Vestibular migraine (VM) is a neurological condition that often goes undiagnosed, leaving many people struggling with dizziness and balance issues without knowing the cause. It’s more than just a headache; VM affects the vestibular (balance) system, leading to episodes of vertigo, dizziness, and other symptoms typically associated with migraines. VM is commonly mistaken for benign paroxysmal positional vertigo (BPPV) due to the elusive and confusing nature of the disease and symptoms. Vestibular Migraine is quite common as it affects nearly 3% of the population.
Vestibular migraine is a type of migraine that’s characterized by dizziness or vertigo, often accompanied by typical migraine features such as headaches, nausea, and light sensitivity. What sets VM apart from traditional migraines is that the dizziness or vertigo can occur independently of a headache. In fact, as many as 50% of individuals with VM experience vertigo or dizziness without having a headache, which can make the condition difficult to diagnose.
The episodes of dizziness can last anywhere from a few minutes to several days and can interfere with daily life, making it difficult to drive, work, or even perform simple tasks. When VM strikes, it can leave you feeling off-balance, disoriented, or even unable to stand without the sensation of spinning.
The symptoms of vestibular migraine can often overlap with other vestibular disorders, such as benign paroxysmal positional vertigo (BPPV) or Meniere’s disease. However, there are a few key signs that can help distinguish VM:
VM episodes can bring a sudden feeling of spinning or imbalance, lasting from minutes to days. Sometimes it can be subtle and the dizziness will be noted with positional changes. These episodes can occur before, during, or after a headache, or even on their own.
Alongside dizziness, individuals with VM may experience the classic symptoms of a migraine, such as a throbbing headache, sensitivity to light (photophobia), sensitivity to sound (phonophobia), and nausea. Visual disturbances or auras, such as flashes of light, may also occur.
VM is most commonly seen in individuals who already have a history of migraines, though not every person with VM will experience a traditional migraine headache with each episode. Some people additionally may not know they even have migraines until they are first diagnosed with Vestibular Migraine because they started noticing new or episodic dizziness.
The exact cause of vestibular migraine is still not fully understood, but it’s believed to result from changes in the brain that affect both the vestibular system and the trigeminal nerve, which processes pain. Essentially, the brain becomes overly reactive, leading to abnormal processing of balance signals and the sensation of vertigo. These symptoms and the process are fully reversible resulting in a return to normal after the episode has ended.
Several factors can trigger or contribute to VM, including:
• Genetics: A family history of migraines or vestibular disorders can increase the likelihood of developing VM.
• Hormonal Changes: VM can occur during females cycles and can be noted during during peri-menopause. What occurs is the hormonal changes that occur during these events trigger the VM episodes.
• Environmental Triggers: Stress, poor sleep, certain foods, dehydration, and even changes in the weather can trigger episodes of VM.
Diagnosing VM can be challenging because it shares symptoms with other vestibular conditions. However, doctors typically rely on clinical criteria to make a diagnosis. This includes:
• Multiple episodes of vertigo lasting between a few minutes to several days.
• A history of migraines, with or without aura.
• Migraine-like features occurring with at least 50% of dizziness episodes, such as headaches, light/sound sensitivity, or visual disturbances.
• Exclusion of other vestibular disorders that could explain the symptoms.
If you’re experiencing these symptoms, it’s important to see a healthcare provider who can help you rule out other conditions and confirm a diagnosis of vestibular migraine.
While there’s no cure for vestibular migraine, the good news is that it’s manageable. A combination of medications, lifestyle changes, and specific therapeutic exercises can significantly reduce the frequency and intensity of VM episodes. Here are some key treatment options:
One of the most effective ways to manage VM is through vestibular rehabilitation therapy (VRT). Vestibular therapy is a form of physical therapy that uses exercises designed to retrain the brain and vestibular system to process balance signals more effectively. The goal is to reduce dizziness and improve stability. VRT may include:
Identifying and avoiding triggers is an important part of managing VM. Common triggers include stress, sleep deprivation, certain foods (like chocolate, caffeine, and alcohol), and hormonal changes. Keeping a symptom diary can help you identify your personal triggers and make adjustments to your routine.
Several medications commonly used to treat migraines can also help manage VM. These can include:
Stress can be a significant trigger for VM. Incorporating relaxation techniques, such as mindfulness, deep breathing, or yoga, can help reduce stress levels and prevent episodes.
Vestibular migraine can be a frustrating and disabling condition, but with the right approach, it’s possible to manage the symptoms and regain control over your life. Whether through vestibular therapy, medication, lifestyle changes or a combination of the three, there are effective treatments that can reduce the frequency and severity of VM episodes.
If you, or someone you know has chronic unexplained episodic dizziness, dizziness with headaches, or chronic positional dizziness call Integrated Movement and Health at 610-679-9051 to schedule an appointment to better understand your symptoms and seek treatment.
