Vestibular Migraine Part I

For the next few weeks, we will discuss Vestibular Migraine (VM). VM has received a lot of attention in the past ten to fifteen years, but was rarely considered as a diagnosis for vertigo and motion intolerance before then. There are still many physicians who don’t consider this diagnosis, and some who are skeptical when the diagnosis is made by a vestibular specialist. This series will conclude with a reprint of a paper recently submitted by one of my students at West Virginia University as a class assignment.

Most people associate “migraine” with “headache.” While it is true that headache is a common symptom of migraine, it is not always part of the symptom complex. Migraine can cause episodes of vertigo (spinning), motion intolerance, nausea and spatial disorientation. Many patients with migraine are mistakenly diagnosed with sinus headaches or Meniere’s disease (an inner ear condition responsible for episodic vertigo).

Migraine is thought to be the result of a combination of two factors: 1. a dilation (enlargement) of certain blood vessels in the brain, and 2. the release of certain chemicals that are responsible for inflammation and pain. The inflammation can affect the sympathetic nervous system, triggering additional symptoms of nausea, vomiting and diarrhea.

Vestibular Migraine Symptoms

There are two typical presentations (and many atypical presentations) of vestibular migraine: 1. Episodes of vertigo lasting minutes to hours, often (but not always) accompanied by either headache, visual disturbance, sensitivity to light or sound, 2. Bothersome motion intolerance, frequently beginning in adulthood.

Migraine Triggers

While the exact mechanism of migraines may be uncertain, there are known triggers that may lead to a migraine attack. Hormonal changes, certain foods such a cheese, chocolate and red wine, stress; bright or flickering light; changes in atmospheric pressure; caffeine withdrawal; and disruption of sleep patterns have all been associated with triggering migraine symptoms.

Treatment
Migraine symptoms are typically not treated by ENT or Audiology specialists. If vestibular migraine is suspected, it is typically best managed by a Neurologist familiar with the variants and current treatments for migraine. The treatment is generally similar to treatment for classic migraine.

The above is obviously a simplistic and limited description (more details over the next few weeks). For those of you who want more detail now, click on this excellent review by Alexandre Bisdorff recently published in Therapeutic Advances in Neurologic Disorders

About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.