Both Migraine and Vestibular Dysfunction affect a large percentage of the population, so it stands to reason that there is a subgroup of people that have both. I am not talking about vestibular migraine here. I am thinking about people with a long, established history of classic migraine headaches, that coincidentally suffer for a vestibular event such as BPPV or Vestibular Neuritis.

Do migrainuers suffer and recover differently from common vestibular disorders? I think they do, but I only have anecdotal evidence.

Think about how migrainuers overreact to motion and visual motion. Think about how they react to and very much dislike vestibular testing. Think about the high incidence of migraine in those diagnosed with Mal de De Barquement Syndrome, which is characterized by poorly adapting to repetitive motion on a boat, etc.. Why wouldn’t they have a more difficult time recovering from a vestibular disorder?

In 2000, Whitney et al published a study demonstrating the migrainuers with vestibular disorders do benefit from Physical Therapy, and that migrainuers show more improvement if their migraines are medically managed.  Yet, they came away with the same question. Is there a difference between migrainuers and non-migrainuers in how they recover from vestibular injuries? The final word is still out on that one.

One particular patient comes to mind. She had a long history of marginally controlled migraine, then was diagnosed and treated for BPPV. By the time she got to us, she was no longer having positional vertigo (negative Dix-Hallpike), but she complained of ongoing motion intolerance, nausea and disorientation that started when the positional vertigo started. It makes me wonder if she had a maladaptation to the positional vertigo as a result of her migranous nature.

Dr. Charles Della Santina

Last week, I attended a conference at Johns Hopkins in Baltimore, MD. It was described as a ‘Vestibular Master Class”, and I agree that the information and faculty were as good as it gets. There was a fairly international attendance, and many of the top people in the United States and Canada were present. These types of conferences are very helpful, not only for the presented information, but also for the little tidbits you learn from speaking with others with similar or greater experience. 

The most fascinating presentation to me was done by Dr. Charles Della Santina from Hopkins. He presented on the current status of a vestibular prosthesis that is currently in clinical trials. He has implanted three patients so far, with encouraging results. The prosthesis is reminiscent of a cochlear implant, in that energy is converted into electrical impulses that are then delivered to the inner ear. With a cochlear implant, sound waves are converted to electricity, and sent to the cochlea (the hearing part of the inner ear). With the Labyrinth Prosthesis, movement is converted to electricity, and sent to various sensors within the labyrinth.  Electrodes are inserted into the motion sensors in each of the three semi-circular canals, while a motion sensor worn on the head registers movement and converts the movement into electrical impulses.

He showed video of the surgery (Amazing!) and video of patients that could detect motion based on changes in electrical currents sent to the electrodes. When the horizontal canal was stimulated, they would register horizontal movement, measured by the patient moving a light bar in the direction of perceived movement. The same was true of posterior and anterior canal stimulation.

The three patients implanted so far are doing so well that the FDA actually loosened up their requirements so the patients could continue to use the implant, as the original application only allowed temporary use of the implant on a trial basis. One of the patients actually sent Dr. Della Santina video of him running on a treadmill.

For more information, you can get on the Johns Hopkins website. If you are interested in the possibility of participating in the trial, click here for an application.