A form of migraine associated with vertigo, dizziness, or balance problems.
A vestibular migraine is a form of migraine associated with vertigo, dizziness, or balance problems. Migraine is a prevalent condition amongst Americans but despite improvements in diagnosis, experts estimate that as many as 50% of people suffering from migraines go undiagnosed. Vestibular migraines are also known as migrainous vertigo, migraine-related dizziness, or migraine with prominent vertigo.
Symptoms of a Vestibular Migraine
A migraine is typically defined as a headache involving severe throbbing pain, though many people with migraines don’t experience the headache. It is often accompanied by other classical symptoms, which can vary between individuals. Common migraine symptoms include:
- Nausea with or without vomiting, and motion sickness
- Photophobia (sensitivity to light)
- Sensitivity to movement and routine physical activity
- Phonophobia (sensitivity to sound) and tinnitus
- Osmophobia (sensitivity to smell)
Some people with migraine may even experience mental disorientation or confusion, and weakness in the limbs.
In the case of a vestibular migraine, the prominent symptom is vertigo, the sensation of dizzying movement, which may lead to losing your balance. You may feel that your surroundings are spinning or swaying. For some people, an episode of vertigo during a vestibular migraine can be debilitating.
Vestibular migraines aren’t the only cause of vertigo. In fact, the most common cause of vertigo is a condition known as benign paroxysmal positional vertigo; vestibular migraines are the second most common cause. Other inner ear disorders associated with vertigo include Meniere’s disease, vestibular neuritis, and labyrinthitis. Vertigo may also be caused by certain medications, head and brain injuries, tumors, and infections.
During a vestibular migraine, the duration of the symptoms can vary from person to person. For some, the vertigo attacks may last only for several minutes, while others experience symptoms for a few days. There have also been reports of vestibular migraine symptoms lasting for weeks.
What Causes Vestibular Migraines?
Similar to common migraines, vestibular migraines can run in families. This means that having a relative who suffers from vestibular migraines increases your chances of experiencing them, too. Women are at a greater likelihood than men to experience vestibular migraines, as are those under the age of 40 years, those with a history of head injury, and those also experiencing anxiety or depression.
The base underlying cause of vestibular migraines is still not fully understood. Apart from recognizing genetic links and environmental or physiological triggers of a migraine attack, doctors believe migraines are associated with abnormal brain signals and changes to blood vessels in the brain.
Many patients with vestibular migraines are able to identify certain triggers that can set off a migraine attack. These can include:
- Hormonal fluctuations, such as during menopause
- Stress and anxiety
- Dehydration and hunger
- Unexpected motion
- Overwhelming visuals, such as busy wallpaper patterns or fast-moving scenes on a screen
- Certain foods, such as those containing an amino acid called tyramine, MSG (monosodium glutamate), preservatives, caffeine, and alcohol
Diagnosing and Managing Vestibular Migraines
Because the symptoms of a vestibular migraine are not unique, it can be difficult to pin down a diagnosis. If you’re experiencing vertigo symptoms, an otolaryngologist (an ear, nose, throat specialist) or neurologist are the most experienced in managing conditions in this area.
For a formal diagnosis of a vestibular migraine, your doctor needs to confirm that you’ve experienced:
- At least 5 episodes of vertigo symptoms
- Vertigo symptoms lasting between 5 minutes and 72 hours
At least half the attacks also need to involve at least one of these other three classic migraine symptoms:
- Throbbing headache only on one side of the head (as opposed to both sides or all over the head), with pain of moderate to severe intensity, that may be aggravated by regular physical activity
- Aversion to lights and sounds
- Visual disturbances (commonly called a visual aura)
If you’re able to identify the triggers that set off your migraine, the obvious treatment option would be to avoid these triggers. Your doctor may suggest you start a journal to help notice patterns in your routines or diet that are associated with a migraine. For many people, avoiding their triggers is enough to manage their migraines.
Medications are available if you’re unable to figure out any triggers (or if they are unavoidable). There are a variety of drugs that can help to manage your symptoms, including ones typically prescribed for depression or seizures. These medications can be used to either prevent a migraine attack from occurring (such as propranolol or verapamil) but can also be used to shorten a migraine episode that’s already started (such as aspirin or ibuprofen). Other steps that help manage a vestibular migraine attack as it’s happening are simply to rest and hydrate.
Your doctor may recommend vestibular rehabilitation. This is a type of physical therapy to desensitize the brain to certain sensory triggers, such as motion or changes in your posture. Vestibular rehabilitation is often used for those with chronic balance disorders.
Vestibular migraines may be difficult to diagnose, especially if you’re not familiar with the condition and its symptoms. As the vertigo attacks can be disabling, especially prolonged episodes, it’s important to seek medical advice for how to manage these symptoms effectively.