Vestibular Migraines: Symptoms, Causes, and Treatment

Introduction

Have you ever felt like the room is spinning when you have a migraine attack?

Migraine and vertigo often go hand in hand in patients. This combination is known as migraine-associated vertigo (MAV) or vestibular migraine. Migraines are not just about headaches. Many migraine patients have other symptoms, too. These can include dizziness, vertigo, and loss of balance.

Since the causes of vertigo may vary, it is important to understand the underlying condition to rule out the diagnosis.

What Is a Vestibular Migraine?

Vestibular migraine is a type of migraine majorly associated with vertigo, affecting balance and coordination, which causes dizziness, lightheadedness, and balance issues during migraine attacks. These symptoms occur in episodes and can last from 5 minutes to 72 hours.

For a proper diagnosis, a patient must have:

• At least five episodes of vertigo.

• Episodes lasting from 5 minutes to 72 hours.

• Symptoms that are not caused by another condition, like ear infections.

Not everyone with migraines will experience vertigo, but for those who do, it can significantly affect their daily life.

Migraines are neurological conditions with different subtypes, such as classic migraine and vestibular migraine. However, both seem to be similar, but may have other symptoms.

Classic migraine can lead to severe headaches and vision problems. Meanwhile, vestibular migraine comes with balancing issues and dizziness. And may also have different triggering factors.

How Common Is Vestibular Migraine?

Vestibular migraines are more common than many people think. Studies show that about one to two percent of people with migraines also experience vertigo.

This condition can affect anyone, but is seen more frequently in:

• Women – Hormonal fluctuations may play a role in triggering symptoms.

• People with a family history of migraines.

• Individuals who are highly sensitive to light, sound, or motion.

Many people with migraines don’t know their dizziness is tied to their headaches. So, this condition is often missed in diagnosis.

What Are the Causes and Triggers of Vestibular Migraines?

Vestibular migraines mainly come with vertigo. The cause of this type of migraine is still under research. However, according to some studies, factors like genetics, hormones, or neurological disorders can be an underlying cause. At the same time, there are many triggering factors. However, it can also be noted that people with vestibular migraine may respond to different kinds of triggers.

So, common triggers are anxiety, stress, disturbances in the mental cycle, and even sleep disturbances, which can lead to dizziness and vertigo. Also, there is a list of food items that may trigger your migraine, like coffee, tea, cheese, fermented food, and processed food.

What Are the Signs and Symptoms of Vestibular Migraine?

Many symptoms can help in the diagnosis of vestibular migraine.

Some Common Symptoms -

• Spinning sensation.

• Balancing problem.

Migraine Associated Symptoms -

• Dizziness.

• Headache.

• A continuously ringing sound in your ear.

• Highly sensitive to light.

• Getting triggered by loud sounds.

• Vomiting.

• Facing problems while focusing.

There are some different symptoms like -

• Alice in Wonderland syndrome (in this condition, the objects appear larger, smaller, or farther away).

• Brain fog feels like trouble focusing.

• Excessive yawning.

• Pain over the scalp area.

What Are the Stages of Vestibular Migraines?

Vestibular migraine comes in different stages. The following are the stages.

1. Prodrome Stage - In this stage, a migraine attack can last for an hour or even a few days. It comes with anxiety, cravings, mood swings, fatigue, and other migraine-associated symptoms.

2. Aura Stages - Aura stages are defined as temporary neurological symptoms that occur before or during migraine attacks. They have common symptoms and some different symptoms, like Alice in Wonderland syndrome.

3. Attack Stage or Acute Episode Phase - This stage is considered the most intense and is very severe. It may last for a minute or days and have a major impact on your life. The symptoms are vertigo, vomiting, nausea, sensitivity to motion, and light and loud sounds.

4. Postdrome Stages - This is also called the recovery stage. It happens after a migraine attack and has symptoms like dizziness and mild to moderate headache.

How Are Vestibular Migraines Diagnosed?

Doctors use different tests to find out if vertigo is caused by migraines. These include:

1. Medical History

Doctors ask about symptoms to help make the right diagnosis. People with migraine-associated vertigo often have:

• Severe headaches (usually on one side of the head).

• Severe pain can be throbbing or pulsating.

• Episodes of vertigo are also seen.

A detailed history helps doctors rule out other causes of vertigo.

2. Rotary Chair Test

In this test, the patient sits on a computer-controlled chair that rotates slowly. Doctors observe eye movements while the chair moves. This helps tell the difference between:

• Benign paroxysmal positional vertigo (BPPV) causes your eyes to move without you wanting them to, when you change the position of your head.

• Migraine-associated vertigo (which does not cause these eye movements).

3. Hearing Test (Audiometry)

This test checks your hearing ability. If a patient has hearing loss, it could be due to an infection or another condition, not migraine.

4. MRI (Magnetic Resonance Imaging) Scan

An MRI scan helps doctors see if vertigo is caused by:

• Migraine.

• Brain tumor.

• Other neurological conditions.

This test is used if doctors suspect a serious underlying cause.

What Are the Dietary Adjustments for Migraine?

• Avoid the Food Items That May Trigger Migraine Attacks - Caffeine, chocolate, aged cheese, alcohol, and processed foods. Keeping a note of the triggering food items helps identify personal triggers and reduce migraine frequency.

• Identifying Your Triggers - Try to have a diet that suits you the most and helps to remove specific food sensitivities. Removing potential triggers for a few weeks and gradually reintroducing them can reveal which foods worsen symptoms. Common triggers are MSG, artificial sweeteners, and gluten.

• Stress Management - Stress can trigger migraine attacks. Yoga, meditation, and mindfulness practices promote relaxation, reduce tension, and improve overall well-being.

• Sleep Pattern - It is highly recommended to have a good sleep schedule, as lack of sleep and oversleeping can trigger migraines.

Certain supplements can help manage migraines:

• Magnesium.

• CoQ10.

• Vitamin B2.

• Ginger.

What Are the Treatment Options for Vestibular Migraine?

The treatment for vestibular migraine is similar to that for other migraine headaches. The following are the drugs indicated to treat vestibular migraine.

• Beta-blocker.

• Tricyclic antidepressants.

• Calcium channel blockers.

• Topiramate.

• Serotonin or Norepinephrine.

• Anti-seizure medications.

• There might be a possibility of an underlying disorder causing attacks. Medicines like Benzodiazepines are indicated to treat stress and anxiety.

• To prevent sleep disturbances, keep a regular sleep schedule. This helps avoid frequent migraine attacks. It is also recommended to stay away from your triggering factors.

Conclusion:

Vestibular migraine is very common and can affect people of any age. Vertigo can happen with Meniere's disease, benign paroxysmal positional vertigo, and basilar migraine. This overlap makes diagnosing migraine-associated vertigo quite challenging. Symptoms in the patient include muscle weakness, balance loss, and hearing issues. Early medical intervention will help in diagnosis and treatment.

Key Takeaway From iCliniq

iCliniq knows how tiring it would be to deal with such problems as vestibular migraines. You may get triggered by any of the factors, and the attack may last from minutes to hours, impacting your social, work, or personal life. But we at iCliniq offer the best treatment according to your symptoms and prognosis.