The Migraine Balancing Act: Vertigo & Vestibular Migraine

What am I talking about? Migraines that occur with severe dizziness or vertigo. You could be sitting down and suddenly your head starts to spin spontaneously. You might be walking down the corridor and lose your balance. Or you might just have moved too quickly and feel unsteady for an extended period of time.

What is a Vestibular Migraine?

Vestibular Migraine (Vertigo)

Vestibular migraines are migraine headaches which occur with dizziness, vertigo or imbalance. 

Vestibular migraine (VM) may also be called migrainous vertigo, migraine-associated vertigo or migraine-related vestibulopathy. 

The International Classification of Headache Disorders 3rd Edition (ICHD III) recognizes VM as an “episodic syndrome that may be associated with migraine”. It is currently listed in the appendix of the ICHD-III which means that if more evidence emerges it may be listed as an official migraine classification in the future.

In some cases, episodes may occur without the migraine headache itself and can be very disrupting for an individual.

What are the symptoms of vestibular migraine?

The vestibular system involves the inner ear which contributes towards our sense of balance, spatial orientation and movement. Problems that arise with the vestibular system commonly result in vertigo, dizziness or imbalance. 

The ICHD-III proposes the following set of vestibular symptoms associated with vestibular migraine (1):

  • Spontaneous vertigo. Including both internal vertigo; the false feeling that your body is moving, and external vertigo; the false feeling that your external environment is spinning or flowing.
  • Positional vertigo. Occurring after a change in head position.
  • Visually induced vertigo.  Caused by the movement of something visually complex or large.
  • Head motion-induced vertigo.  Due to movement of the head.
  • Head motion-induced dizziness with nausea. Refers to dizziness that feels like spatial disorientation.

Auditory symptoms, including hearing loss, tinnitus, and aural pressure have been reported in up to 38% patients with vestibular migraine. (2)

How long does it last?

The duration of attacks is highly variable. Episodes of dizziness can last a few seconds up to a few days (2).  

About 30% of patients have episodes lasting minutes, 30% have attacks for hours and another 30% have attacks over several days. The remaining 10% have attacks lasting seconds only, which tend to occur repeatedly during head motion, visual stimulation, or after changes of head position. (4)

Who experiences Vestibular Migraine?

40% to 70% of migraineurs will experience vertigo at some point but not necessarily with every attack. (2)

In most cases migraines occur earlier in life than VM (2). VM also arises more often in women than in men.

Janet Jackson, experiences this form of migraine. 

Why does vertigo occur in some, but not all people with migraines?

The mechanism of VM is not fully understood. There may be interactions between pain and balance pathways in the brain during attacks of VM that do not occur during typical migraine attacks. Any abnormalities in the inner ear of VM sufferers may also be causing balance problems. 

What triggers Vestibular Migraine?

The most common causes that have been associated with triggering vestibular migraines are:

  • Deficient sleep
  • Excessive stress
  • Menstruation
  • Specific foods (or trigger foods which may be specific to the individual)
  • Sensory stimuli
    • bright or scintillating lights
    • intense smells
    • intense noise
  • Lack of exercise 

Looking at complex patterns, bright computer screens, smelling wet paint, eating chocolate, not getting enough sleep, running late to an important event or meeting or drinking champagne are all common triggers of vestibular migraine (or migraine in general).

Are there any other disorders associated with vestibular migraine?

Those with VM are more likely to suffer from motion sickness. (5) There is a link between anxiety and VM. (5) Meniere’s Disease which is an inner ear disorder characterized by tinnitus (ringing in the ears), hearing loss, dizziness and ear pressure may also be linked with VM. (6) 

How to treat Vestibular Migraine?

In many VM patients, the attacks are severe, long and frequent enough to warrant treatment. Due to a lack of research and clinical trials for VM patients specific treatments have not yet been developed for Vestibular Migraine patients. This area is in need for further research and development.  

Currently, VM are treated much the same a standard migraine headaches. Acute medications such as Triptans or anti-inflammatories can be helpful for treating individual attacks whilst daily preventative medications can be used to reduce the frequency of attacks. (7) Physiotherapy may also be particularly helpful for VM patients.

How do you experience Vestibular Migraines?

No two migraineurs are exactly the same. Each experiences migraines differently. The same can be said for Vestibular Migraines. We can learn from each other's own experience, so help out another reader by adding your own experience VM in the comments below. 



SOURCES:

1) Headache Classification Subcommittee of the International Headache Society. The international classification of headache disorders: 3rd edition. Cephalalgia. 2013;33:629-808.
2) Lempert T. Vestibular Migraine. Semin in Neurol. 2013;33(3):212-218.
3) Hsu LC, Wang SJ, Fuh JL. Prevalence and impact of migrainous vertigo in mid-life women: a community-based study. Cephalalgia 2011; 31 (1) 77-83
4) Bisdorff A, Von Brevern M, Lempert T, Newman-Toker DE. Classification of vestibular symptoms: towards an international classification of vestibular disorders. J Vestib Res 2009; 19 (1-2) 1-13
5) Lempert T, Neuhauser H (March 2009). "Epidemiology of vertigo, migraine and vestibular migraine". J. Neurol.256 (3): 333–8. doi:10.1007/s00415-009-0149-2.PMID 19225823.
6) Cha YH, Kane MJ, Baloh RW. Familial clustering of migraine, episodic vertigo, and Ménière's disease. Otol Neurotol 2008; 29 (1) 93-96
7) Fotuhi M, Glaun B, Quan SY, Sofare T (May 2009). "Vestibular migraine: a critical review of treatment trials". J. Neurol. 256 (5): 711–6. doi:10.1007/s00415-009-5050-5. PMID 19252785.