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