have vestibular migraine instead of Ménière’ s disease.
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 diuretic( water pill) to help reduce the frequency of Ménière’ s attacks. In severe cases, inner ear surgery may be needed.
“ Treatments that target balance disorders combined with migraine therapies may be helpful in the management of disabling balance problems …”
What’ s the take-home message?
Dizziness and vertigo can occur from a broad range of health conditions, including migraine. They can also occur when you have an infection, chemical or hormonal imbalances, and anemia. Dizziness and vertigo can be caused by problems in your ear, your brain, or other organs. Because dizziness and vertigo can occur with so many disorders, it is important to contact your physician when you experience these symptoms or if your chronic balance symptoms become worse.
If you experience migraine, you are more likely to also have problems with dizziness and vertigo. At times, the dizziness or vertigo may be part of your migraine episode, as in the case with vestibular migraine. Occasionally, dizzy or vertigo symptoms may be a separate problem, as in motion sickness or Ménière’ s disease. Be sure to consult your physician about problems with dizziness or vertigo. Treatments that target balance disorders combined with migraine therapies may be helpful in the management of disabling balance problems that commonly occur with migraine.
Case Report
Mary is a healthy 20-year-old woman who has been having problems with dizzy spells for the last 6 months. Normally, she has no problems with dizziness or balance problems. About once a month, she experiences a bout of severe dizziness that lasts a few hours. The dizziness can become so severe that she feels like she is walking on a boat during a storm. If she tries to walk, she veers to the side and is afraid she will fall. In addition to the nausea, she becomes sensitive to sounds and lights during her dizzy attacks and prefers to stay in bed in a dark, quiet room. After the dizziness resolves, she is left with a mild, throbbing headache.
Mary is otherwise in good health and takes no medications besides birth control pills. Her only other problem is migraine headaches which began at the initial onset of her menstrual periods at age 15. Her migraine headaches start as a severe throbbing pain on one side of her head, and are associated with nausea and sensitivity to light, noises, and smells. The migraine attacks typically occur about twice a month. Treating her migraines early in the attack with sumatriptan is generally effective.
Like Mary, patients with migrainous vertigo often experience migraine without vertigo for many years before having episodes of migraine with vertigo. The duration of balance problems during migrainous vertigo attacks can last between seconds to a full day. Because the balance symptoms are generally quite severe and disabling, patients often do not notice the migraine features that also occur during migrainous vertigo episodes. Once Mary was diagnosed, she used sumatriptan to treat her vertigo episodes as she would her other migraine attacks –
with good relief. HW
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