Vestibular migraine

Vestibular migraine or migraine-associated vertigo (MAV) is a common cause of dizziness and balance impairment. Benign recurrent vertigo is another term for this condition. In general it is estimated that 14% of the population suffers from migraine and that 1% of this patients have dizziness.

Aura in migraine

Aura in migraine

There seems to be a link between vestibular migraine, Meniere’s disease and motion sickness. Many patients with vestibular migraine are wrongly diagnosed with Meniere’s disease.

The exact mechanism of how migraine affects the brain is still debated. One of the theories is that it is due to the inappropriate sectretion of certain chemicals in the brain. In vestibular migraine a patient need not have a headache during the episode to make the diagnosis. Headaches can occur after a dizzy spell. In some cases a family member may also suffer from migraine which may point towards a genetic predisposition. Female gender, hormones, lack of exercise, poor sleeping patterns and stress can all contribute to the development of vestibular migraine. It can manifest as attacks of dizziness without hearing loss, positional dizziness  and motion intolerance. It is often mistaken for benign paroxysmal positional vertigo (BPPV).

Bright light and movement sensitivity in vestibular migraine

Bright light and movement sensitivity in vestibular migraine

Sometimes it can be triggered by certain odours. The patient may complain of photophobia (sensitivity to bright lights) and phonophobia (sensitivity to sound). Hearing loss is uncommon. Patients often have high tone tinnitus in both ears. The clinical examination may yield abnormalities.

Unfortunately there are currently no diagnostic test to confirm vestibular migraine. A MRI scan may be ordered to exclude other causes. Sleeping it off or lying in a dark room often helps. Something in the diet can be responsible for evoking the symptoms and modifying the diet by excluding some foodstuff or drink is a good way to commence treatment. Medication, often in combination and botolinum toxin injections help to control the symptoms and prevent attacks.

 

Further reading

Migraine-associated vertigo and dizziness as presenting complaint in a private general medical practice

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Migraine treatment

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