When people first experience migraine, they’re often surprised to find that the sensation of pain can be accompanied by a host of other unpleasant ─ even debilitating ─ symptoms. These ill effects may include visual disturbances (aura); nausea and vomiting; sensitivity to light, noise or smell; neck pain; insomnia; tingling or numbness in the extremities…and vertigo.
Vertigo is the feeling that you or your surroundings are in motion when no movement is actually occurring.
Vertigo can be quite disorienting, rendering everyday activities difficult. For many people with vertigo, even standing up or walking is a challenge. Some report feeling as if they are spinning around or on a boat at sea. Others feel as if they are falling.
Migraine-associated vertigo is also known as vestibular migraine, migraine-related dizziness, or migrainous vertigo. It is believed to be caused by changes in how the vestibular system, part of the inner ear responsible for balance and spatial awareness, functions during a migraine attack. These changes are thought to induce a kind of "confusion" in the brain, manifesting as vertigo.
According to the American Migraine Foundation, migraine-associated vertigo affects up to 3% of the adult population, and five times more women than men. And even though migraine episodes tend to lessen with age, vestibular symptoms often worsen.
Vestibular migraines can be incapacitating, even more so than other types of migraines. The sensation of uncontrollable motion or dizziness can make it very difficult to carry out everyday activities. Injury from falling is a common occurrence during attacks, and a person with vertigo also may have serious difficulty driving or operating heavy machinery.
Some adults who experience migraine-induced vertigo have what is known as benign recurrent vertigo (paroxysmal vertigo in children). Those who present with true benign paroxysmal positional vertigo (BPPV) may continue to be affected even after their migraine has passed, in the form of short intense episodes of vertigo brought on by specific changes in head position.
An estimated 40% of people who experience migraines also experience vertigo at some point during the attack. For some, it is an occasional symptom; for others, a regular occurrence. The vertigo typically occurs during the migraine attack but may also be felt before or after the headache phase.
Interestingly, in some cases, vestibular migraine sufferers may not experience a headache at all. Vertigo may be their only symptom of a migraine attack or may be accompanied by symptoms like light sensitivity or nausea. Because vertigo is sometimes a person’s main symptom, that person’s migraine may be misdiagnosed, as the symptom doesn’t match certain criteria generally understood to pertain to migraine.
If you regularly experience vertigo, it's important to consult a physician for a proper diagnosis, based on your symptoms and medical history. Your doctor will inquire about your migraine history, other health conditions you may have, family history, and medications you're currently taking. They will also conduct a physical exam to check for other possible causes of your symptoms.
If your doctor suspects vestibular migraines, they will refer you to a specialist for further testing. For example, it is important for a medical professional to rule out Ménière’s disease, a disorder of the inner ear that may contribute to vertigo, hearing loss, and tinnitus (ringing in the ears). Migraine and Ménière's disease can have similar symptoms; however, an attack from Ménière's disease can last up to 24 hours, while vestibular migraine may last for days. Ménière’s disease is also associated with sensorineural hearing loss; vestibular migraine is typically not.
To differentiate one from the other, the specialist will consider whether someone with vertigo is exhibiting any other classic migraine symptoms, such as photosensitivity or nausea. Of course, it is possible to simultaneously have both Ménière’s disease and vestibular migraines, and doctors may treat for both conditions if Ménière’s disease is confirmed.
The exact cause and mechanism of vestibular migraines are not well known. However, triggers tend to be like those of normal migraine sufferers, including:
For some people, vestibular migraines may be triggered by moving their head in a certain way or by looking at specific patterns on the wall. Studies also show that people who tend to feel car-sick, air-sick, or seasick are more likely to experience vestibular migraines.
Treatment for migraine-associated vertigo must be tailored to the individual. The best approach is to work with your doctor to find an optimum treatment, which may involve trying a few options before you find something that helps. People with vestibular migraine may find relief from vertigo by taking medication to counteract the dizziness; however, that won't stop the pain of the migraine attack, just as migraine painkillers will not alleviate the vertigo.
Another approach is to treat the vertigo itself via vestibular rehabilitation exercises, often combined with a course of medication. Vestibular rehabilitation exercises are specific movements that help retrain your brain to process information from your inner ear correctly. These exercises can effectively reduce vestibular-related symptoms and help restore function. You can perform the exercises at home, but best results come when you work with a physiotherapist or other health professional who tailors them specifically to you.
For people with high frequency or intensity of migraines, prevention is usually preferable to treatment. And if you can prevent migraines, you may also be able to prevent the vertigo that may accompany them.
Prevention is possible through medication, lifestyle changes, or some combination. Medication to prevent migraines ─ beta-blockers, tricyclic antidepressants, calcium channel blockers, triptans, and anticonvulsants ─ work by stabilizing electrical activity in your brain and reducing inflammation.
Neuromodulation devices, such as the vagus nerve stimulator or the external trigeminal nerve stimulator, can also effectively prevent migraines by sending electrical signals to the brain to help regulate the activity of migraine-related nerves. For some people, the vestibular rehabilitation exercises covered earlier can help ease vertigo symptoms by retraining the brain.
And of course, as a course of migraine prevention, people who’ve identified their likely migraine triggers should avoid them to help prevent recurrence. Certain lifestyle changes may also help you avoid migraines, including:
Keep a migraine journal to help narrow down your potential migraine triggers. Note what happens before, during, and after each migraine episode ─ your symptoms, how long they last, and other relevant observations. Then use your journal to help you and your doctor identify possible triggers for your migraines, and to track the effectiveness of treatments you’re trying.
Migraine with accompanying vertigo can have a frustrating and energy-draining effect on your everyday life. The most important thing to remember: if you experience dizziness or motion sickness with migraine, be sure to see a doctor for a proper diagnosis and to help you find a treatment plan that works for you.
Headaches have different causes and triggers, and the best way forward is often through a specialized treatment program that considers the unique needs of the individual. Get in-depth information on how to prevent migraines from Mable’s team of migraine specialists.
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