Vestibular Migraine- Symptoms & Treatment

By Dr. Pallavi Sharma

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Migraine headaches are caused by changes in the blood vessels of the brain. It is a neurological disease that can cause severe headaches.

It is defined as an attack of severe pain, usually on one side of the head, and is often accompanied by nausea and sensitivity to light, sound, or smell.

Migraine attacks vary in duration from 15 minutes to 72 hours. The causes of migraine are not fully understood, but they appear to be due to abnormal changes in brain function in response to changes in blood flow through the brain.

One theory is that migraine headaches occur when there is an imbalance between oxygen supply and demand in the brain due to abnormalities in vasoconstrictive mechanisms that govern blood flow through the head.

Another theory involves abnormalities in glutamate neurotransmission that may lead to excessive release of glutamate, which may then trigger excessive firing of neurons in the brain, causing pain signals.

Everyone doesn’t experience migraines the same way. There are deviations in symptoms that have been observed in people from time to time.

Vestibular migraine is an atypical migraine that is seen among the migraine population.

Vestibular migraine: What is it?

Migraines that occur in response to stress, anxiety, or another mental health issue can cause vestibular migraines. Other triggers include extreme temperatures, dehydration, lack of sleep, and too much caffeine.

The symptoms of these migraines typically include nausea, vomiting, and sensitivity to light and sound.

Vestibular system is affected in vestibular migraine. It’s characterized by symptoms that involve the inner ear, including a sense of dizziness, nausea, and tinnitus. Vestibular migraine is more common in women than in men.

It is called migrainous vertigo or migraine with vertigo.

The headache is not an essential symptom of vestibular headache.

Causes of Vestibular Migraine

  • Genetics: vestibular migraine is commonly seen among families and it has a family history.
  • Overlapping nerve pathways: Some believe that there are overlapping nerve pathways of the trigeminal and vestibular nerves that can cause symptoms of vertigo with a headache.

Risk factors

The incidence of vestibular migraine is 1–3% in the general population.

  • Age: Vestibular migraines are more common in people over 40 years old.
  • Sex: Females are three times more likely to get vestibular migraines than males.
  • Family history of migraines: About 10 percent of people with a family history of migraines may also have a family history of vestibular migraines.
  • Childhood history: Children who have motion sickness or sensitivity have a risk of developing vestibular migraine later in adulthood.

Triggers for Vestibular Migraine!

Vestibular migraine is a type of migraine that occurs when the brain detects motion or movement in the inner ear. The condition can be extremely painful, and it can cause dizziness and nausea.

  • Vestibular migraines can be triggered by noises, light, or motion, or in some cases, all three.
  • Food: chocolate, cheese, food additives
  • Stress, anxiety, emotional changes
  • Dehydration
  • Hormonal changes (menstruation, menopause, and pregnancy)

Symptoms of Vestibular Migraine

Vestibular migraine is a type of migraine with an aura, which means that the first symptom of the condition is usually a visual disturbance.

The second symptom is often a feeling of dizziness or spinning.

  • A third and final symptom may be nausea and vomiting.
  • Ear-ringing, fullness, and pressure
  • Irritability
  • Difficulty in tolerating lights, sounds, and strong smells.
  • Cranial allodynia: highly sensitive to touch
  • Photic allodynia: highly sensitive to light
  • Sensitivity to motion, balance, and unsteadiness
  • Sensitivity to Smell

How to Diagnose Vestibular Migraine?

Vestibular migraine is a severe type of migraine that affects the head, neck, and eyes. It’s not fully understood what causes it, but it is thought that it may be caused by a problem with the brain’s vestibular system.

Vestibular migraines are sometimes confused with labyrinthitis and other forms of migraine. However, there are differences between them.

Vestibular migraines result in pain that starts in the head and spreads to the neck and back of the head. They can last for hours or days at a time and may be accompanied by nausea and vomiting.

