Vestibular migraine is a complex and often debilitating condition that combines symptoms of migraine headaches with vertigo and balance issues. This blog post will delve into what vestibular migraine is, the diagnostic criteria, and the various treatments available, including medications, lifestyle modifications, and therapy.

What is a Vestibular Migraine?

A vestibular migraine is a type of migraine that specifically affects the vestibular system, which controls balance and spatial orientation. Unlike typical migraines that primarily cause severe headaches, vestibular migraines can result in dizziness, vertigo, balance problems, and sensitivity to motion. These symptoms can occur with or without a headache, making the condition challenging to diagnose.

Diagnostic Criteria

Diagnosing vestibular migraine can be complex due to its varied symptoms. According to the International Classification of Headache Disorders, 3rd edition (ICHD-3) by the International Headache Society, the diagnostic criteria for vestibular migraine include:

At least five episodes with vestibular symptoms of moderate or severe intensity, lasting 5 minutes to 72 hours.
Current or past history of migraine with or without aura.
One or more migraine features with at least 50% of vestibular episodes:

Headache with at least two of the following characteristics

Unilateral location
Pulsating quality,
Moderate or severe pain intensity
Aggravation by routine physical activity.

Photophobia and phonophobia.
Visual aura.

Not better accounted for by another diagnosis.

Key Characteristics of Vestibular Migraine:

Dizziness and Vertigo: Patients often experience episodes of dizziness or vertigo, which can last from a few minutes to several hours.
Balance Issues: There may be a feeling of unsteadiness or imbalance.
Sensitivity to Motion: People with vestibular migraines may become more sensitive to motion, leading to increased dizziness when moving.
Headache: While headaches are not always present when they do occur, they typically resemble typical migraine headaches (unilateral, pulsating pain).
Nausea and Vomiting: Similar to other types of migraines, vestibular migraines can cause nausea and vomiting.
Visual Disturbances: Some patients experience visual symptoms such as light sensitivity (photophobia) and visual aura (flashing lights, zigzag patterns).

Causes and Triggers

The exact cause of vestibular migraines is not fully understood, but they are thought to involve a combination of genetic and environmental factors. Common triggers include:

Stress: Emotional stress can precipitate migraine episodes.
Hormonal Changes: Particularly in women, hormonal fluctuations can trigger vestibular migraines.
Certain Foods and Drinks: Foods like chocolate, caffeine, alcohol, and aged cheeses can trigger migraines.
Sleep Disturbances: Irregular sleep patterns or poor-quality sleep can be a trigger.
Sensory Stimuli: Bright lights, loud noises, and strong smells can initiate an episode.

Treatment Options

Managing vestibular migraine involves a combination of medications, lifestyle modifications, and therapy. The goal is to reduce the frequency and severity of symptoms and improve the patient's quality of life.

1. Medications:

Acute Treatment: Triptans, nonsteroidal anti-inflammatory drugs (NSAIDs), and antiemetics can be used to manage acute migraine episodes.
Preventive Treatment: Beta-blockers, anticonvulsants, and antidepressants are commonly prescribed to prevent migraine attacks. Medications specifically targeting vestibular symptoms, such as vestibular suppressants (e.g., meclizine) and benzodiazepines, may also be used.

2. Lifestyle Modifications:

Lifestyle changes can play a crucial role in managing vestibular migraine. Key modifications include:

Dietary Adjustments: Avoiding known migraine triggers.

Regular Exercise: Engaging in consistent physical activity to help reduce the frequency of migraine episodes.
Sleep Hygiene: Maintaining a regular sleep schedule and ensuring adequate rest. Download Sleep Hygiene handout here.
Stress Management: Techniques such as yoga, meditation, and biofeedback can help manage stress levels, which are often linked to migraine attacks.

3. Therapy:

Various forms of therapy can be beneficial for vestibular migraine patients:

Vestibular Rehabilitation Therapy (VRT): This specialized form of physical therapy focuses on improving balance and reducing dizziness through specific exercises. These exercises will typically include habituation exercises that include movements of the eyes, body, and or head that reproduce symptoms. These movements are then typically repeated at a tolerable level to improve one’s vestibular function.
Cognitive Behavioral Therapy (CBT): CBT can help patients manage the anxiety and stress that often accompany chronic migraine conditions.
Biofeedback: This technique involves using electronic monitoring to train patients to control certain physiological functions, such as muscle tension and heart rate, which can help reduce migraine frequency.

Conclusion

Vestibular migraine is a multifaceted condition that requires a comprehensive approach to diagnosis and treatment. By understanding the interplay between the vestibular system and migraine symptoms, healthcare providers can offer more personalized and effective care. Continued research and clinical innovation will undoubtedly enhance our understanding and treatment strategies for vestibular migraine, offering hope to those affected by this challenging condition.

References:

· Shen, Y., Qi, X., & Wan, T. (2020). The Treatment of Vestibular Migraine: A Narrative Review. Annals of Indian Academy of Neurology, 23(5), 602–607. https://doi.org/10.4103/aian.AIAN_591_19

· Smyth, D., Britton, Z., Murdin, L., Arshad, Q., & Kaski, D. (2022). Vestibular migraine treatment: a comprehensive practical review. Brain, 145(11), 3741. https://doi.org/10.1093/BRAIN/AWAC264

· Olesen, J. (2018). Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. In Cephalalgia (Vol. 38, Issue 1, pp. 1–211). SAGE Publications Ltd. https://doi.org/10.1177/0333102417738202

· Roberts, R. A., Watford, K. E., Picou, E. M., Hatton, K., Trone, T. H., & Brignola, E. Y. (2021). Effects of Lifestyle Modification on Vestibular Migraine. Otology and Neurotology, 42(10), E1537–E1543. https://doi.org/10.1097/MAO.0000000000003297

Navigating the World of Vestibular Migraine: Symptoms, Triggers, and Treatments