When we think of migraine, we imagine the common symptoms of debilitating headache, aura, nausea, and poor tolerance of smells, sounds, and light. While these symptoms are indeed most commonly associated with migraine, many individuals also experience dizziness and/or vertigo (sensation of movement when still) with their migraine headaches. In some cases, people with migraine have no headache symptoms whatsoever and the only symptoms they experience are episodic dizziness and/or vertigo. This type of migraine is called a vestibular migraine. While there is currently no test available to diagnose vestibular migraine, there are signs and symptoms that point to this diagnosis and effective treatments available to relieve the symptoms of vestibular migraine.
The Vestibular Disorders Association (VEDA) reports that as many as 40% of individuals with migraine headache also experience dizziness and/or vertigo either at the time of a migraine headache, or completely independent of headache. Symptoms of vestibular migraine may include:
-dizziness (constant or episodic)
-motion intolerance with respect to head, eyes, and/or body
-spontaneous vertigo attacks (often accompanied by nausea and vomiting)
-diminished eye focus with photosensitivity
-sound sensitivity and tinnitus (ringing in ear)
-balance loss and ataxia (impaired coordination)
-cervicalgia (neck pain) with associated muscle spasms in the upper cervical spine musculature
-confusion with altered cognition often described as ‘brain fog’
These symptoms can be alarming and even debilitating. They can come on without warning and leave as mysteriously as they came, or can be relatively constant. Like migraine headaches, these symptoms may be triggered by certain foods or drinks, elevated stress levels, changes in weather, hormonal changes, dehydration, and lack of sleep.
Diagnosis of vestibular migraine typically involves a collaboration between medical professionals such as neurologists, otolaryngologists, audiologists, and vestibular physical therapists. This condition is a diagnosis of exclusion (other possible diagnoses should be ruled out before settling on a diagnosis of vestibular migraine) with testing including but not limited to MRI, vestibular function tests, video-oculography, balance testing, and audiological testing. Often with vestibular migraine, test results show a combination of both central and peripheral nervous system impairments in the vestibular system as well as balance impairments caused by an impaired ability to organize and process sensory information correctly.
Video-oculography assessment, like that available at Mainstay physical therapy, allows a practitioner to detect abnormalities in the vestibular system by blocking a patient’s vision while their eye movements are recorded using an infrared camera. These eye movements are a direct response to the functioning of the vestibular system. Characteristic abnormal eye movements associated with vestibular migraine are easily viewed with this type of testing and can help to strengthen the diagnosis of vestibular migraine. Video-oculography assessment can also serve to rule in or out other possible causes of vertigo and dizziness.
Effective treatments for symptoms associated with vestibular migraine include medication, trigger identification and management, stress reduction strategies, activity pacing strategies, vestibular rehabilitation with focus on activities that habituate the central nervous system to vestibular stimulation and improve head-eye coordination, balance training with focus on improving sensory selection and organization, manual therapy and dry needling if there is cervical spine involvement, nerve blocks or botox, and biofeedback.
With appropriate diagnosis, medical treatment, coordination of care, and skilled rehabilitation, patients can expect significant and long-lasting relief in their symptoms, regardless of how long they have been suffering or the severity of their symptoms.