Vestibular migraine
Some individuals experience disabling dizziness or other balance symptoms during their migraine attacks . When patients have experienced severe dizziness or vertigo with several migraine attacks , they may be experiencing a specific type of migraine , vestibular migraine , or migraine-related vertigo . Patients with vestibular migraine generally experience some migraine attacks with disabling dizziness or vertigo , and other migraine attacks with no vertigo symptoms . They may also complain of attacks in which vertigo is the main problem and pain and other migraine symptoms are minor or may not even be present . Vestibular migraine may be more common than we think . Vestibular migraine occurs in about 1 in every 10 migraineurs .
Balance problems with vestibular migraine usually involve the symptom of vertigo . Vertigo is a feeling like you are spinning or the world around you is spinning when , in actuality , there is no movement . Vertigo can make walking difficult or impossible and people often become very nauseated with vertigo . The vertigo in vestibular migraine occurs as intermittent attacks . Between attacks , patients generally have no problems with their balance . Vestibular migraine is diagnosed when :
• You have been diagnosed with migraine
• You get spells of disabling vertigo that come and go
• Migraine aura , migraine pain , or sensitivity to noises or lights occur during at least some of your vertigo spells
• You do not have another cause for vertigo , such as Ménière ’ s disease ( see below )
Women are five times more likely to have vestibular migraine than men . In most cases , individuals report migraine attacks without vertigo for several years before developing vestibular migraine .
Vestibular migraine is treated using the same therapies that are used for other migraine types . Both acute
therapies ( such as the triptans ) and prevention therapies including verapamil ( Calan ), antidepressants ( amitriptyline [ Elavil ]), or topiramate ( Topamax ) have been shown to effectively treat vestibular migraine . Biofeedback has also been shown to be effective . In some cases , anti-vertigo agents , such as promethazine ( Phenergan ) or meclizine ( Antivert ), are used during attacks .
Ménière ’ s disease
Ménière ’ s disease is another condition with episodes of vertigo . Ménière ’ s disease represents an inner ear problem . Ménière ’ s disease attacks also include hearing loss and ringing or fullness in one of the ears . Some hearing loss can become permanent .
Unlike vestibular migraine , Ménière ’ s disease is not a special type of migraine . Although Ménière ’ s disease and migraine are two distinct syndromes , patients with Ménière ’ s disease ( about 50 to 60 percent ) also experience migraine .
Episodes of vertigo in Ménière ’ s disease may be treated with meclizine ( Antivert ), diazepam ( Valium ), or promethazine ( Phenergan ). Your doctor may also advise you to eat a low salt diet or may prescribe a water pill or diuretic to help reduce the frequency of Ménière ’ s attacks . In severe cases , inner ear surgery may be needed .
Although Ménière ’ s disease is an inner ear disease and migraine is linked with abnormal balance of brain chemicals and sensitivity of pain-producing nerves , it can often be difficult for physicians to distinguish between these two conditions . For example a recent study in the journal Neurology found that nearly half of people with Ménière ’ s disease experienced at least one migraine symptom during their attacks of vertigo . Often , physicians use response to treatment to help establish the diagnosis . For example , if typical Ménière ’ s disease treatment with a diuretic is ineffective , your doctor may try a migraine therapy like verapamil ( Calan ). If you respond to the migraine therapy , the doctor may determine that you
22 HEAD WISE | Volume 3 , Issue 1 • 2013