Have you ever been dizzy?
I mean, really dizzy, where you couldn’t do much if you could get up at all.
This is not a “too much spinning on the playground equipment” dizziness. No, this dizziness comes on seemingly out of the blue. It can last several minutes or drag on for up to three days and you have this feeling of spinning or moving. You might be unsteady on your feet, like the floor is rocking underneath you.
On top of all that, you may have a headache, see flashing or shimmering lights in your field of vision, and experience a sensitivity to sound or light or both.
If you have experienced these issues, talked to your doctor about it, and he or she could find nothing amiss, it probably left you feeling frustrated and perhaps a little hopeless. After all, if they can’t find out what’s wrong, how can you be treated for it?
However, there is a simple question that could shed a great deal of light on your malady. One question that could potentially make all the pieces come together.
Have you ever had migraines?
If you answer yes, it could be that you are suffering from vestibular migraine – even if your dizzy episodes do not include headache.
We bring you the latest research on vestibular migraine, specifically, we’ll summarize an article for you that is hot off the presses from the Journal of Neuro-Ophthalmology, Vestibular Migraine: How to Sort it Out and What to Do About it. It’s an extensive review of academic literature on this rather uncommon, misunderstood type of migraine. Read on to learn more and you can also visit this resource for more information about vestibular migraine.
The Vestibular System: An Overview
The vestibular system is responsible for spatial orientation (to coordinate balance and movement), controlling eye movements during movement of the head, and overall sense of balance. It is located in the vestibulum which resides within the inner ear. However, it is directly networked to several different areas of the brain: the somatic sensory cortices, the cerebellum, and the brainstem.
If there is a malfunction at any point in the network, it can greatly affect balance and cause dizziness. However, vestibular problems can also include symptoms such as hypersensitivity to sounds or lights (photosensitivity). Visual auras like flashing or shimmering lights may also be present, particularly in vestibular migraine. This short video provides a concise overview of the vestibular system.
There are a number of factors that can contribute to vestibular disorders. Inner ear problems as well as neurological issues can all cause problems that affect your balance and often make you feel dizzy.
What is Vestibular Migraine?
A vestibular migraine is a problem with the nervous system. The message from the inner ear to the brain gets scrambled and neural pathways misfire or short circuit. This leads to repeated episodes of vertigo (dizziness) in migraineurs or people who have a history of migraine.
The good news is, a headache may not always accompany these unusual migraines. The bad news is, they make you so dizzy you still can’t function. The vestibular migraine is known by many names:
- Migraine-related vestibulopathy
- Migrainous vertigo
- Migraine-associated vertigo
Symptoms can last a few minutes or a few days.
Vestibular Migraine Symptoms
The most obvious symptom of vestibular migraine is, of course, dizziness. It isn’t necessarily continuous but tends to come and go. You may feel dizzy for five minutes, several hours, or up to three days. The truth is, around 40% of people who suffer from migraine also experience some type of vestibular problem as some point during the attack.
Specific vestibular symptoms include:
- Spontaneous vertigo
- Positional vertigo
- Vertigo or dizziness caused by head motion
- Postural unsteadiness
- Oscillopsia (objects in the field of vision appear to move or oscillate even though they are still)
- Vertigo or dizziness induced visually
- Directional pulsion (falling in a certain direction while walking, standing, or sitting)
That is the symptom that most people look for first, but that isn’t the only symptom – and it isn’t enough for your doctor to make a diagnosis either. Other vestibular migraine symptoms include:
- Problems with balance
- Disoriented or confused
- Hypersensitive to sound
- Photophobia or light sensitivity
- Severe sensitivity to motion – dizziness is increased when you move your body, eyes, or head (often increases nausea as well)
- Feeling of being unsteady, like you are in a boat that is rocking on rough waves
While it is possible to experience dizziness and problems with your balance without any type of headache or migraine, it is also possible to experience vertigo symptoms at any point of your migraine – before an attack, during it, or after.
A study published in Neurology Advisor found that more than 70% of their test subjects had anxiety while more than 40% had depression. Additionally, 26% had insomnia. It is difficult to tell if these are comorbidities that existed prior to the migraine attacks, if the attacks brought them to the surface, or if the attacks caused them.
Some people have migraines for years, only to have the vertigo symptoms begin later in life. If you have a history of migraine and you have vertigo, even if they don’t occur together, it is likely that you have vestibular migraine. Also, while this type of migraine is more prevalent in older adults, children can get them too.
