What is Vestibular Migraine?
Migraine is one of the most common neurological conditions, but what is vestibular migraine? Vestibular migraine is a subtype of migraine that manifests with vestibular symptoms, such as vertigo, balance issues, nausea and vomiting and may or may not be accompanied by the pain associated with the usual migraine.
Vestibular refers to the system in your inner ear that controls balance and positional awareness. People who experience episodes of vertigo and have previous history of migraine may be suffering from vestibular migraine.
Vestibular migraine, due to its nature, is also called migraine-associated vertigo, migrainous vertigo, or migraine-related vestibulopathy.
What Are the Symptoms of a Vestibular Migraine?
Vestibular symptoms that may last from 5 minutes to 72 hours and include the following:
1. Vertigo
If you experience this, you may feel that you or the objects around you are moving or spinning, even when they are not. This occurs spontaneously and is usually described as a sensation similar to rocking on a boat.
2. Unsteadiness or Loss of Balance
You may feel like you are swaying and have difficulty maintaining an upright posture due to balance difficulties. This may prevent you from standing up due to the loss of spatial awareness.
3. Sensitivity to Motion
If you experience an attack, you may opt to lay still to avoid any additional movement that may aggravate symptoms.
Migraine symptoms may include one or more of the following:
- Severe, throbbing or pounding headache usually localized on one side of the head.
- Nausea or vomiting.
- Sensitivity to light, smell, or sound that seems to make the pain or vertigo worse.
- Experiencing an aura (this may or may not happen).
Causes of Vestibular Migraine
Although vestibular migraine can occur in about 1% of the population, there is no consensus among doctors yet as to what really causes them, but some believe that abnormal release of chemicals and hormones in the brain may play a role.
Triggers that may aggravate vestibular migraine are the same factors that may also trigger other types of migraine. These may include:
- Stress.
- Insufficient sleep.
- Dehydration.
- Menstruation.
- Changes in the environment, such as barometric pressure or temperature.
Some foods may also be linked to triggering vestibular migraines. Some of these food items include:
- Red wine.
- Aged cheese.
- Chocolates.
- Caffeine.
- Monosodium glutamate (MSG).
- Processed meats.
Women are more prone to getting vestibular migraine. Some doctors theorize that it may run in families but there are not enough studies to prove that link yet.
Diagnosis of Vestibular Migraine
The diagnosis of vestibular migraine is based on symptoms. There are no imaging tests or blood work that can directly give a diagnosis for this condition. The International Headache Society has developed a guide that includes the diagnostic criteria for vestibular migraine.
The criteria consist of the following:
- Having at least five episodes of vestibular symptoms of moderate to severe intensity lasting from 5 minutes to 72 hours
- Current or previous history of migraine attacks – even if it happened a long time ago.
- Half of the attacks must have one or more of the following symptoms along with the vestibular symptoms: one-sided, pulsating quality, moderate or severe pain intensity, triggered by physical activity, sensitivity to light or sound, visual aura.
- No other conditions have been diagnosed that may cause the symptoms.
Although your doctor may rule out other conditions by ordering some tests, such as an MRI or run hearing and balance tests, it is diagnosed through careful history documentation and a thorough physical examination by your doctor.
Treatment and Prevention
There are currently no specific medications for vestibular migraine, but some people may respond with the medications. Common medications that are prescribed may alleviate the symptoms of vertigo, balance issues and lightheadedness.
If you experience frequent attacks, your doctor may give them your one or a combination of the following medications:
- Beta blockers.
- Triptans.
- Anti-seizure drugs, such as Lamotrigine.
- Calcium channel blockers.
The best way to prevent attacks is controlling the triggers that may cause them. If you find a pattern within some triggering factors, it would be best to avoid these to prevent an episode to occur. One example is avoidance of a specific food item that may recurrently cause attacks of the symptoms.
Lifestyle changes may also be beneficial to limit the occurrence. Maintaining a great sleep hygiene, hydrating with enough fluids, being mindful of stressors, regular exercise and a well-balanced diet may all be beneficial in avoiding the debilitating symptoms of vestibular migraine.