Vestibular Migraine

Migraine, a disorder usually associated with headache, can cause several vestibular syndromes. Migraine is extremely common. Studies suggest that more than 20 million people in the United States suffer from migraine and that about 25 percent of these experience dizziness during attacks.

The International Headache Society classifies migraine disorders into several types. Migraine without aura consists of periodic headaches that are usually throbbing and one-sided, made worse by activity, and associated with nausea and increased sensitivity to light and noise. Vertigo can occur before, during, or separately from the episodes of migrainous headache. Migraine with aura, or classic migraine, is associated with short-lived symptoms (noises, flashes of light, tingling, numbness, vertigo, and others) known as the aura. These symptoms usually precede the headache and usually last 5 to 20 minutes. In a variation called migraine with prolonged aura, these symptoms may last a week. Migraine patients may experience migraine with aura on some occasions and migraine without aura on other occasions. Symptoms of basilar migraine include vertigo, tinnitus, decreased hearing, and ataxia (loss of coordination).

Several vestibular syndromes are caused by migraine. Benign recurrent vertigo of adults (not to be confused with BPPV, or benign paroxysmal positional vertigo) consists of spells of vertigo, occasionally with tinnitus but without hearing loss. Doctors must rule out other possible causes before making a diagnosis of migraine-induced vertigo. Benign paroxysmal vertigo of childhood (not to be confused with BPPV) consists of spells of imbalance and vertigo without hearing loss or tinnitus (ringing in the ears). The majority of cases occur between the ages of 1 and 4 but may occur up to age 10. Migrainous infarction or complicated migraine is a migraine with aura associated with a stroke (blood-flow problem resulting in cell death); one of the symptoms may be vertigo.

In addition to the syndromes caused by migraine, several vestibular disorders have been associated with migraine. Studies indicate that people with migraine are much more likely than other people to experience severe motion sickness and may be more likely to suffer from Meniere’s disease or BPPV.

Stress, anxiety, hypoglycemia, fluctuating estrogen, certain foods, smoking, and other factors can trigger migraine. Vertigo and imbalance secondary to migraine usually respond to the same treatment used for migraine headaches. Treatment of migraine includes eliminating from the diet substances known to trigger migraine attacks, such as chocolate, nuts, cheese, red wine, and other foods. Medications may also be prescribed.