Vestibular Migraine

March 6, 2017
Jim Carleton
The Vestibular Migraine Mystery 
 
The medical community is just now waking up to the high prevalence of vestibular migraine (VM). Current estimates vary but VM appears to affect up to 1- 3% of the general population. 10% of all migraineurs may suffer from VM. And more than 50% of people complaining of dizziness have VM. We are talking about millions of sufferers - many of whom remain undiagnosed. 
Vestibular migraine occurs when migraine disease affects the inner ear. Symptoms may include the following:
  • Trouble walking or standing (ataxia)
  • A sensation that you are spinning (internal vertigo)
  • A sensation that the world is spinning or moving abnormally (external vertigo)
  • Feeling sick with any movement, including those caused by a car, movie or computer (motion sensitivity, car sickness)
  • Feeling as if you are losing your balance or confused (lightheadedness)
An episode of VM can last from a few minutes to hours, or even weeks. If you are a sufferer, an ENT or Neurologist can help you to sort these symptoms out and arrive at a proper diagnosis. In general, the diagnosis of VM depends on a person describing his or her symptoms in detail, including the sensation (spinning, lightheaded, walking like intoxicated), its severity, its duration, any other symptoms, such as ringing in the ears, hearing loss or headache, and what activity brings on an episode. You need to tell your healthcare provider if you have any personal or family history of migraine disease. Your healthcare provider will need to rule out other causes. Unfortunately, at this moment, there is no definitive test that can identify VM. 
 
Here are some questions you might ask yourself if you are feeling dizzy: 
  • When you are dizzy, do you ever have a bad headache? Light or noise sensitivity?(If you answered YES to either of these questions, you may have VM because it is estimated that 50% of people with VM have a headache when they are dizzy.)
     
  • Do you have a brief spinning sensation (less than 15 seconds) when you turn over in bed? (If you answered YES, you are more likely to have a problem with the "crystals" in your inner ear. This condition is called benign positional vertigo)
     
  • Do you become disoriented or unsteady when walking down a long store aisle? (If YES, this is a typical symptom of VM)
     
  • When you have a sensation of spinning that lasts for hours, do you notice that you have a ringing noise in one ear, feel that the ear is blocked and cannot hear as well from that ear? (If YES, it is more likely that you are suffering from Meniere's disease. VM is not associated with having a hearing loss.)
 
Although there is still much to be learned about the best treatment of VM, most healthcare professionals follow the guidelines for treating traditional migraine disease. This is a trial and error process, selecting from changes in lifestyle (stress reduction, more routine sleep and meals), identification of triggers (with the help of diary and subsequent avoidance of triggers) and often the use of migraine supplements and medications. Vestibular rehabilitation can help. 
 
For an excellent description of VM and treatment options in detail, visit the Vestibular Disorders Association (VEDA) website
 
Another helpful article is " Recent Advances in the Understanding of Vestibular Migraine ". This current study covers pathophysiology including links to the trigeminal nervous system. It also includes more details about the diagnostic criteria of VM. 
 
VM is a new and helpful diagnosis that helps to explain the wide-ranging and long-lasting symptoms of vestibular dysfunction. VM underscores the principal that migraine disease is not all about headaches. And this new diagnosis has promoted better understanding and treatment of this perplexing condition.