About Vestibular Migraine
The exact cause of vestibular migraines is still unknown, but various theories suggest genetic, neurochemical, and inflammatory mechanisms derived from the pathophysiology of migraines. Some studies have found abnormalities in vestibular tests in children with vestibular migraines, indicating possible peripheral vestibular dysfunction (inner ear dysfunction) as a contributing factor. There are several non-modifiable and modifiable risk factors that may contribute to their development.
Non-modifiable (things that cannot be changed) risk factors for vestibular migraines include:
- Age: As people get older, they may be more likely to experience vestibular migraines.
- Sex assigned at birth: Females tend to have a higher risk of vestibular migraines compared to males.
- Genetic factors: Having a family history of migraines or vestibular disorders may increase the risk of developing vestibular migraines.
- Hormonal changes: Fluctuations in hormone levels, particularly in women during menstruation or menopause, may trigger vestibular migraines.
Modifiable (things that can be changed) risk factors for vestibular migraines include:
- Lifestyle factors: Certain lifestyle choices, such as lack of sleep, poor diet, and high stress levels, may increase the risk of vestibular migraines.
- Medication use: Overuse or misuse of certain medications, such as painkillers or migraine medications, can increase the risk of developing vestibular migraines.
It's important to note that having one or more risk factors does not guarantee that a person will develop vestibular migraines. Some people who have vestibular migraines do not have risk factors. Identifying these risk factors can help individuals make informed decisions about their lifestyle and seek appropriate medical care if needed.
Vestibular migraines can have a variety of symptoms, both early and later on. Here are some common symptoms:
- Vertigo: A feeling of spinning, swaying or rocking
- Heightened senses
- Nausea or vomiting
- Difficulty with balance
In addition to these common symptoms, other symptoms may occur with vestibular migraine, including:
- Headache: Typically pulsing or throbbing on one side of the head
- Feelings of disorientation
- Tinnitus: ringing in the ears
- Pressure in the ears
It's important to note that some people with vestibular migraines may not experience a headache at all. They may only have vestibular symptoms like vertigo. It is also important to seek immediate medical attention if you have a new headache with vertigo, trouble walking, weakness or numbness on one side of the body or trouble speaking.
Vestibular migraines may follow the standard phases of migraines. These phases include:
- Prodrome: This is the early warning phase where symptoms like irritability or neck stiffness may occur.
- Aura: Some people with migraines may experience visual disturbances like flashing lights, blurry spots, or shimmering lines during this phase. However, vestibular migraines don't typically cause these visual disturbances.
- Headache stage: This is when the throbbing headache associated with migraines occurs. In vestibular migraines, vertigo is the main symptom and headache may not occur.
- Postdrome: After the headache subsides, there may be a recovery phase where symptoms gradually resolve. It may take a few days for all symptoms to completely clear up.
It's important to remember that the timeline and intensity of vestibular migraine symptoms can vary from person to person. Vestibular symptoms can last anywhere from 5 minutes to 72 hours and may happen before, after, or during a headache. In some cases, vertigo may occur on its own without an accompanying headache.
If you're experiencing any of these symptoms and suspect you may have vestibular migraines, it's a good idea to reach out to a healthcare professional for an accurate diagnosis and appropriate management strategies.
To diagnose vestibular migraines, doctors may perform several examinations, tests, and procedures. These include:
- Medical history: The doctor will ask about the person's medical history, including any previous migraines or vestibular symptoms.
- Symptom assessment: The doctor will gather information on the symptoms experienced and how often they occur. This includes evaluating the severity and frequency of vestibular symptoms such as vertigo (a spinning sensation), dizziness, and balance problems.
- Migraine assessment: The doctor will assess for a current or past history of migraines. They will ask about headache characteristics, such as intensity, duration, and any associated symptoms like visual disturbances or sensitivity to light and sound.
- Physical examination: A thorough physical examination will be conducted, with a focus on neurological assessments to check for any abnormalities in reflexes, strength, and coordination.
