Introduction:
The link between migraine and episodic vertigo has become very common in patients having migraine with aura. Many patients with migraine also have other additive symptoms besides headaches, like dizziness, vertigo, and loss of balance. The episodes of migraine associated with vertigo last from five to 60 minutes. As many causes can lead to symptoms of vertigo, it usually becomes very difficult to diagnose whether the vertigo symptoms are due to infections or it is associated with migraine.
What Is the Incidence and Prevalence of Migraine Associated With Vertigo?
Migraine associated with vertigo can affect people of any age, but it is seen more commonly among women than men. The prevalence of episodic attacks of vertigo in persons with migraine ranges from about one to two percent.
What Is the Cause of Migraine Associated With Vertigo?
The exact cause of vertigo attacks in migraine sufferers is still unknown, but some factors which are supposed to be responsible for vertigo episodes in migraine patients are:
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Genetics: Many studies reveal the link of vertigo symptoms in patients with migraine is mainly due to gene locus 5q35 or involvement of chromosomal factor 22q12/11q.
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Neuropeptides: Some studies have reported the involvement of calcitonin gene-related polypeptide (CGRP) in causing migraine associated with vertigo attacks.
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Stress and Anxiety: It can trigger vertigo symptoms in migraine patients.
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Poor Sleep Quality/Sleep Disturbances: It results in mental fatigue and can lead to migraine-associated vertigo.
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Trigger Factors: Migraine attacks can trigger by foods like cheese, excess caffeine, fermented dairy products, and alcohol.
What Are the Signs and Symptoms?
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Lightheadedness.
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Sensitivity to light and sound.
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The spinning sensation of the head (vertigo).
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Ringing sensation in the ear (tinnitus).
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Motion sickness.
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Nausea and vomiting.
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Loss of concentration.
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Severe headaches.
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Loss of balance.
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Aggravating symptoms due to physical activities.
What Are the Other Related Disorders?
Other disorders which have similar symptoms to migrainous vertigo which make the diagnosis difficult are:
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Meniere’s Disease: Meniere's disease is the most confusing entity, which makes the diagnosis of migraine-associated vertigo difficult as both disorders share a similar duration of vertigo episodes. Vestibular symptoms like fullness in the ear and gradual hearing loss differentiate Meniere's disease from migraine-associated vertigo.
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Benign Paroxysmal Positional Vertigo (BPPV): It also has many symptoms similar to migraine-associated vertigo, which makes it difficult to differentiate. Patients with benign paroxysmal positional vertigo have positional nystagmus (involuntary movement of eye muscles on changing head position) on testing, which differentiates it from migraine-associated vertigo.
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Migraine Anxiety Related Dizziness (MARD): It is a condition in which a patient has frequent episodes of dizziness due to anxiety. Symptoms get relieved by anti-anxiety medications.
What Are the Red Warning Signals of Vertigo?
Sometimes it is very difficult to differentiate whether the vertigo episodes are occurring due to other causes or it is associated with migraine. Some red warning signs that help to differentiate between the two are:
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Sudden hearing loss may be a sign of infection that needs immediate management.
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Loss of balance alone or with muscular weakness is a sign of vascular diseases.
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In Meniere's disease, there is gradual progressive hearing loss.
How to Diagnose Migraines Associated With Vertigo?
Various diagnostic factors for migraine associated with vertigo are:
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Clinical History: Patients with migrainous vertigo mostly complain of unilateral headache, severe headache, pulsating pain, and vertigo attacks lasting from five minutes to 72 hours. These symptoms help in giving an accurate diagnosis, so the complete clinical history of the patient should be recorded.
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Rotary Chair Test: In this test, a computerized controlled chair is used, and a patient is made to sit on the chair. The chair is rotated slowly towards gravity, and simultaneous eye muscle movements are recorded for the patient. This test helps in differentiating benign paroxysmal positional vertigo (which shows the involuntary movement of eye muscle with a change in head position) from migraine-associated vertigo.
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Audiometry (Hearing Test): This test is done to check the hearing efficiency of the patient. Any hearing loss present indicates the infection, which needs early intervention.
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Magnetic Resonance Imaging (MRI): It helps to rule out whether the vertigo symptoms are due to migraine or other causes. Magnetic resonance imaging is done to identify the presence of any cancerous or non-cancerous growth on the brain stem, which may be the cause of vertigo symptoms in the patient.
What Is the Treatment for Migraine-Associated With Vertigo?
Various treatment options to control episodes of vertigo in migraine are:
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Medicinal Therapy: Drugs like beta-blockers, calcium channel blockers, and anticonvulsants (Topiramate) are used to reduce migraine attacks. Drugs like Tryptans are prescribed to reduce the length of the attacks.
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Treatment of Underlying Cause: Benzodiazepines like Diazepam are used for treating underlying stress and anxiety.
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Avoid Trigger Factors: Trigger factors like alcohol, smoking, excess caffeine, dairy products, and fermented food should be avoided to prevent recurrent episodes of migraine.
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Vestibular Rehabilitation: It is a physical therapy that is advised to treat chronic balance dysfunction. This therapy trains the brain to avoid sensory triggers.
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Regular Sleep Schedule: Maintaining a regular sleep schedule to prevent any sleep disturbances is necessary to avoid frequent migraine attacks.
Conclusion:
Migraine-associated vertigo is very common and can affect people of any age. However, the episodes of vertigo are commonly seen in various disorders like Meniere's disease, benign paroxysmal positional vertigo, and basilar migraine, which makes the diagnosis of migraine-associated vertigo very difficult. The presence of red warning symptoms in the patient, like muscular weakness with loss of balance and partial or complete hearing loss, should not be confused with migraine-associated vertigo, and early intervention is needed in such cases.
Patients with migraine-associated vertigo have attacks lasting from five minutes to 72 hours. The diagnostic criteria for migraine-associated vertigo should always be kept in mind to rule out the exact diagnosis and differentiate it from other related disorders for early as well as effective management of the condition before it worsens.
