Key takeaways:
- Vestibular migraine is a neurological condition that causes dizziness, vertigo, and balance problems, accompanied by migraine headaches.
- Symptoms include vertigo, nausea, vomiting, sensitivity to light, sound, or motion, throbbing headache on one side, balance issues, and fatigue.
- Diagnosis requires vertigo episodes in the past, a history of migraine, and dizziness, confirmed through neurological examinations and imaging if necessary.
- Lifestyle modification by getting enough sleep, exercising, reducing stress, and avoiding triggers is important for minimizing the frequency of episodes.
- Long-term care varies from person to person; some need constant medication, while others improve with lifestyle changes alone.
What is vestibular migraine?
Headaches accompanied by additional symptoms, such as nausea, vomiting, or sensitivity to light, sound, or movement, are classified as migraines. Typically, people prefer to rest in a quiet, dark room until their symptoms subside. Sometimes, migraines are followed by an Aura, which can be a Visual Aura, such as patterns, lines, dots, or flashes of bright lights, or a Sensory Aura, involving tingling or numbness.
Migraine can trigger dizziness and a sensation of spinning or movement of you or the surrounding environment, also known as vertigo. Up to 40% of migraine sufferers experience spinning or balance problems during their migraines. This neurological condition is called Vestibular Migraine (VM), or migraine-associated vertigo (VAM), migraine-related vestibulopathy, or migrainous vertigo. Vestibular refers to the inner ear, which is responsible for hearing and balance. Therefore, migraine with balance issues and dizziness is named vestibular migraine.
While headaches and vertigo often happen together, not every vertigo attack is connected to a migraine headache, which makes diagnosis more difficult.
How common is vestibular migraine?
It is estimated that about 2.7% of people in the United States experience symptoms of vestibular migraine. Research suggests that many people being treated for dizziness and balance problems may actually have vestibular migraines.
What are the concerning symptoms of vestibular migraine?
The most common symptoms include balance issues and feeling lightheaded. However, it may also present other symptoms that could cause concern. Here are a few:
- Nausea and vomiting
- Sensitivity to light, sound, and smell
- Severe throbbing headache, typically on one side of the head.
- ‘Dizziness lasting minutes to hours, or sometimes days
- Sensitivity to motion
- Unsteadiness and balance loss
- Sensitivity to visual stimuli and movement
- Sweating or panic
- Fatigue or tiredness
- Feeling of pins and needles or numbness in the face.
Some people may also experience:
- Tinnitus (sounds such as ringing or buzzing in one or both ears)
- Fullness or pressure in the ears
- Hearing loss (might be confused with Meniere’s Disease, a chronic inner disorder that leads to vertigo and hearing loss.)
If you experience any of these symptoms or a combination of them, consult your doctor immediately.
What's causing your dizzy head?
Some common causes of vestibular migraine may include:
- History of migraine, such as childhood migraine
- Stress
- Lack of sleep or fatigue
- History of migraine in family
- Serotonin imbalance
- Hormonal imbalance may be because of menopause or periods
- Quick movements of the head or the body
- Being in a crowded or confusing place
- Body to experience weather changes
- Certain foods or liquids (such as chocolate, aged cheese, or red wine)
It has been noted that various factors can cause vestibular migraines. However, it is recommended to understand your personal triggers and consult your doctor for optimal care.
How will your doctor diagnose vestibular migraine?
It is recommended to see a General physician, neurologist, neuro-otologist, or ENT specialist for the diagnosis of vestibular migraine. Your doctor may ask about your symptoms, especially dizziness and balance issues. They will then rule out other possible causes related to dizziness or balance and focus on vestibular migraine as the primary cause. According to the classification of ICHD-3, the diagnosis of vestibular migraine requires:
- A minimum of five episodes
- A history of migraine, whether present or past
- Vestibular symptoms (vertigo or dizziness) lasting from five minutes to 72 hours
- Migraine headache or other migraine-related symptoms in at least half of the episodes.
- Sudden attacks of vertigo that make you vomit or feel nauseous.
- Severe vertigo that interferes with your ability to work or handle everyday tasks
- Migraine Aura
If your healthcare provider suspects vestibular migraine, they might perform the following tests:
- Neurological examination.
