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Dizziness and headache: do you have vestibular migraine?

Vestibular migraine, a complex neurological condition, is a common form of dizziness that is often misdiagnosed. Did you know vestibular migraine is the second most common form of vertigo in adults?



Understanding Vestibular Migraine:

1. Defining Vestibular Migraine:

Vestibular migraine is a subtype of migraine characterized by vertigo, dizziness and problems with coordination in addition to other features of migraine. The hallmark of vestibular migraine is the involvement of the vestibular system, responsible for balance and spatial orientation. Vertigo is a sensation where even though you are stationary, the room feels like it is spinning, you feel like you are falling or you feel like you are moving. This feeling can occur at any point during a headache attack. It may also occur independent of migraine. In other words, individuals with vestibular migraine may experience vertigo in the absence of a headache. The diagnostic pearl here is that for vestibular migraine, there is a history of migraine and vertigo.


2. Symptoms:

In addition to classic symptoms of migraine including nausea, vomiting, sensitivity to light and sound, those with vestibular migraine will also experience vertigo or dizziness. This vertigo may occur even if the patient does not have a migraine attack. To fit the diagnosis of vestibular migraine according to the International Classification of Headache Disorders 3rd Edition, the patient should be a history of migraine and five episodes of dizziness or vertigo. Half of those five episodes of vertigo are associated with migrainous features.


3. Diagnosis Challenges:

Diagnosing vestibular migraine can be challenging due to its overlapping symptoms with other vestibular disorders including benign positional paroxysmal vertigo (BPPV). Clinicians need to consider the patient's medical history, conduct a thorough examination, and sometimes collaborate with specialists to rule out other potential causes.


4. Prevalence:

Vestibular migraine is believed to affect 3% of the adult population and occurs more commonly in women than men.


How is it treated?

1. Pharmacological Approaches:

Vestibular migraine is treated similar to migraine with medication being a common treatment modality. Abortive and preventative medications are commonly used along with botox. Additionally, neutraceuticals, such as magnesium, and neuromodulation devices may also be helpful.

2. Lifestyle Modifications:

Lifestyle changes that can minimize triggers are key components of both traditional and vestibular migraine management. Patients are encouraged to manage stress, maintain a regular sleep schedule, and identify and avoid specific food triggers.

3. Vestibular Rehabilitation:

Physical therapy and vestibular rehabilitation can be beneficial in managing symptoms and improving the patient's overall balance and stability. As an orofacial pain specialist focused on multidisciplinary care, I incorporate these approaches into many patients' comprehensive care plan.


Conclusion:

Vestibular migraine can be challenging to diagnose but with a multidisciplinary treatment plan, patients can find relief, and clinicians can navigate this complex condition more effectively. Through understanding, support, and ongoing research, the journey with vestibular migraine can be one of improved quality of life. The shared treatment strategies with traditional migraine underscore the interconnected nature of various migraine disorders, emphasizing the need for comprehensive, individualized care plans.

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