Vestibular Migraines

By Abi Michels, Au.D., CCC-A. F/AAA

Migraines affect a large percent of the population. It is estimated that roughly 40% of migraine patients have accompanying vertigo at one time or another (1). Vestibular migraines are similar to migraines, but vestibular migraines do not always cause headaches. According to Johns Hopkins, vestibular migraines are not fully understood but may result from overlapping pathways that modulate pain and vestibular inputs into the brain (2).

Possible triggers of vestibular migraine may include:

• Hormonal fluctuations

• Barometric-pressure variations

• Sleep disturbance

• Stress

• Medications

• Foods including chocolate, cheese, alcohol, and MSG

Vestibular migraine can be difficult to diagnose since symptoms do not always include headache. The International Headache Society created the following criteria to help diagnose vestibular migraines (3):

• You have migraines or had them in the past.

• You have at least 5 episodes of vertigo that make you feel like you are spinning or moving. This isn’t the same as motion sickness or feeling faint.

• Symptoms last between 5 minutes to 72 hours.

• Your symptoms are moderate to severe. That means they stop you from doing everyday tasks or they’re so bad you can't do anything at all.

• At least half of the episodes happen with one of the following migraine symptoms:

1. A headache that has two of these characteristics: is one-sided, pulsing, moderate to severe, or gets worse with activity

2. Sensitivity to light or sound

3. Seeing shimmering or flashing lights in your vision

Patients with vestibular migraine are often seen by one or more of the following providers for evaluation and treatment; neurologists, otolaryngologists, internists, audiologists, and/or vestibular rehabilitation therapists. Management of vestibular migraine may include medication prescribed by your doctor, vestibular rehabilitation, and lifestyle modifications.

References:

1. Jeffrey Kramer, MD, Chief of Neurology, Mercy Hospital & Medical Center, Chicago, Illinois and Jim Buskirk, PT, SCS, PEAK & Balance Centers of America, Chicago, Illinois

2. https://www.hopkinsmedicine.org/health/conditions-and-diseases/vestibular-migraine

3. https://ichd-3.org/appendix/a1-migraine/a1-6-episodic-syndromes-that-may-be-associated-with-migraine/a1-6-6-vestibular-migraine/

4. Photo credit: https://www.theraspecs.com/blog/top-vestibular-migraine-symptoms/