Vestibular migraine (also known as Migraine Associated Vertigo) is a migraine variant. It is a sense of general imbalance accompanied by vertigo or dizziness, sometimes leading to nausea and vomiting. Some people compare it to seasickness on dry land. During the vestibular migraine attack, the sick person may have difficulty processing head movement. Standing up, bending down, or looking up will trigger dizziness.
'Vestibular' means the involvement of a system in the inner ear that controls body balance. Despite the 'migraine' element in the name of the condition, often the sufferers do not experience severe headaches that characterize a migraine. However, just like typical migraine, vestibular migraine can be triggered by alcohol, spicy food, and caffeine.
Although it is the second most common cause of vertigo, vestibular migraine is a relatively new condition recognized only in 2012. Three-quarters of vestibular migraine sufferers are women, and it usually starts in their 40s. However, some people may begin experiencing mild attacks in childhood.
The causes of vestibular migraine are not entirely understood. The proposed mechanism of vestibular migraine involves the nervous system – the misfiring of nerves that lead from the vestibular system results in a temporary enlargement of the brain blood vessels. The brain has difficulty integrating the visual and auditory cues, which results in the sensation of spinning and dizziness.
The inner ear consists of the auditory and vestibular systems, so attacks of dizziness during a vestibular migraine occur due to an impairment in the vestibular system.
A common hearing-related symptom associated with vestibular migraine is tinnitus. Tinnitus is a constant sound in one or two ears – buzzing, ringing, clicking, or whistling. This sound is not external but registers due to the misfiring of the hearing nerve brought on by vestibular migraine.
Common symptoms of vestibular migraine may lead to misdiagnosis of Ménière’s disease, an inner-ear disorder. Not only that, but half of those who suffer from the condition experience episodes of vestibular migraine, too. Misdiagnosed patients receive drugs that reduce the intensity of vertigo, which are much less effective than migraine-specific treatments.
Vestibular migraine management strategies that reduce incidence of hearing loss and tinnitus include:
● Trigger avoidance
● Lifestyle changes
Avoid caffeine, nicotine, red wine, chocolate, aged cheeses, cured meats and food with MSG. It's also important to drink enough fluids and take regular exercise. Keeping a diary will allow you to identify triggers and avoid them.
Stress can make migraine attacks, including vestibular migraine, more likely to occur. Therefore, a healthy lifestyle will reduce the chance of vestibular migraine episodes.
It is vital to develop and maintain a sleep-associated routine that allows 7-8 hours of uninterrupted sleep. Avoiding electronic devices for a couple of hours before bed may improve sleep quality, too.
Regular moderate exercise such as walking, is proven to relieve stress and promote sleep. Moderate aerobic exercise such as yoga or Pilates will improve muscle tone and posture, which is especially crucial in alleviating vestibular disorders.
Medication for vestibular migraine sufferers is divided into preventative and medication to relieve migraine symptoms. Preventative medication is prescribed when the attacks are regular and significantly decrease the quality of life.
Proven anti-migraine therapies are a good way to avoid vestibular migraines and alleviating its symptoms – anti-migraine drugs include metoprolol.
If vestibular migraine symptoms include vomiting, then anti-vomiting drugs may be effective. Other types of drugs that may be effective are those that reduce blood pressure, as well as tricyclic antidepressants and anticonvulsants.
All of these should be prescribed by a doctor, which makes effective diagnosis especially important.
Vestibular Rehabilitation Therapy (VRT) is a specialized form of physical therapy. It is prescribed to people who experience dizziness, imbalance, or vertigo and includes people suffering from vestibular migraine. After assessing your balance, gait, mobility, and a full audiometric assessment an inner ear exam, the therapist will recommend a plan that will involve exercises designed to improve your sense of balance.
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