Diagnostic Challenges of Vestibular Migraine
Vestibular migraine is not a straightforward diagnosis. Often the patient does not experience a headache so symptoms may not immediately point to a type of migraine. There are other migrainosus features that do accompany it such as phonophobia, photophobia, and visual aura. These are considered to be part of the diagnostic criteria.The official diagnostic criteria for vestibular migraine includes:
- A minimum of five episodes that include vestibular symptoms, must
- Be moderate to severe in intensity
- Last between five minutes and 72 hours
- History of current or previous migraine attacks (with or without aura)
- At least 50% of vestibular episodes must include at least one of these migraine features:
- Headache with a minimum of two migraine characteristics:
- Located on one side
- Pain pulsates
- Pain is moderate or severe in intensity
- Routine physical activity causes pain to increase
- Phonophobia or photophobia
- Visual aura
- Headache with a minimum of two migraine characteristics:
- Other vestibular disorders have been ruled out
Your doctor may perform one or more vestibular function tests to get a better understanding of your vertigo. These tests are very simple, and several can even be performed on comatose patients. This allows them to rule out other issues that may be causing your symptoms.
Meniere Disease presents doctors with the greatest diagnostic challenge when determining whether a patient’s vertigo is due to vestibular migraine or Meniere disease. This is because not only do the two conditions share similar markers, migraine is also common among people with Meniere disease. About a third of people diagnosed with Meniere disease also have migraine. What’s more, headaches and migraine symptoms often accompany Meniere disease attacks.
Benign Paroxysmal Positional Vertigo is another common vestibular disorder that can easily be confused with vestibular migraine. It is the most common cause of dizziness and vertigo among adults. It also has very close ties to migraine. An attack can trigger a migraine and patients with the disorder often have migraine as well.
Vertebrobasilar Ischemia is another condition that has some similarities to vestibular migraine. The episodic vertigo comes on abruptly and lasts within the diagnostic criteria for vestibular migraine. There are tests that are stroke specific that your doctor may perform to rule it out.
Your doctor may run a variety of tests including an MRI, balance test, vestibular event monitor, and hearing test.
Causes of Vestibular Migraine
A history of migraine is one of the most common conditions associated with vestibular migraine. The two conditions even share many of the same triggers. One study identified stress as a trigger in nearly 40% of the test subjects. Bright lights came in next at almost 27%, with weather changes at 26% and sleep deprivation at 26%.As for causes of vestibular migraine, doctors simply do not know. Like migraines, there are plenty of theories out there, but nothing very concrete.
It is difficult to determine how many people have vestibular migraine. The symptoms are too close to other symptoms of other disorders, making it hard to pinpoint. Researchers believe that about 1% of the population is affected, but that number could easily be much higher.
Like regular migraines, they tend to occur more often in women than men and usually strike later in life, when the patient is around 40 years old. However, it is not confined to just adults. There are reported cases where children are diagnosed with vestibular migraine too.
Treatment for Vestibular Migraine
There are no specific medications or treatments for vestibular migraine. Like other types of migraine, treatment often depends on the patient and what they best respond to. Often doctors will prescribe abortive therapy, meaning medications that will stop an attack. Other medications may ease the vertigo symptoms and others may be used to prevent attacks. The most common vestibular migraine medications include:
- Triptans – Abortive therapy to be taken at the first sign of migraine or headache.
- Vestibular suppressant – Helps with the vertigo symptoms to ease dizziness and help with balance. Benzodiazepines and antihistamines are in this category.
- Anti-nausea medication – Helps to ease the nausea associated with vertigo.
- Prevention medication – Helps to prevent vestibular migraine. Seizure medication, certain antidepressants, and blood pressure medication fall under this category.
Sometimes the best you can do is manage your symptoms. My favorite cure for the nausea caused by the vertigo is sour candy. Sucking on a super sour candy when you begin to feel nauseous from the dizziness can help keep your stomach settled. It is also great for motion sickness. Carry some hard, sour candies (preferably sugar free), and when you start to feel woozy, pop one in your mouth. Don’t chew it, just slowly suck on it and you should feel better rather quickly.
Migraine glasses are great for filtering out the light and making the world a little more inhabitable. Look for lenses with SpectraShield to ensure you are getting glasses with latest research and most effective tint to guard against light sensitivity.
Ice packs can help with the migraine pain and magnesium cream massaged into the temples are also effective treatments.
Lifestyle changes are often recommended for patients who suffer from migraine. A healthy, balanced diet, exercise, proper hydration, and adequate, high quality sleep are all very important for keeping migraines at bay. Avoiding triggers is also a very good, healthy move.
Some patients have found relief with biofeedback methods. This is particularly helpful with people suffering from vertigo. There isn’t much data on it, but researchers and patients alike are hopeful.
There currently is not enough research on vestibular rehabilitation to establish it as an effective treatment for vestibular migraine, but it is very helpful for other vestibular conditions. What is interesting is that physiotherapy, a part of vestibular rehabilitation, has been found to be quite helpful in treating conditions that are considered to be complications of vestibular migraine such as fear of falling, anxiety, and not trusting the balance system.
