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Vestibular Migraine

Migraine headache is one of the more common neurological conditions. In fact it is so common that some people don’t even consider it a disease, but rather a normal variant of the human condition. Although the word migraine conjures up the image of extremely painful headaches, migraine often involves much more than headache. In fact, at times the headache may be minor, or may not even exist.

Many people who experience migraine are familiar with visual aura when, just before the headache, one sees flickering light spots sometimes with dark holes inside or zigzagged light flashes like lightening. These visual phenomenon tend to appear about 15 minutes before the headache.

Classic Symptoms of Migraine

  • Severe throbbing headache on one side of the head
  • Nausea and vomiting
  • Extreme sensitivity to light and noise
  • The need to go to a dark, quiet room to sleep

While these symptoms may seem common to migraine sufferers, many people don’t realize there is also an association between migraine and the inner ear and brain mechanisms that influence hearing and balance.

Vestibular Symptoms

  • Vertigo
  • Imbalance
  • Dizziness
  • Unsteadiness
  • Extreme sensitivity to motion

Hearing Symptoms

  • Muffled hearing
  • Ear fullness
  • Tinnitus or ringing in the ear

The hearing symptoms are associated with Otic Migraine, from the word meaning ear, and often occur without headaches.

The cause of migraine headaches probably relates to both abnormal discharges in cells within the brain and to the constriction of the walls of the blood vessels in and around the brain. Although we don’t completely understand the causes of migraine, we know that it can be provoked or made worse by a number of factors, including:

  • Hypoglycemia (low blood sugar)
  • Stress and altered sleep patterns
  • Diet
  • Chocolate, red wine
  • Coffee, sodas with caffeine
  • Cheeses, Monosodium glutamate (MSG)

Factors Related to Migraine

  • Women are more likely to get migraines than men
  • Symptoms are often worse around menstruation
  • Family history – migraines have a strong tendency to run in families

We now recognize that there are many variations of migraine and some produce symptoms associated with inner ear balance and mechanisms. We also know that symptoms of migraines can appear independently of headaches. For example, just as some patients can experience a visual aura without the headache, some patients can have balance and hearing issues without the headache. In some cases, patients may have headaches in the remote past, commonly in teenage and young adult years, and now – while having outgrown the headaches – still continue to have some of the other symptoms related to migraine. While some patients do have headaches, either before or after the vestibular symptoms, many may only have an occasional migraine headache and they may never occur at the same time as their vestibular symptoms. In fact, in the majority of patients who have vestibular migraine, the vestibular symptoms and headaches do not occur at the same time. This is why the onset of dizziness by itself makes a correct diagnosis difficult.

Establishing a correct diagnosis requires excluding other conditions that can cause similar symptoms, such as:

  • Benign Paroxysmal Positional Vertigo (BPPV)
  • Ménierès Disease (also called hydrops)
  • Transient Ischemic Attacks (TIAs) or small strokes
  • Fluid leaks in the inner ear
  • Vestibular nerve irritation

Vestibular migraine is treated similarly to other types of migraine.

For attacks of dizziness that include nausea, we use drugs such as meclizine to provide relief of symptoms.

If events are incapacitating or frequent, we use medications to prevent the attacks, including:

  • Beta-blocking agents
  • Calcium channel blockers
  • Tricyclic antidepressants
  • Serotonergic agents (SSRIs)
  • Gabapentin or Neurontin
  • Clonazepam or Klonapin
  • Acetazolamide or Diamox
  • Sodium valproate or Depakote
  • Topiramate or Topamax
  • Oxycarbazapine or Trileptal

Your doctor is the best person to guide you through the use of these medications.

We also rely on more natural preventative treatments, such as:

  • Avoiding particular foods that might trigger migraines, such as chocolate, red wine, cheese, caffeine and monosodium glutamate (MSG).
  • Exercise
  • Stress management
  • When migraines are associated with menstrual periods, taking a water pill or diuretic and restricting salt intake around the time of menstruation may help.

As with all chronic or unpredictable vestibular disorders, attention to the psychological consequences of the disorder is necessary with appropriate medications and consultations. For almost all patients, the proper combination of diet, exercise and drug treatment (if necessary) will lead to good relief of symptoms and return of a normal lifestyle.

 
 
 
 
 
 

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