Vestibular Migraine: Symptoms, Causes, Treatment

What are the symptoms of a vestibular migraine?

Vestibular migraines, also known as migrainous vertigo, can present with a variety of symptoms, including:

• Vertigo: A sensation of spinning or dizziness that can be brief or last for hours.
• Unsteadiness: A feeling of imbalance or unsteadiness, often described as a “drunken” feeling.
• Nausea: Feelings of nausea or even vomiting may accompany the dizziness.
• Headache: Some people experience headaches, which can vary in intensity and may be unilateral or bilateral.
• Sensitivity to Light and Sound: Increased sensitivity to light (photophobia) and sound (phonophobia) during an episode.
• Aura Symptoms: Visual disturbances like flashing lights, blind spots, or zigzag lines, which are often seen in classic migraine auras.
• Hearing Changes: Ringing in the ears (tinnitus) or hearing loss may occur, though these are less common.
• Difficulty with Concentration: Problems with focus or cognitive function during or after an episode.
• Motion Sensitivity: Increased sensitivity to motion, which may worsen symptoms or trigger episodes.

These symptoms can vary greatly from person to person and may be accompanied by or occur in isolation from traditional migraine symptoms.

What are the causes of a vestibular migraine?

The exact causes of vestibular migraine are not fully understood, but several factors may contribute to its development:

• Genetics: A family history of migraines or vestibular disorders can increase the likelihood of experiencing vestibular migraines.
• Migraine Pathophysiology: Vestibular migraines are believed to involve the same mechanisms as other types of migraines, including abnormal brain activity and changes in neurotransmitter levels.
• Trigger Factors: Various triggers can provoke vestibular migraines, including:
• Dietary Factors: Certain foods or drinks, such as caffeine, alcohol, or aged cheeses.
• Hormonal Changes: Fluctuations in hormones, particularly in women, can trigger migraines.
• Stress: Emotional or physical stress is a common migraine trigger.
• Sensory Overload: Bright lights, loud noises, or strong smells can contribute.
• Sleep Patterns: Irregular sleep or lack of sleep can precipitate migraines.
• Weather Changes: Changes in weather or barometric pressure can be a trigger.
• Inner Ear Dysfunction: Issues with the inner ear or vestibular system, which helps control balance and spatial orientation, may play a role in the development of vestibular migraines.
• Cervical Issues: Problems in the neck, such as cervical spine disorders, may be associated with vestibular symptoms.
• Autonomic Nervous System Dysregulation: Abnormalities in the autonomic nervous system, which regulates bodily functions like heart rate and blood pressure, may be involved in migraine and vestibular symptoms.

Vestibular migraines often occur in individuals with a history of migraine, and they may be influenced by a combination of these factors.

What is the treatment for a vestibular migraine?

The treatment for vestibular migraine typically involves a combination of strategies to manage both the migraine and the associated vestibular symptoms. Here are some common approaches:

• Lifestyle Modifications: Identifying and avoiding migraine triggers, such as specific foods, stress, or sleep disturbances, can help prevent episodes.
• Dietary Adjustments: Maintaining a regular eating schedule and avoiding known trigger foods and beverages, such as caffeine, alcohol, and aged cheeses, can be beneficial.
• Medications:
• Acute Treatments: Medications to relieve symptoms during an attack, such as triptans (e.g., sumatriptan), anti-nausea drugs (e.g., meclizine), or over-the-counter pain relievers (e.g., ibuprofen, acetaminophen).
• Preventive Medications: Long-term medications to reduce the frequency and severity of migraines, such as beta-blockers (e.g., propranolol), calcium channel blockers (e.g., verapamil), antidepressants (e.g., amitriptyline), or antiepileptic drugs (e.g., topiramate).
• Vestibular Rehabilitation Therapy: Physical therapy focused on improving balance and reducing dizziness. This therapy may include exercises to help the brain adapt to and compensate for vestibular dysfunction.
• Cognitive Behavioral Therapy (CBT): A type of therapy that can help manage stress and anxiety, which may be contributing to migraine episodes.
• Lifestyle Adjustments: Regular exercise, good sleep hygiene, and stress management techniques, such as relaxation exercises or mindfulness, can support overall well-being and help reduce migraine frequency.
• Hydration: Ensuring adequate fluid intake to prevent dehydration, which can trigger migraines.
• Avoiding Triggers: Keeping a migraine diary to track symptoms and identify potential triggers can help in avoiding them and managing the condition more effectively.

Treatment plans should be individualized, as what works for one person may not work for another. Consulting with a healthcare provider, often a neurologist or headache specialist, is essential to develop an appropriate treatment strategy.