- Videonstagmography or electronystagmography
- Imaging tests such as computed tomography (CT) scans or brain magnetic resonance imaging (MRI) scans.
- Hearing loss test.
What is the treatment plan to follow?
Your doctor might advise the following as treatment for vestibular migraine:
1. Medications
Your doctor might suggest daily or weekly medications to lower your risk of a vestibular migraine. They may also recommend medication to relieve migraine symptoms when you experience one. Medicines that may prevent vestibular migraine include tricyclic antidepressants, calcium channel blockers, antiseizure medications, or Beta-blockers.
Medications used to reduce symptoms of vestibular migraine include NSAIDs, Triptans, motion-sickness drugs, and antipsychotics (used in treatment-resistant or chronic cases).
2. Lifestyle changes
Your doctor might suggest some lifestyle changes. These could include getting more rest, setting regular meal and snack times, and avoiding certain foods and drinks that may trigger your migraine. If you have vestibular migraines, your doctor will discuss lifestyle adjustments, such as adding exercise and managing stress effectively.
3. Vestibular rehabilitation therapy
Vestibular rehabilitation therapy includes exercises designed to help manage dizziness and balance problems. This therapy can help individuals manage symptoms associated with conditions such as vertigo and labyrinthitis.
4. Natural remedies
Your doctor may recommend starting certain supplements that can interact with other medications and enhance your overall well-being. Commonly suggested supplements include magnesium, Vitamin B2 (Riboflavin), and Coenzyme Q10 (CoQ10) for the prevention of symptoms, and ginger to treat the symptoms of an acute vestibular migraine attack, such as pain, nausea, and vomiting.
Living with vestibular migraine
Consult your doctor if you often experience dizziness or balance issues that interfere with your daily activities, especially if you suffer from migraines. If diagnosed with vestibular migraines, seek medical advice if dizziness worsens or occurs more frequently, if sensitivity to light and sound increases, or if headaches become more severe. It is also important to identify your triggers so you can avoid them for a better daily routine. It is recommended to get adequate sleep, eat a balanced diet, and exercise regularly.
Conclusion
Vestibular migraine is a complex but treatable condition that involves both the brain and inner ear, causing vertigo, dizziness, and migraine headache. With a combination of drugs, lifestyle modifications, and vestibular rehabilitation therapy, the majority of individuals are able to decrease the severity and frequency of attacks effectively. If you frequently suffer from dizziness or balance disorders caused by migraine, speak with your doctor to receive an appropriate diagnosis and a personalized treatment strategy. By taking matters into your own hands today, you can lead a healthier, more balanced life despite vestibular migraine.
Frequently asked questions
Does pregnancy increase my risk of vestibular migraine?
You might find relief from vestibular migraines during pregnancy, especially if you have experienced menstrual migraines or migraines without aura. However, some symptoms may stay the same or even worsen, particularly if you had migraines with aura. Symptoms can improve due to increased estrogen and endorphin levels during pregnancy. Still, you could experience a postpartum recurrence of migraines shortly after delivery when estrogen levels decrease. Moreover, migraine pain, whether pregnant or not, often manifests behind the eyes. Some headaches may be related to changes in blood pressure or eye conditions, such as glaucoma. Because medication options may be limited during pregnancy, it’s essential to consult your doctor to identify the safest treatments for you.
What should I expect if I have vestibular migraines?
That depends on your situation. Some people may require ongoing treatment to manage their condition, while others may benefit from modifying their diet or increasing their exercise and rest.
What questions should I ask my healthcare provider?
Vestibular migraines are rare. Consider consulting your doctor to understand the cause, potential progression of symptoms, treatment options, long-term medication use, and strategies to manage and prevent future episodes.
Is vestibular migraine a brain disorder?
Vestibular migraine is a brain and nervous system disorder that impacts how your brain manages balance and your sense of orientation. This causes symptoms such as vertigo and dizziness.
What are the four stages of vestibular migraine?
Migraines typically progress through four stages: prodrome, aura, headache, and postdrome. Prodrome includes early warning signs like mood swings or cravings. Aura can cause visual or sensory disruptions. The headache stage involves severe pain. The postdrome might leave you feeling exhausted or confused.
