Migraine headache disorders do not always exclusively feature severe headache pain as the primary symptom, as is the case with vestibular migraines. A vestibular migraine, sometimes called migrainous vertigo, is described by the International Classification of Headache Disorders (ICHD-3) as a nervous system disorder dominated by dizziness and spontaneous vertigo symptoms.
Vestibular migraines are commonly experienced by those who already have a family history or genetic predisposition to classic and common migraines. Affecting men, women, and sometimes children (paroxysmal vertigo of childhood), vestibular migraines are experienced by 3% of adults, with the majority of sufferers being women.
Symptoms of Vestibular Migraine
While headache pain can accompany Vestibular migraines, it is not the primary symptom of episodes. Vestibular migraines are commonly reported to cause symptoms that affect balance and coordination, such as:
- Nausea & vomiting
- Phonophobia (sensitivity to sound)
- Photophobia (sensitivity to light)
- Osmophobia (sensitivity to smell)
- Recurrent Vertigo
- Cephalalgia (pain in the head, face, or brainstem)
These symptoms can occur individually throughout a vestibular migraine episode or be compounded together for a difficult experience to manage. Most often, symptoms will ease within a few hours and up to one day, but the duration of episodes can vary from person to person and fluctuate between episodes due to changes such as fatigue or stress.
Primarily, vestibular migraines are marked by their vertigo sensations. Vertigo is the sensation of movement that can cause those suffering from its effects to feel as though they are spinning, moving, or floating, leading to a loss of balance and motor coordination. Vertigo has the highest reported prevalence among those who suffer from vestibular migraines.
What Causes Vestibular Migraines?
While researchers are still searching for the specific neurological causes of vestibular migraines, a few known risk factors can increase a person’s chances of having an episode.
First and foremost, those who have a history of migraines in the past are naturally at higher risk for having a vestibular migraine.
Outside of a history of previous migraine attacks, vestibular migraines are also thought to be caused by:
- Stress & fatigue
- Serotonin imbalance
- Hormonal changes from menopause or menstruation
- Changes in the weather
- Postural hypotension
- Overconsumption of alcohol such as beer and red wine
- Food additives such as MSG
This list is not exhaustive and only covers the most common causes for vestibular migraines. Recent studies have discovered that vestibular migraine patients who suffer from anxiety and depression and those with a history of mental illness could also be more likely to experience vestibular migraines.
How to Diagnose Vestibular Migraines
The diagnosis of vestibular migraines starts with a visit to a neurologist or ENT health care professional. Each of these types of medical practitioners is trained in diagnosing headache disorders and can help individuals who are suffering determine if they are experiencing vestibular migraines.
Diagnosing vestibular migraines usually means ruling out other possible diagnoses that affect the inner ear, such as:
- Meniere’s disease
- Episodic Vertigo
- Benign paroxysmal positional vertigo (BPPV)
- Kinetosis (motion sickness)
Because of the comorbidity (or the presence of multiple diagnoses) in some individuals who suffer from vestibular migraines, it can be hard to identify whether a disease process is a secondary condition or a sign of one disorder.
In these cases, a patient may need additional tests to help confirm a diagnosis and rule out other potential causes. Confirming the diagnostic criteria of vestibular migraines can be done through:
- Neuro examination to test eye movement coordination, muscle strength, and other neurological functions
- Dizziness/balance tests which can include computerized dynamic posturography or electronystagmography
- Imaging studies such as CT scans or MRI of the brain
- Auditory tests to check for hearing loss
- Questionnaires that measure how dizziness affects an individual’s life for statistical analysis
Furthermore, to meet the criteria for having a migraine vestibular disorder, an episode must include:
- Spontaneously onset of vertigo attacks with nausea or vomiting
- At least one visual aura symptom (similar to a migraine aura)
- Increased sensitivity or pain to sound, light, or touch
- Vestibular symptoms lasting from 5 minutes to 3 days
- A minimum of 5 episodes with half of those episodes also having other migraine symptoms such as headache
Ensuring that the criteria are met helps neurology specialists rule out other potential diagnoses and helps confirm vestibular migraine diagnosis. Additionally, the medications used to treat vestibular migraines are specific to the condition. Attempts to treat a different condition misdiagnosed as vestibular migraines may only worsen the symptoms of individuals who suffer from this disorder.
Vestibular Migraine Treatment Options
Much like other types of migraine disorders, there are two types of treatments used to reduce or stop the effects of a vestibular migraine: preventive and abortive.
Preventative treatments are those that require chronic intake at regular intervals to reduce the chances of experiencing migraine-related vestibulopathy:
- Tricyclic antidepressants such as lithium, amitriptyline, and nortriptyline
- Vascular medications such as flunarizine
- Anti-seizure medications such as gabapentin or topiramate
- Natural supplements such as CBD oil (see Blessed CBD) and vitamins
- Beta blockers such as propranolol
- Calcium channel blockers such as triptans and sumatriptan
- Vestibular rehabilitation exercises
Abortive treatments are those that must be taken after the first signs of a vestibular migraine to stop it from progressing and, in some cases, to stop it shortly after it begins. These medications include:
- Non-steroidal anti-inflammatories
- Motion-sickness medications
- Antipsychotic medication such as prochlorperazine
In the event of vestibular migraine onset, migraineurs should avoid taking opioids and muscle relaxants, as well as abstaining from smoking or drinking alcohol. These are known to exacerbate vestibular symptoms and increase the intensity of the migraine.