Vestibular Migraine

Approximately 35% of people who suffer from migraine headaches will have some degree of vestibular association during their lifetime. This type of migraine can cause dizziness, vertigo, imbalance, problems with hearing, nausea, fatigue, anxiety, concentration and other symptoms. Vestibular migraines deeply affect a person\’s day-to-day functioning, their ability to work, their social relationships and definitely their quality of life. (1)

A vestibular migraine is actually a variation of the typical migraine, where instead of a headache being the most predominant feature, the person becomes dizzy. Patients often report that out of absolutely nowhere they get extremely dizzy and don\’t even feel like they\’re even on the ground anymore. Some describe it as a spinning or rocking sensation and others have light or sound sensitivity. Episodes can last minutes or hours.

In many instances people have had a history of migraine headaches before a vestibular migraine shows up. At this time researchers believe that they are an inherited disorder. On MRI imaging the brain looks the same as they would in any individual who suffers from migraine. This means that there is an abnormal firing in the pain pathways. Researchers are still trying to understand the mechanism. This overlap in hyper excitability in the brainstem is what is believed to cause the dizziness.

Migraines are actually more common than asthma and diabetes combined. It affects more women than men and women often began to get their first migraines during adolescence when their hormones kick in. The average onset is anywhere from the midteens to age 40.

Vestibular migraines are not very common but have a female predominance as do typical migraines. However, there has been some significant research which indicates that many men do not seek the care of their primary care physician or any other doctor for the treatment of migraine headaches. There is some belief that vestibular migraines may fall under that category as well.

If you suffer from any symptoms of a vestibular headache it is important to seek the advice and care of your primary care physician to rule out any other underlying medical conditions. The doctors should rule out other causes first in order to determine the right course of treatment which will be the most successful.

Adults will also experience occasional tinnitus, ringing in the ears, but will not experience hearing loss. Children report occasional spells of imbalance but not hearing loss.

Vestibular migraines are usually treated as typical migraine headaches, using anti-inflammatory medications or one of the triptans. Some physicians believe that treating a vestibular migraine can be resistant to common treatment protocols but each headache sufferer will respond to treatment in in their own unique and individual way.

Management is divided into two different categories: symptomatic and preventative. An attempt is made to stop or abort an acute attack with a variety of different medications including Imitrex, Midrin and and Fiorinal. Preventative treatment is usually attempted with Inderal. Individuals who suffer from vestibular symptoms which are associated with the typical migraine and not a vestibular migraine may find the use of channel blockers and amitriptyline useful in preventative treatment.

For most people who suffer from vestibular migraine, vertigo doesn\’t happen at the time of the severe headache. Instead, the typical migraine triggers can lead to vertigo without an actual migraine. The vertigo attack can last anywhere from a few minutes to several days significantly impacting the individual\’s ability to complete daily living activities and go to work.

Thankfully, with the increased research and imaging technologies available, as well as medication for prevention and treatment, many people who suffer from vestibular migraines is are able to live without fear of being stuck somewhere on able to get home. However, it is in a person\’s best interest to wear a medical alert bracelet in order to warn emergency medical personnel as well as law-enforcement agencies of any medical issues which may cause a significant change in your ability to communicate. This helps to ensure that you receive the best treatment possible in the shortest amount of time.

(1) Vestibular Disorders Association: Migraine Associated Vertigo

RESOURCES

Johns Hopkins Medicine: Vestibular Migraine

Therapeutic Advances in Neurological Disorders: Management of Vestibular Migraine

MayoClinic: Dizziness

Headache: Vestibular Migraine

Handbook of Clinical Neurology: Vestibular Migraine