Vestibular Migraine (Migraine Associated Vertigo)
What is Vestibular Migraine?
Vestibular migraine is a type of migraine that is characterised by recurrent episodes of vertigo (rotary or spinning sensation), nausea and/or loss of balance. In most people, it occurs WITHOUT any headache pain, often confusing the process of diagnosis. Vestibular migraine is more common than many people believe, and patients are often diagnosed incorrectly as having other conditions such as Meniere’s or vestibular neuritis/labyrinthitis.
The actual mechanisms involved in vestibular migraine, as with all forms of migraine, are not fully understood. It is known that migraine involves activation and over-sensitisation of several neural pathways within the brain, but the reasons behind why this happens is not yet known.
What causes Vestibular Migraine?
We still don’t fully understand what causes vestibular migraine to occur in most cases. We know that some people have a strong genetic predisposition to suffering migraines and migraine episodes can be associated with certain triggers in sufferers. These triggers are often individual to the person but may include stress and anxiety, poor sleep, hunger and dehydration, dietary triggers and hormonal changes.
What are the symptoms of Vestibular Migraine?
The most common symptom of vestibular migraine is repeated episodes of vertigo (rotary or spinning sensation), that may last several minutes to several hours. In some patients with vestibular migraine, they may not experience a sensation of rotary vertigo, but may feel similar symptoms such as dizziness, imbalance, rocking sensations or sensitivity to movement within their visual field. As well as these symptoms, vestibular migraine can have associated nausea, vomiting, sweating and visual changes such as blurred vision, flashing lights and spots in their vision. Patients may also report being sensitive to loud noise and bright light.
How is Vestibular Migraine diagnosed?
Vestibular migraine is usually diagnosed based on the patient’s history (an interview describing the symptoms). There is no specific scan or test to diagnose vestibular migraine, but carefully listening to a patient’s story can reveal very specific sets of symptoms and history of progression. If there is any uncertainty around the diagnosis, patients will often be sent for tests that help to rule out other conditions such as Meniere’s and vestibular neuritis or labyrinthitis. These tests include hearing tests and vestibular function testing.
How is Vestibular Migraine treated?
The first line of treatment for vestibular migraine is to try to reduce the frequency and severity of symptoms without medications, which is an approach that works well for many patients. These non-medication-based treatments include:
• Stress reduction, which involves ensuring regular meals, keeping to stable sleep schedules, participation in aerobic exercise and/or meditation.
• Avoiding nicotine and caffeine.
• Sticking to a “migraine diet”, which is where a patient avoids triggers such as aged alcohol (alcohol with colour), MSG, chocolate, caffeine, artificial sweeteners, processed foods and cheeses. Triggers can be different between people and a patient may benefit from keeping a dietary log.
• Neck examination and treatment. Some patients’ symptoms may be triggered by tightness in their upper neck. Treatment of this area using specific manual therapy techniques and exercises if often effective in these patients.
If a patient continues to experience symptoms of vestibular migraine, the choice may be made to commence medication-based treatment. With the help of a doctor, patients may trial a range of different medication types until an effective drug and dose is found.
Our vestibular physiotherapist Justin has undergone extensive training in the rehabilitation of dizziness and balance conditions including vestibular migraine.
If you would like to ask Justin a question about vestibular migraine or anything else, visit our Contact Us page to get in touch.
If you are ready to make an appointment, visit our make a booking page and let us help you with your recovery.
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