Additional examinations: In some cases, additional examinations may be performed to exclude other vestibular or neurological disorders that could be causing similar symptoms. These may include:
- Audiometric evaluation: This evaluates hearing function.
- Videonystagmography (VNG): This test measures eye movements to assess the function of the inner ear.
- High-frequency headshake test: This assesses the vestibulo-ocular reflex by measuring eye movements in response to head movements.
- Video head impulse test (vHIT): This measures head and eye velocity in response to small head movements in different planes of each semicircular canal.
- Bi-thermal caloric testing: This evaluates the function of the inner ear by stimulating it with warm and cool air or water.
To determine the stage or severity of vestibular migraines, doctors may consider additional examinations, tests, and procedures. However, it's important to note that there is no specific staging system for vestibular migraines. The focus is primarily on assessing symptom severity and impact on daily functioning. Some additional assessments that may be used include:
- Migraine Disability Assessment Scale (MIDAS): This scale evaluates the impact of migraines on a person's daily life and functioning.
- Dizziness Handicap Inventory (DHI) scale: This scale assesses the impact of vertigo and dizziness on a person's quality of life.
- Evaluation of attack frequency: Doctors may ask about the frequency of vestibular migraine attacks over a specific period of time, such as three months.
It's important to remember that diagnosing vestibular migraines involves a comprehensive evaluation by a healthcare professional and may include specialists in migraines or neurology. They will consider all relevant information from medical history, physical examination, symptom assessment, and additional tests to make an accurate diagnosis. Once diagnosed, treatment options can be discussed to help manage the condition effectively.
Treatment options may vary based on individual factors, such as whether the vestibular migraine is associated with throbbing headaches. The goals of treatment for vestibular migraines are to relieve symptoms during episodes, prevent future episodes, and improve overall quality of life. To achieve these goals, various medication types, therapies, therapeutic procedures, health behavior changes, and other treatments may be recommended, including:
Medication:
- Over-the-Counter Medications: Nonprescription drugs like ibuprofen and naproxen can help relieve migraine pain by reducing inflammation.
- Medications for vertigo: These include antihistamines such as meclizine, antinausea medications such as prochlorperazine, and benzodiazepines such as diazepam.
- Abortive Medications: These medications are used to stop the symptoms of a migraine when it occurs. Examples include triptans (such as sumatriptan), which works on the trigeminal nerves to change blood flow and reduce inflammation. Calcitonin gene-related peptide (CGRP) antagonists (blockers) are newer medications that may be considered for people with vestibular migraine headaches.
- Preventive Medications: These medications aim to reduce the frequency and severity of migraine headaches. Examples include beta-blockers (such as propranolol), antidepressants (such as amitriptyline), antiseizure medications (such as topiramate), and certain CGRP antagonists. These work by altering the levels of certain chemicals in the brain that help prevent migraines. Botulinum toxin injections may helpful for patients who have not responded to traditional therapy.
Health Behavior Changes:
- Behavioral: Changing lifestyle behaviors is often the first step in treatment. This includes adopting an adequate diet, maintaining good sleeping habits, engaging in regular physical exercise, and reducing stress levels.
- Trigger Identification and Avoidance: Keeping a symptom journal can help identify triggers more easily so they can be avoided. Trigger foods should be eliminated from the diet if they contribute to symptoms. Lifestyle factors like poor sleep should also be addressed.
It's important to note that treatment options may vary depending on individual needs and preferences. Working closely with a healthcare professional is recommended to determine the most suitable treatment plan for managing vestibular migraines effectively.
Vestibular migraines have a significant impact on daily life and activities:
- Individuals with vestibular migraines may experience difficulties at work or school due to sickness or absenteeism.
- Over 70% of people with vestibular migraines report that their symptoms have a moderate or severe impact on their daily activities.
Remember that it's always important to consult with a healthcare professional for proper diagnosis and guidance regarding your specific condition. They can provide personalized recommendations based on your individual needs and medical history.