Introduction
Around 55% of people with migraines will at some point experience symptoms related to balance, like dizziness or vertigo. Many of these individuals might not even have headaches but mainly feel off-balance. They could be suffering from a type of migraine that affects the vestibular system. To help patients with vestibular migraine, doctors need to use a combination of medication, lifestyle changes, and rehabilitation techniques. This holistic approach can offer the most effective long-term relief for patients.
What is Vestibular Migraine?
Migraine is the second leading cause of disability in the world. It typically presents as a throbbing headache on one side of the head. It can also cause other symptoms, such as sensitivity to light and sound, nausea/vomiting, or an aura (a warning sign that a headache is approaching). Migraines can even make people feel dizzy or have vertigo. Vestibular migraine is a type of migraine and is the most common neurological cause of dizziness in adults. It primarily affects women in their 40s who have a history of migraines and/or motion sickness. Typical migraine triggers like stress, changes in weather or hormones, skipped meals, dehydration, and certain foods (like caffeine, chocolate, and alcohol) can provoke these attacks.
Diagnosis
To be diagnosed with vestibular migraine, patients must meet specific criteria, as outlined in the guidelines of the Barany Society and the International Headache Society. This includes having at least five episodes of dizziness/vertigo that last from 5 minutes to 72 hours that are accompanied by migraine symptoms, like headache, sensitivity to light/sound, or aura. Patients with vestibular migraine often mention feeling dizzy or off-balance, and even when they do have headaches, they might not be as uncomfortable as the dizziness. Other common symptoms can include neck pain, brain fog, anxiety, and visual disturbances. These symptoms must not be due to another vestibular disorder, like benign paroxysmal positional vertigo (BPPV), persistent postural perceptual dizziness (PPPD), Meniere’s disease, or Mal de Debarquement syndrome (MdDS), which people with migraine are at higher risk.
To diagnose vestibular migraine, patients typically consult various healthcare specialists, including neurologists, otolaryngologists, audiologists, physical therapists, and vestibular therapists. Often, patients with vertigo are initially seen in emergency departments or by their primary care providers. While diagnosis is primarily based on symptoms, additional tests are frequently performed to rule out other conditions, such as a brain MRI, vestibular tests, or hearing tests. Tracking symptoms using questionnaires can help healthcare providers understand the impact of dizziness on a patient’s daily life and guide treatment.
Treatment
The best way to treat vestibular migraine is through multiple different approaches, such as vitamins, lifestyle changes, medications, and vestibular therapy to improve balance. Helpful supplements include riboflavin, magnesium, vitamin D3, melatonin, and coenzyme Q10. Regular exercise, stress management, consistent mealtimes, and good sleep are also important, while avoiding common triggers such as caffeine, alcohol, and processed foods. For those with frequent or severe migraines, preventive medications such as certain antidepressants, anti-seizure drugs, beta-blockers, and newer CGRP treatments may be helpful. During migraine attacks, rescue treatments like triptans, anti-nausea drugs, and pain relievers can provide relief. Vestibular rehabilitation therapy (VRT) can also help to improve balance and reduce dizziness. It includes specific exercises tailored to the patient. People with vestibular migraines often deal with other health issues, like neck pain, tinnitus, or mood disorders. These can be treated through therapy, specific exercises, or referrals to specialists if needed.
Summary
Vestibular migraine is a condition that affects many people and can be hard for doctors to figure out. It is often misdiagnosed, so healthcare workers need to learn more about it. Managing vestibular migraines effectively requires teamwork among the patient, doctors, and other healthcare professionals.
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