Scientists, doctors, and researchers are delving deep into migraines, the brain, and related conditions. They are making great strides and there are several new, effective medications on the market to prove it. Vestibular migraine does present the added challenge of dizziness to the mix, but at its core, there are a number of markers that point to migraine.
If you believe you have vestibular migraine, talk to your doctor. He or she can diagnose the problem then discuss with you the best way to approach it.
Axon Optics has a wide selection of migraine glasses that are tinted with our own SpectraShield to ensure you have the utmost protection for your light sensitivity. Take a look for yourself and find a pair that suits your style, then join our every growing list of satisfied customers.
Here’s to fewer migraine days!
- Beh, Shin C. “Vestibular Migraine: How to Sort It Out and What to Do About It.” Journal of Neuro-Ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society, U.S. National Library of Medicine, June 2019, www.ncbi.nlm.nih.gov/pubmed/31094996.
- Bisdorff, Alexandre R. “Management of Vestibular Migraine.” Therapeutic Advances in Neurological Disorders, SAGE Publications, May 2011, www.ncbi.nlm.nih.gov/pmc/articles/PMC3105632/.
- “Global Migraine Therapeutics Market 2019-2023 to Post a CAGR of 8.4%, Segmentation by Key Regions, Gross Margin, Profit, Analysis, Market Share: 360 Research Reports.” TheWindReports, thewindreports.com/global-migraine-therapeutics-market-2019-2023-to-post-a-cagr-of-8-4-segmentation-by-key-regions-gross-margin-profit-analysis-market-share-360-research-reports/29959/.
- HospiMedica International. “Vestibular Event Monitor Provides Accurate Vertigo Diagnosis.” Hospimedica.com, HospiMedica International, 17 June 2019, www.hospimedica.com/health-it/articles/294778325/vestibular-event-monitor-provides-accurate-vertigo-diagnosis.html.
- Lempert, et al. “Vestibular Migraine: Diagnostic Criteria.” Journal of Vestibular Research, IOS Press, 1 Jan. 2012, content.iospress.com/articles/journal-of-vestibular-research/ves00453.
- McNamara, Lindsay. “Vestibular Migraine: Johns Hopkins Vestibular Disorders Center.” Vestibular Migraine | Johns Hopkins Vestibular Disorders Center, 5 Oct. 2017, www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/vestibular/conditions/vestibular_migraine.html.
- “Oxford Textbook of Vertigo and Imbalance.” Google Books, books.google.com/books?id=lP_J8RCgWdkC&pg=PA308&lpg=PA308&dq=•+Directional+pulsion&source=bl&ots=ZwyW2HUTyN&sig=ACfU3U1OudJB-NJuKl9f3DoIV-B0Hhr7sg&hl=en&sa=X&ved=2ahUKEwif8v7wu4vjAhVOa80KHWqaBsgQ6AEwBHoECAgQAQ#v=onepage&q=• Directional pulsion&f=false.
- Purves, Dale. “The Vestibular System.” Neuroscience. 2nd Edition., U.S. National Library of Medicine, 1 Jan. 1970, www.ncbi.nlm.nih.gov/books/NBK10819/.
- Robinson, Barbara Susan. “Common Vestibular Function Tests.” American Physical Therapy Association. http://www.neuropt.org/docs/vsig-english-pt-fact-sheets/common-vestibular-tests-performed.pdf?sfvrsn=525cce48_2
- Rothbard, Gary. “Episodic Vertigo May Be Associated With Migraine.” Neurology Advisor, 7 May 2019, www.neurologyadvisor.com/topics/migraine-and-headache/episodic-vertigo-may-be-associated-with-migraine/.
- Tilikete, Caroline, and Alain Vighetto. “Oscillopsia: Causes and Management.” Current Opinion in Neurology, U.S. National Library of Medicine, Feb. 2011, www.ncbi.nlm.nih.gov/pubmed/21102332.
- “Vestibular Migraine.” Ménière’s Society: Vestibular Migraine, www.menieres.org.uk/information-and-support/symptoms-and-conditions/migraine-associated-vertigo.
- “Vestibular Migraine (A.k.a. Migraine Associated Vertigo or MAV).” Vestibular Disorders Association, 3 July 2019, vestibular.org/migraine-associated-vertigo-mav.
- “Vestibular Migraine Associated With Various Indicators, Comorbidities.” AJMC, www.ajmc.com/newsroom/vestibular-migraine-associated-with-various-indicators-comorbidities-.
- Writer, Neurology Advisor Contributing. “Vestibular Migraine Features Wide Range of Symptoms and Comorbidities.” Neurology Advisor, 1 Apr. 2019, www.neurologyadvisor.com/advisor-channels/headache-migraine-advisor/vestibular-migraine-features-wide-range-of-symptoms-and-comorbidities/.