Vestibular Migraine Overview

vestibular migraine

Migraine is an extremely common complaint with up to 37 million people in the US suffering from this neurological condition, but what most people don’t realise is that migraines can be caused by the same problems with the inner ear and brain mechanisms that can cause the condition vertigo.

These types of migraines are called Vestibular Migraines, and approximately 40% of migraine sufferers are affected by them. Along with the typical migraine symptoms such as severe throbbing headache, nausea and vomiting, and sensitivity to light and noise, sufferers may also display some or all of the following symptoms.

Vestibular Migraine Symptoms:

  • Vertigo
  • Imbalance
  • Dizziness
  • Unsteadiness
  • Extreme sensitivity to motion
  • Muffled hearing
  • Ear fullness
  • Tinnitus
  • Motion intolerance
  • Confusion

The thing that makes Vestibular Migraine unique to other types of migraine is that sufferers don’t always display the classic signs of a throbbing headache. Because of the conditions close association to forms of vertigo such as vestibular, symptoms can manifest themselves as balance or hearing difficulties, rather than the throbbing pain typically associated with a migraine.

Some sufferers do experience the headaches, commonly either shortly before or after the vestibular symptoms such as dizziness and loss of balance, but many others only rarely experience migraine headache, and when they do it does not occur anywhere near the same time as their vestibular symptoms.

Other sufferers of Vestibular Migraine never experience a migraine headache at all, with the vestibular symptoms such as tinnitus, nausea, and difficulty balancing, the only ones that choose to manifest.

Who is most at risk of Vestibular Migraine?

Women are in general far more likely to suffer from any type of migraine that men are and symptoms can often worsen around the time of menstruation. Migraine can also have a familial link, and can be genetically passed on through blood relatives, as the condition is proven to have a tendency to run in families.

The condition is most common among 20-40 year old women with the age bracket for males being ever so slightly higher.

Vertigo sufferers in particular are highly likely to be affected by this condition due to the vascular events and neural activity that follow after a migraine attack that can worsen the symptoms of vertigo.

There is even evidence to suggest that Vestibular Migraine can trigger vertigo itself, as it is believed to damage both the utricle and the superior portion of the vestibular nerve, triggering symptoms such as loss of balance.

How is Vestibular Migraine diagnosed?

Diagnosing this condition is often tricky as it requires the assessing clinician to exclude other conditions that can commonly induce the symptoms the patient is experiencing.

Conditions that must be excluded before a diagnosis of Vestibular Migraine can be made:

  • Benign Paroxysmal Positional Vertigo (BPPV)
  • Menieres Disease
  • Transient Ischemic Attacks (TIAs)
  • Fluid leaks in the inner ear
  • Vestibular nerve irritation

Treatment

The treatment for Vestibular migraine is actually very similar to that prescribed for sufferers of other types of migraine, depending on the severity of the individual sufferers symptoms.

It may include conventional medication such as prescription drugs, or, after making a full clinical assessment of the patient’s condition and medical history, the assessing doctor may deem a more natural preventative method to be more beneficial, such as avoiding caffeine or stress management.

Typical treatments prescribed for Vestibular Migraine:

  • Calcium channel blockers
  • Selective Serotonin Re-uptake Inhibitors(SSRIs)
  • Clonazepam or Klonapin
  • Tricyclic antidepressants
  • Beta-blocking agents
  • Other prescription medication proven to successfully treat migraines
  • Stress management
  • Exercise
  • Changing diet to avoid migraine triggering foods

In addition, if the doctor finds that the symptoms are closely associated with the onset of menstruation, he or she may recommend the sufferer restrict their salt intake around the time of menstruation. A diuretic or water pill may also be prescribed in this case to prevent the water retention that can induce or worsen symptoms.

In almost all cases of Vestibular Migraine, adherence to a healthy diet, avoidance of caffeine and excess alcohol, and regular exercise in combination with taking any prescribed medication should see an improvement in symptoms relatively quickly.

Helpful tips

If you are prone to Vestibular Migraine attacks then there are a number of things you should avoid that have a proven link to inducing symptoms.

Things that can induce a Vestibular Migraine attack:

  • Stress
  • Insomnia
  • Poor diet
  • Chocolate
  • Red wine
  • Caffeine
  • Cheese
  • Monosodium glutamate
  • Low blood sugar

As well, you should make sure you get regular exercise of at least 30 minutes duration, a minimum of three times weekly, as inactivity can make symptoms of this uncomfortable condition worsen.

Vestibular Migraine has close links to vertigo, which manifests in different forms such as Labyrinthitis and BPPV.

If you are suffering from the symptoms of Vestibular Migraine, you should ensure you receive a thorough clinical assessment from your doctor to discern if you are also a sufferer of vertigo, and to receive the recommended treatment guidelines that you should follow.