Vestibular migraines: the headache difficult to diagnose

Dizzy migraine

When you hear the word migraine, you might think of a life-threatening headache. But for some people, vertigo – or vertigo – is a hallmark of their condition. This is known as a vestibular migraine.

“Vestibular migraine is a variant of migraine. These patients have symptoms that result from a dysfunction in their equilibrium system,” says Adrian Priesol, MD, a Boston otoneurologist specializing in the management of patients with dizziness and disturbed balance.

Migraine is a neurological disorder characterized by moderate to severe head pain, which can be on one side of the head or both. Some people also experience nausea or vomiting and sensitivity to light, noise or smells.

According to the American Migraine Foundation, at least 39 million Americans live with migraines. It is well known that a subset of migraine sufferers experience an aura – visual disturbances, including spots, zig-zags or lightning.

(Here’s what you need to know about eye migraine.)

Recently, researchers have recognized that some migraine patients have symptoms related to their vestibular system or balance.

“What we’ve learned over the past decade is that probably half of the people I see who experience dizziness have an underlying migraine disorder that is causing their problem,” says Dennis Fitzgerald, MD , a Philadelphia otolaryngologist on the board of directors of the Vestibular Disorders Association.

It is not known how many people suffer from vestibular migraine, although some studies, like this 2016 study Behavioral neurology, suggest that it is about 1 percent of the general population and 10 percent of people with migraines.

Symptoms of vestibular migraine

People with vestibular migraines report a range of symptoms.

“They may have real dizziness where the room is spinning or they may have a swaying sensation or lightheadedness,” says Dr Priesol.

“And a lot of patients develop what we call visual vertigo, where visual stimulation, like seeing things moving on computer screens, will make them feel dizzy or make their lightheadedness worse.” These episodes can last from a few seconds to several days.

Some patients have other ear symptoms, such as ear pain and a feeling of fullness and pressure in the ear, says Dr. Fitzgerald. These symptoms can be before or during a headache, although some patients never experience a headache and always have a vestibular migraine.

“This can make the diagnosis a bit difficult because it doesn’t have to happen with a typical migraine,” says Dr Priesol.

Causes of vestibular migraine

It is not known what causes migraines, but genetics and the environment play a role.

“In fact, you were born with the genetics that lead to migraine symptoms, which means you are what we call a ‘migraine’ your whole life,” says Dr. Fitzgerald.

But while you are a lifelong migraine sufferer, your symptoms may change over time. For example, you might have migraines throughout your life, but the symptoms of dizziness don’t appear until later.

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How is vestibular migraine diagnosed?

Vestibular migraine can be difficult to diagnose. There’s no specific test – and when most people go to the doctor to complain of dizziness, they don’t immediately think of telling them they have migraines, too, says Dr Fitzgerald.

“He’s also a great imitator,” says Dr Priesol. “It can cause symptoms very similar to many inner ear balance problems or other neurological problems.”

A diagnosis of vestibular migraine is made by ruling out other conditions and / or seeing whether a patient responds to treatment for migraine. If the dizziness seems to be triggered by diet, weather fluctuations or hormones, that’s another clue that it may be part of a migraine disorder, says Dr. Fitzgerald.

It is important, however, if a patient has a history of migraine and complains of dizziness, not to automatically assume that their dizziness is caused by the migraine.

“Migraine itself is very common,” says Dr Priesol. “It could be a coincidence and there could be some inner ear pathology causing their dizziness.”

Treat vestibular migraine

For the most part, vestibular migraine is treated the same way as more typical migraines – by avoiding triggers and taking medications and supplements.

Manage triggers

Diet

For some people, certain foods can trigger a migraine. These may include:

• Chocolate
• alcohol, especially red wine
• Processed meats
• artificial sweeteners like aspartame
• dairy products, especially ripened cheese
• caffeine
• food containing the food additive monosodium glutamate (MSG)

“We will often recommend a migraine elimination diet,” says Dr. Priesol, “which is basically a guide to avoiding certain foods. I’m going to have my patients try it for a month or two and see if we can get these symptoms. calm down with that. “

Irregular sleep schedule

Changes in your sleep schedule can trigger a migraine. The American Migraine Foundation recommends going to sleep and waking up at the same time each day and aiming for seven to eight hours of sleep.

Stress

Stress is a big trigger for migraines. “Learning to improve your relaxation reactions, with programs like mind and body, can be very helpful in minimizing migraine symptoms,” says Dr. Priesol.

Some triggers, like hormonal fluctuations and weather changes, can be difficult to manage or control, acknowledges Dr. Fitzgerald. In some cases, if other lifestyle changes don’t improve symptoms, you may need preventative medication.

Drugs and Supplements

Medicines to prevent migraine

If lifestyle changes and avoiding triggers don’t get the symptoms of vestibular migraine under control, doctors will start looking for medications to prevent a vestibular migraine. These are the same drugs used for the prevention of regular migraines and could include beta blockers or calcium channel blockers or older generation antidepressants.

“The great thing about preventative drugs is that you don’t have to take them forever. One way to think about this is that they reset the chemistry in the brain, and once you do this has happened and as the person’s symptoms become rare it can be alleviated, “says Dr Priesol.

(These are the remedies for migraine that are proven to work.)

Symptomatic treatment

When you have a vertigo attack, typical anti-migraine medications that target pain, such as ibuprofen, acetaminophen, and triptans, are not helpful for the symptoms of dizziness. Although they can still be of benefit if you have a headache along with your dizziness.

To target symptoms of vertigo, doctors may prescribe or recommend meclizine or dimenhydrinate, which are antihistamines used to treat motion sickness and dizziness.

Supplements

According to Dr. Fitzgerald, certain supplements and herbs, such as magnesium, vitamin B2, coenzyme Q10, and butterbur, help prevent migraines.

Your takeaway meals

A vestibular migraine can be difficult to diagnose and treat. Currently there is no cure, but there are preventative drugs that can help. However, these drugs are not always available to all patients.

If you experience dizziness, it is always best to see your doctor to see what might be happening. But don’t hesitate to ask about vestibular migraine. “It’s underdiagnosed and very treatable,” says Dr Priesol. “Go see a doctor for a proper assessment. There are good treatments out there, and you don’t have to live with them.”

Next, here’s how to identify the warning signs of a migraine.

Post-vestibular migraines: The hard-to-diagnose headache first appeared on The Healthy.