Your doctor will ask you questions about your symptoms, conduct an exam of your head and neck area, and may order an MRI scan of your brain or spinal cord to confirm a diagnosis.

From the main complaint, vertigo, you might be directed to an ENT specialist first and then to a neurologist after no pathologies have been found from the ENT point of view.

Key factors in diagnosis:

  • History of migraine
  • Having at least five episodes of headaches
  • Experiencing vertigo or dizziness with each episode
  • Appear either headache or migraine related symptoms with vertigo

Other differentials of diagnosis

  • Meniree’s disease
  • Labyrinthitis
  • Transient Ischemic Attack or Stroke
  • Benign Paroxysmal Positional Vertigo (BPPV)

Vestibular migraine can coexist with the above diseases as well.

Treating Vestibular Migraine

There are several treatments available for vestibular migraines:

Medications

The first line of treatment for vestibular migraine is a variety of over-the-counter medications specifically, triptans such as sumatriptan or rizatriptan.

These medications work by blocking chemicals in your brain that stimulate the trigeminal nerve, which is responsible for triggering migraines and other types of headaches.

For pain relievers and NSAIDs, Tylenol may be helpful.

Other preventive medications are antiepileptics (Valporate, topiramate), calcium channel blockers, etc.

Neuro-stimulation Therapy

This uses electrical impulses to stimulate areas of your brain that are responsible for balance, as well as other parts of your nervous system, such as the vagus.

You’ll need to wear a small device on your head for about 30 minutes at a time every day for about six weeks. This type of therapy has been shown to help some people who experience vestibular migraines return to normal activity levels within one month after starting treatment.

Botulinum Toxin Injections

Injections of Botox have also been used as a treatment option for people who experience vestibular migraines because they help reduce muscle spasms in the muscles around the eyes and in the eyes themselves.

A doctor will inject Botox directly into these muscles. This may help relieve some of the pain associated with these migraines as well.

Great Occipital Nerve Block

Injecting a local anesthetic around the greater occipital nerve is used as a short-term reliever and preventer of migraine.

Vestibular migraines are caused by a problem with your inner ear nerve system. The most common cause is an infection in the vestibular nerve, the branch of nerves that connects your inner ear with your brain. This can occur when there’s inflammation or infection in this area of your body.

Prevention Tips

To prevent vestibular migraine, follow these tips:

Caffeine

Reduce or eliminate caffeine from your diet.

Caffeine is a vasoconstrictor and can cause symptoms of vestibular migraine, such as dizziness and nausea.

Stop Smoking

Smoking can increase the risk of developing vestibular migraine by increasing blood pressure, which can lead to dizziness and nausea.

Exercise Regularly

Exercise helps with circulation and may help decrease symptoms caused by an imbalance in the fluid levels within your body, particularly if you are prone to dizziness or vertigo (optic neuritis).

Yoga for Migraine

Yoga as a treatment for migraines has been popular for many years now due to its ability to reduce stress levels and improve moods, thus reducing anxiety levels, which can be directly related to migraine sufferers experiencing more intense headaches during stressful events or periods.

When to See the Doctor

The diagnosis of vestibular migraine is based solely on history-taking and excludes all other conditions. Thus, maintaining a headache diary will help the doctor diagnose vestibular migraine.

If the headache is accompanied by the following symptoms, it might indicate another cause rather than a bed.

  • Fever
  • muscle wasting.
  • Diplopia
  • Confusion
  • Severe headache

These symptoms might indicate a sinister pathology. Thus, brain imaging (using CT or MRT) might be necessary.

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TeleHealthDoc articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Dr. Pallavi Sharma

Dr. Pallavi Sharma is one of Melbourne’s best, well respected cosmetic doctors and aims to provide longstanding anti-aging benefits for her clients. With over 11 years experience in Performing cosmetic procedures, Dr. Sharma has lectured medical professionals regarding cosmetic treatments and is heavily involved in providing up to date cosmetic treatments to her clients and friends.
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