Migraine is probably one of the least understood conditions that undermine people’s health and well-being. And yet, it is almost as common as high blood pressure and more common than asthma. 

According to the National Headache Foundation, almost 30 million Americans suffer from the condition. It affects more women than men, with most patients first experiencing migraine headaches between the ages of 20 and 40.

Not only is migraine misunderstood amongst the public, for some people it is also difficult to get an accurate diagnosis. Many end up treating themselves or being treated wrongly following a misdiagnosis. Common misdiagnoses of vestibular migraine include Meniere’s disease or Benign Positional Vertigo, which is cause by a disorder in the inner ear.

The situation is complicated because migraine presents so many variations, and while debilitating pain is a feature in the vast majority of cases, this is accompanied by many different symptoms that vary from person to person. Some people display symptoms of photophobia that is an extreme sensitivity to light, whilst others experience phonosentivity, which is an acute intolerance to noise.

It is thought that around 40% of migraineurs suffer from some vestibular dysfunction.

Vestibular Migraine Explained

Simply put, vestibular refers to a disruption in balance, often accompanied by a sense of dizziness or vertigo. This condition can exist alongside more common migraine symptoms, or it can manifest as a symptom by itself. For people who suffer this variant of migraine, the most disturbing feature is the dizziness rather than the actual pain.

The dizziness can reach alarming levels, with some patients saying they don’t even feel like they’re on the ground, and other describing a spinning sensation. Both can cause nausea or actual vomiting, with attacks lasting from a few minutes to several hours. In its chronic form, the sensation never truly goes away. Often, vestibular migraine occurs in people who have a migraine history.

Triggers of vestibular migraine are similar to those experienced by general migraine sufferers. They include hormonal fluctuations, food and drink triggers, and environmental changes in air pressure. Other similarities to migraine include photosensitivity with a reduced ability to focus the eyes, tinnitus accompanied by sound sensitivity, confusion, and a sense of spatial disorientation. Anxiety and/or panic attacks are also common associated symptoms.

Getting an Accurate Diagnoses

The complexities of migraine make it difficult to diagnose vestibular migraine, since the headache pain and the vestibular symptoms may not be present at the same time.

Some other conditions have similar symptoms and these must be ruled out before vestibular migraine can be accurately diagnosed. Conditions with similar symptoms include:

• Benign Paroxysmal Positional Vertigo (BPPV)
• Vestibular Nerve Irritation
• Transient Ischemic Attacks  (TIAs), also known as small strokes
• Meniere’s Disease
• Inner ear fluid leaks

Patients undergo various tests to help doctors understand exactly what is causing the condition, and sometimes a complicated mixture of causes confuses the diagnostic process. The International Headache Society has an international classification of headache disorders, which sets out the criteria used by neurologists and other specialists in the diagnosis of primary headache disorders.

Other variants of migraine headaches can include those which are brought on by exercise or post-traumatic headaches in patients who have suffered concussive injury. These variants are becoming more recognized, along with the possibility that sufferers may also develop vestibular migraines that are often harder to cope with than migraine pain. Other specialists who may be involved in the diagnosis of migraine associated vertigo include audiologists and vestibular rehabilitation therapists.  At present, there is no single way of testing for vestibular migraine although medical understanding is growing all the time.

How Is Vestibular Migraine Treated?

This migraine variant is treated similarly to other types of migraine.

Treatment includes both medication and lifestyle changes, and rehabilitation. Drugs such as meclizine may be offered to combat dizziness attacks that include nausea, with other drugs offered to either prevent or abort pain.

Vestibular rehabilitation may also be offered depending on the cause of the vertigo and dizziness. If rehabilitation is offered, it is generally recommended that any medication has already been started. Because vestibular disorders can be unpredictable, medical practitioners should also pay attention to any psychological consequences of the condition such as panic attacks or anxiety.

Natural preventative treatments may also be offered, with the patient expected to play their part managing their condition. Such preventative treatments include:

• Avoiding migraine triggers such as particular foods. This may include items like chocolate, cheese, and red wine.
• Taking moderate, appropriate exercise.
• Managing stress levels.
• Identifying hormonal changes such as those around menstruation in which case diuretics may help, as well as restricting salt intake.

For most patients, an accurate diagnosis coupled with appropriate consultations and medication along with recommended lifestyle changes results in a significant relief of symptoms.