The two most common causes of recurrent episodes of prolonged vertigo (lasting at least 20-30 minutes) are Vestibular Migraine and Meniere’s disease. Most practitioners make the distinction between the two by considering symptoms that accompany the vertigo attacks. Migrainuers often have visual complaints (increased sensitivity to light), and Meniere’s patient have unilateral auditory complaints (tinnitus, ear fullness, decreased and fluctuating hearing).
Researchers from California (UC Irvine) have posed a theory that Meniere’s may actually be a variant of migraine, suggesting that Meniere’s patients may benefit from migraine treatment instead of standard Meniere’s treatment. This is interesting to me because Meniere’s is poorly understood and not very responsive to treatment intended to regulate fluid pressure within the labyrinth. There are several theories regarding the cause of Meniere’s symptoms, but no one knows for sure.
They found a high overlap of migraine symptoms in patients that had previously been diagnosed with Meniere’s disease. They report that symptoms typically associated with migraine (such as increased “sensitivity to visual motion, light and sound, head motion, smells, weather changes or medication”) were present in 95% of patients that had previously been diagnosed with definite Meniere’s disease.
The theory proposed by Ghavami and colleagues involves repeated migraine type vasospasms in the small arteries feeding into the labyrinth and cochlea. They recommend treating Meniere’s patients with migraine medication, and report that this approach has been successful in their clinical trials.
This is attractive because treatments for migraine are not known for potentially toxic side effects, as are the most aggressive and effective treatments for Meniere’s disease.