Vestibular Migraines

What are vestibular migraines? 

Migraine is the second most disabling chronic disorder in the world. Approximately 55% of migraine patients experience vestibular symptoms at one time or another. Vestibular migraine is one of the most common neurological causes of vertigo among adults. It typically affects women in their 40s, especially those with a previous history of migraine headache. 

How are vestibular migraines diagnosed? 

According to the Barany Society and International Headache Society, the consensus diagnostic criteria for diagnosing vestibular migraine are: (1) at least five episodes of vestibular symptoms of moderate to severe intensity, lasting between 5 minutes to 72 hours; (2) with at least half of these episodes accompanied by at least one migraine symptom, which include (a) headache (with at least two features: unilateral, throbbing, moderate/severe intensity, aggravated by routine physical activity), (b) photophobia and phonophobia, or (c) visual aura; (3) current or previous history of migraine with or without aura; (4) not better accounted for by another diagnosis.

What are symptoms of vestibular migraines? 

Separate from the diagnostic criteria for vestibular migraines other symptoms may include neck pain, osmophobia (hypersensitivity to odors), neuropsychiatric symptoms (e.g., word-finding difficulties, trouble thinking, anxiety, depression), autonomic symptoms (e.g., diaphoresis, dry mouth, tearing, nasal congestion, diarrhea) and visual disturbances (e.g., visual snow, blurred vision). 

What causes vestibular migraines? 

Vestibular migraine attacks are often provoked by typical migraine triggers, including stress, weather changes, menstruation, sleep irregularities, missing meals, dehydration, bright lights, loud noise or motion sickness. Furthermore, migraine food triggers like caffeine, chocolate, and alcohol are also well-recognized.

How are vestibular migraines treated? 

The best approach to vestibular migraine treatment is a holistic, multidisciplinary plan that encompasses non-pharmacologic nutraceuticals, medications, lifestyle changes, vestibular rehabilitation therapy and addressing comorbidities. Vestibular rehabilitation (VRT) specifically for vestibular migraine typically consists of repeated vestibulo-spinal and vestibulo-ocular reflex training. Postural stability training relies on enhancing the visual and somatosensory system in order to help patients learn to use their remaining vestibular function and recover normal postural strategies that are efficient and effective.

Patient holding sticks and performing eye movements

 Patient performing CTSIB

Walking with head turns