Vestibular Migraine

Migraines are a common inherited form of severe headache, often on one side of the head.  Nausea and worsening with bright lights or loud noises is typical.  People with migraine are more sensitive to all sensations than other people, including sensitivity to motion, dizziness and pain.   Reduced blood flow in the brain can cause temporary malfunction of the affected area of brain, causing transient neurological symptoms, called aura, such as dizziness, tingling, visual illusions such as flickering lights in the eyes, or a blind spot in vision.

Vestibular migraine is a diagnostic name for dizziness in people with a migraine tendency or with a family history of migraine.  There will often be an increase in the number and severity of headaches during a flare-up, but sometimes dizziness is the only manifestation of migraine.  Severe motion sickness in children or adults is also an indicator of a migraine tendency.  Most people that will be prone to migraine first develop a flare of symptoms during puberty.  These symptoms are usually more severe in women and tend to worsen near the time of their menstrual period.  Because hormone changes worsen migraine, symptoms also increase near menopause and during pregnancy or after delivery.  Migraines tend to become less frequent after menopause unless hormone replacement is used.

If you have vestibular migraine, you may notice that your spells tend to vary in severity and duration from attack to attack.  Sometimes, your dizziness will be fleeting, only lasting for a second or two; at other times, it can last for minutes or hours.  There can be times when a feeling of motion sickness persists for days or weeks in a row.  Your dizziness may vary in quality, from a mild queasy feeling to sudden bouts of profound whirling dizziness.  It can be worsened by changes in head position, or can occur spontaneously, when your head is perfectly still.  The dizziness of migraine can occur instead of a headache or can be present just before or during the headache phase.

Because migraine episodes are often set off by environmental triggers, if these can be modified, the frequency and severity of your headaches can be reduced.  Lack of sleep (sleep apnea or night shift work), skipping meals, and exposure to strong stimuli (glaring or flashing lights, strong odors, loud noise, intense motion) can set off spells and you should avoid these when a flare-up of symptoms is occurring.  Hormone replacement should be stopped if migraine continue after menopause.  Certain foods contain natural chemicals that can worsen migraine; these include chocolate, red wine, fermented or aged products (such as cheese, pickled foods, and yeast), and the additive monosodium glutamate or MSG (found in certain Chinese and Mexican food sauces and mixes).  Daily stresses and weather changes may also set off your spells.

There are a number of medications that are effective in controlling both the headaches and dizziness caused by migraine.   Medications for migraine headache pain are not effective for controlling dizziness; it is necessary to take a prophylactic medication on a daily basis to reduce dizziness and the number of headaches that occur.  These can be obtained from a physician.  Once a dizzy spell begins, an over-the-counter motion-sickness medication such as meclizine or diphenhydramine can be used to reduce the severity of the dizziness and nausea.   B-vitamin and magnesium supplements can also help the symptoms. 

Many patients with inner ear damage also have a history of migraine.  This suggests that occasionally a migraine episode can damage the ear, but the risk appears to be small.  Watch for permanent hearing loss or ringing in just one ear, or a spell during which the room spins continuously for days.  If this happens, you should see a physician.

Sleep apnea can cause migraines to flare up and can cause its own form of dizziness. We’ll discuss these symptoms in the next post.

Published by Vertigone

I translate the medical world of dizziness for non-medical people

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