, tested products
- Avoid any plastic, rubber or petroleum products
- Avoid plastic wrapping, plastic bags, plastic containers for food
- Switch our cookware to things like titanium or cast iron instead of aluminum, teflon or non stick
- Eat pesticide, herbicide, insecticide, antibiotic, hormone and cruelty free foods
- Wear organic clothing that as synthetics dont breath and are made of synthetics
- Use more natural cleaning and laundry supplies
What Are My Treatment Options
Medications may be prescribed to prevent episodes if avoiding triggers does not help control symptoms. Preventative mediations can include a beta-blocker , calcium channel blocker , antidepressant , and/or an anticonvulsant . Treatment with an antidepressant or anticonvulsant does not mean you have depression or seizures; they are intended to stabilize the central nervous system and raise the threshold at which attacks are triggered. Medication regimens may be tailored to your existing medical conditions. Once symptoms are controlled, medications may be weaned off and do not necessarily need to be taken forever.
Vestibular rehabilitation is a type of physical therapy that may also be recommended to treat chronic balance dysfunction. Vestibular therapy will train your brain to desensitize itself to common sensory triggers. The course of therapy is often gradually increased in its intensity and can be widely varied to combat multiple types of triggers that include movement, visual perceptions, and posture instability.
Treatment to help stop a vestibular migraine attack once it begins includes rest, observation, hydration, and medications such as anti-nausea, antihistamine, or sedatives if needed. However, the most effective way to treat vestibular migraine is preventing an attack as described above, and it is critical to recognize your triggers. Many cases can be treated with trigger avoidance alone.
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Caffeine And Vestibular Migraine
Interestingly, this same study also tested the effect of caffeine intake on Vestibular Migraine and unexplained dizziness. It found a 14% reduction in vestibular symptoms for those who completely quit caffeine, but 46% of patients found a reduction in dizziness with nortriptyline therapy.
This shows that eliminating caffeine can be a helpful addition, but medication provides the greatest reduction in symptoms of headache and dizziness.
Falling in between caffeine cessation and nortriptyline in terms of efficacy was treatment with topiramate , which resulted in a 25% reduction of dizziness.
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.
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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.
Deterrence And Patient Education
Convincing a patient of the diagnosis of a vestibular migraine can prove difficult and lead to delay in treatment or absence of treatment. This is understandable based on the fact that vertiginous symptoms are often asynchronous with a headache and may be a difficult connection for the practitioner or patient to grasp.;Medication adherence and close follow-up should be encouraged.
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Amys Story: What Its Like Living With Vestibular Migraines
November 21, 2019 by micheleweinstein
From Michele: Migraines. Have you ever had one? If you havent, they are extremely excruciating . The migraine research foundation claims that migraines are the 6th most disabling disease in the world. And there are countless of other statistics that we could share, but what we think is most important is hearing from those who struggle with migraines. Hearing their perspective. So read Amys story below on what its really like to deal with vestibular migraines. If you want, you can connect with her and PLEASE pin some of these statistics to raise awareness.
I was finally diagnosed with vestibular migraines in August this year after suffering with symptoms for over a year! Id suffered migraines since 2011-2012. It had taken that long to be seen by a neurologist that Id already figured out my own diagnosis! I was so happy when the neurologist said its vestibular migraines & refractory migraines as I knew I wasnt going mad!;
I had to stop work in July this year due to my symptoms becoming increasingly worse Im a cancer research nurse. During the last 4 months my vestibular symptoms have got increasingly worse I spend each day on the sofa or in bed.;
Every day since the end of July 2019 Ive suffered from vestibular migraines.
What Is A Vestibular Migraine
Migraine can affect the vestibular system of the inner ear, which impacts the way the brain controls balance and the way a person experiences the space around them. When this system does not work properly, a person may experience feelings of vertigo, unsteadiness, or dizziness that can be triggered by movement.
A doctor may think a person has vestibular migraine when the person experiences these kinds of symptoms for minutes or hours.
A person with vestibular migraine may also have a history of migraine headaches. About 40% of people who suffer from migraine headaches also have vestibular symptoms. However, a person can also experience vestibular migraine without headaches.
Vestibular migraine can cause a feeling that the ground is moving or falling, or cause problems coordinating movement. It can also impact the senses and distort hearing.
Other than a headache, symptoms can include:
- sensitivity to light, sound, or smell
- nausea or vomiting
- discomfort turning, bending down, or looking up
- feeling of pressure in the head or the ear
- ringing in the ears, known as tinnitus
- partial or complete loss of vision
- visual disturbances, such as flashing lights, spots, or blurring
These symptoms can vary in severity. There may be warning signs that vestibular symptoms are about to happen. A person may see flashing lights or other visual disturbances, a phenomenon also known as an aura.
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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?