Vestibular Migraines: What are They and How to Treat Them
Migraines are more common in our culture now than they’ve ever been. They’re the 3rd most prevalent disease in the world and the 6th most debilitating one. They’re right up there with diabetes and hypertension. Even still, more than 50% of migraine sufferers are undiagnosed or grossly under-treated.
There are several types of migraines, and each migraineur has a unique constellation of symptoms and triggers. While some have infrequent attacks that come on because of a specific trigger, others have chronic migraine conditions that have no easily identifiable cause.
About 40% of migraineurs have a vestibular dysfunction in addition to their migraines, which means they experience dizziness and imbalance during attacks. Vestibular migraines are also referred to as migraine associated with vertigo, or MAV. Vertigo is just a fancy medical word for dizziness.
Since 40% is a pretty hefty percentage, I’d like to cover some of the basics:
- Causes and Symptoms
- Diagnosing vestibular migraines
- Treatment and prevention options
Vestibular Dysfunction and Migraines
Vestibular dysfunction means that you frequently get dizzy or lose your balance, and this can happen with or without a migraine syndrome. What’s interesting is that there seem to be some parallels between non-migrainous and migraine vestibular dysfunction, especially regarding the triggers.
Migraineurs and non-migraineurs with vestibular dysfunction share some common triggers, including:
- Hormonal fluctuations
- Weather changes
Diet changes and lifestyle modifications help to eliminate vertigo symptoms in migraineurs with a vestibular dysfunction.
Symptoms and Diagnosis of Vestibular Migraines
The clinical presentation of vestibular migraines includes:
- Motion sickness
- Loss of balance
- Nausea and vomiting with vertigo
- Sensitivity to light and sound
- Eye pain and/or blurred vision
- Neck pain
- Muscle spasms
- Confusion and impaired cognitive function
- Impaired spatial perception
No matter the type of migraine, the condition must be thoroughly investigated in the clinical setting using a combination of:
- Medical management
- Preventive treatments
- Comprehensive testing
- Rehabilitation techniques
The International Classification of Headache Disorders lists the following diagnostic criteria for vestibular migraines:
- At least five episodes fulfilling criteria C and D
- A current or past history of migraine with or without aura
- Vestibular symptoms of moderate or severe intensity, lasting between 5 min and 72 hr
- At least 50% of episodes are associated with at least one of the following three migrainous features:
- Headache with at least two of the following four characteristics:
- Unilateral location
- Pulsating quality
- Moderate or severe intensity
- Aggravation by routine physical activity
- Photophobia and phonophobia
- Visual aura
- Not better accounted for by another ICHD-3 diagnosis or by another vestibular disorder.
The most important aspect of diagnosing and treating vestibular migraines is in obtaining an accurate, detailed history of the condition and any genetic links. If you haven’t done so already, it’s time to start journaling the migraines.
The Migraine Trust offers a few good templates to start.
Treating and Preventing Vestibular Migraines
Some acute medications are used to treat vestibular dysfunction, which may also relieve migraine symptoms; however, it should be emphasized that these drugs should be used sparingly.
Your best bet is always in prevention – avoiding triggers and behaviors that exacerbate the condition. Some lifestyle changes to consider are:
- Restoring sleep to make sure you’re getting enough quality rest
- Exercise regularly
- Drink lots of water (eight to ten 8-oz glasses of water a day, at least)
- Try magnesium if your trigger is related to your menstrual cycle
- Practice stress coping techniques like meditation, reading, coloring, gardening, etc.
- Avoid common trigger foods like dairy, sugar, caffeine, and alcohol
As with any changes to your treatment plan, or if you don’t have a treatment plan, talk to your doctor first. Make sure he or she is willing to listen and work with you as a partner in health. You don’t need someone who is going to push your worries and symptoms aside in favor of his or her theories about your body. Migraines can be tricky to diagnose, and migraines associated with vertigo can be even more difficult. Remember to keep a journal of symptoms and triggers, as well as do your research and keep good notes. Your health is your responsibility. It’s time to take back control.
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