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Vestibular Migraine/Migraine Associated Vertigo

For a quick overview of Vestibular Migraine click here.

For more detailed information click on links below:

Note: this information is sourced from Timothy Hain


Migraine Associated Vertigo is dizziness that is associated with a migraine headache condition. Dizziness and headache are individually very common human conditions and their combination is also a common symptom complex. Diagnostically, one must determine whether the dizziness and headaches are independent or related to each other, and in particular, whether they are a manifestation of migraine. Here we will review the association between vertigo and migraine.


Symptoms of Vestibular Migraine

Migraine without aura (about 80%) and migraine with aura (about 15 to 20%) are the most prevalent forms of migraine and also are the most prevalent types of migraine associated with dizziness and vertigo. Symptoms include true vertigo with or without nausea and vomiting, and motion intolerance. Headache is usual but not required. Auditory symptoms are common but usually bilateral. Hyperacusis is common in migraine, which may differentiate it from most ear disorders. When patients are examined acutely when vertiginous, there is usually minimal or no spontaneous nystagmus (jumping of the eyes). This provides a differential feature from most peripheral vestibular syndromes.


Causes of Vestibular Migraine

The underlying cause for migraine and thus migraine associated vertigo remains unclear. It is presently thought that migraine reflects the action of a common gene in the population, that is related to pain control, and also to a neurotransmitter called “serotonin”.


Diagnosing Vestibular Migraine

There are no diagnostic tests specific for migraine associated vertigo. The diagnosis is made by clinical history, or when the history is unclear, by a therapeutic response to treatment. A definite diagnosis of migraine associated vertigo can be made when patients have migraine with aura that is accompanied by concurrent episodes of vertigo, or when they have migraine without aura that is repeatedly associated with vertigo immediately before or during the headache.


Treating Vestibular Migraine

Eliminating food triggers and prophylactic treatment are the methods used most frequently in treatment. Patients are initially told to abstain from foods such as chocolate, cheese, alcohol, and MSG-containing preparations. If this is not successful, after a month, patients are started on verapamil, or a long-acting beta-blocker such as long acting propranolol or a tricyclic medication such as amitriptyline. Verapamil and amitriptyline are particularly useful because of their anticholinergic properties may help control vertigo independently of whether they are useful for migraine.



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