Vestibular Migrane

What is Vestibular Migraine?

The basic problem is that many patients who have migraine headaches also have vertigo or motion intolerance as part of their symptom complex.  However, if we were to focus on only their vertigo and motion intolerance, these patient’s symptoms do not fit into a clear pattern as seen with other inner ear problems such as Meniere’s disease, BPPV, or vestibular neuritis. 

So, about 15 years ago, groups of physicians that manage migraine (usually neurologists), and groups of physicians that manage inner ear/vestibular disorders (usually ENT physicians), proposed that there should be a new type of migraine – Vestibular Migraine.  Without getting technical, a patient who has recurring episodes of severe pounding headaches associated with sensitivity to bright lights and/or loud noises, nausea and vomiting, and recurring episodes of vertigo more than likely has Vestibular Migraines.

While we usually use the diagnostic studies to make sure there is not another vestibular (inner ear) disorder present, the clinical picture of a patient with Vestibular Migraine gets complicated by three problems:

• Many of these patients may also have spontaneous occurrences of BPPV;
• About 15% of these patients may also fit the diagnosis of Meniere’s Disease;
• About 30% of these patients may also have evidence for uncompensated vestibulopathy or permanent damage to the inner ear . 

Treatment for Vestibular Migraine usually involves lifestyle changes to avoid the usual triggers for migraines… poor diet, poor sleep, and lack of exercise.

One practical description could be:

 “There is an abnormal brain chemistry searching for trouble… so decrease the triggers.”

As a start, there are many ‘migraine diets’ that focus on trying to identify specific food triggers:

In addition, some patients may benefit from the use of medications to prevent the onset of Vestibular Migraines.  These prophylactic medications may include:

• B-blockers… propranolol
• Antidepressants… nortriptyline
• Anticonvulsants (seizure medications)…
  topiramate
• Selective serotonin reuptake inhibitors (SSRI)… venlafaxine
• Magnesium supplements

Each of these medications have side effects and are usually chosen based upon the patient’s other health issues… such as using a B-blocker (propranolol) in a patient with high blood pressure.

Lastly, patients having migraines that result in damage to the vestibular system may also develop an uncompensated vestibulopathy – permanent damage to the inner ear’s vestibular system – may benefit from the addition of Vestibular Rehabilitation.