Vestibular Migraine briefly made the news in 2008 when Janet Jackson canceled her tour due to this particular type of Migraine. Otherwise, Vestibular Migraine is relatively unheard of in the public sphere, and it is often underdiagnosed and misdiagnosed. In his 2017 interview on the Migraine World Summit, Dr. David Dodick of Mayo Clinic indicated that “vestibular migraine may be much more common than we ever realized.”
THAT DIZZY IMBALANCE YOU FEEL MAY BE AN IMPORTANT CLUE TO DISCOVER YOUR TRUE MIGRAINE TYPE DIAGNOSIS.
Vestibular Migraine is a type of Migraine characterized by vertigo, dizziness, and balance disturbance along with more typical migraine symptoms.(1). “Vestibular” references a part of the inner ear called the vestibule, which affects your sense of balance. You may have heard Vestibular Migraine referred to as Migraine-associated vertigo (MAV) or migrainous vertigo, although the International Headache Society recognizes “Vestibular Migraine” as the most accurate, up-to-date term. (2)
VERTIGO TURNS LIFE INTO A BALANCING ACT
The association between Migraine and dizziness has long been understood, but Vestibular Migraine has only recently been recognized as an independent diagnosis. Researchers estimate that somewhere between 30-50% of people with Migraine have experienced vertigo, dizziness, or balance disturbance with at least one migraine attack, and it has been estimated that up to 1% of the population has Vestibular Migraine. (3)
How do you know if you’re experiencing vertigo? The final scene of Alfred Hitchcock’s thriller Vertigo offers a fairly accurate representation of the sensation. In the film, actor James Stewart experiences an unsettling spinning sensation and extreme dizziness when he is forced to confront his fear of heights. In medicine, vertigo is a condition characterized by spells of such dizziness and spinning. Vertigo is a symptom of Migraine, and medical research confirms that Migraine is the most common cause of vertigo in children (4)
Can you relate to Hitchcock’s representation of vertigo? Do you ever feel like you’re dizzy or spinning during a migraine attack? Do you feel as if you are rocking or in motion even when you are still? You may consider talking to your doctor about your symptoms, so she can explore the possibility of Vestibular Migraine.
SIGNS AND SYMPTOMS OF VESTIBULAR MIGRAINE
This variant of migraine is often misdiagnosed as Ménière’s disease, another disease characterized by vertigo. Diagnosing Vestibular Migraine is challenging because you first must rule out other causes of vertigo like structural abnormalities.
According to the International Headache Society’s diagnosis system, the ICHD-3, the diagnostic criteria for Vestibular Migraine is as follows: (5)
A. At least five episodes fulfilling criteria C and D
B. A current or past history of 1.1 Migraine without aura or 1.2 Migraine with aura
C. Vestibular symptoms (i.e. vertigo) of moderate or severe intensity, lasting between 5 min and 72 hr
D. At least 50% of episodes are associated with at least one of the following three migrainous features:
1. headache with at least two of the following four characteristics:
a) unilateral location
b) pulsating quality
c) aggravation by routine physical activity
d) moderate or severe intensity
2. photophobia and phonophobia
3. visual aura
E. Not better accounted for by another ICHD-3 diagnosis or by another vestibular disorder
4 SIGNS YOU HAVE VESTIBULAR MIGRAINE
In other words, the following four signs point to Vestibular Migraine: (6)
1. Do you experience dizziness that can even be categorized as vertigo?
2. Do the vestibular symptoms last 5 minutes to 72 hours?
3. Do you have underlying Migraine or Chronic Migraine – with or without aura?
4. Are at least half of your migraine attacks associated with one or more of the following:
- unilateral location
- pulsating quality
- moderate/severe intensity
- aggravated by physical activity
- photophobia and phonophobia or sensitivity to light and sound
- visual aura
If you can relate to the symptoms detailed in this article, it is important to speak with your doctors. Many people with Vestibular Migraine are not diagnosed or misdiagnosed.
TREATMENT OPTIONS OF VESTIBULAR MIGRAINE
If you experience symptoms of vertigo or dizziness, you do not have to rely on self-treatment. Treatment for Vestibular Migraine is similar to that for Migraine. A combination of prescription medication, vestibular rehabilitation therapy, and lifestyle changes are often used under the supervision of a physician. Regular migraine maintenance; such as avoidance of triggers including sleep, diet, stress, environment and exercise are also recommended.
COMMENTS? DO YOU EXPERIENCE DIZZINESS OR VERTIGO DURING MIGRAINE ATTACKS? HAVE YOU BEEN DIAGNOSED WITH VESTIBULAR MIGRAINE?