Vestibular migraine is severe dizziness often associated with a migraine headache. It is the second commonest cause of vertigo (the first being crystal disease). This occurs in approximately 1% of the population.
The symptoms of vestibular migraine start in childhood when there is motion sickness, there is also a history of previous migraines and also family history of migraines. The headaches are severe, one sided and throbbing and are often associated with sensitivity to noise, smell, touch and light. There are ear symptoms too such as ringing, a blocked sensation and pressure. With migraines, there is often a warning such as mood changes or certain cravings, followed by an aura, for instance, visual flashing. Then the attack sets in which lasts a while followed by a post-migraine confusion.
The dizziness is a spinning associated with nausea and sometimes vomiting. The headaches and the dizziness are not always together and can occur every day or once or twice a month. Clinically, these patients are off-balance and appear ill but the basic examination is normal. The typical patient is a female around the age of 40.
The exact cause of migraines or vestibular migraines has not yet been defined but there are certain triggers. These triggers are unique to each person but it is often difficult to identify the specific trigger. These are lack of sleep, stress, certain foods, such as red wine, cheese and caffeine, weather changes and flashing lights.
Investigations including brain scans are generally normal. The differential diagnosis includes Menieres Syndrome, crystal disease and TIA (mini strokes)
Treatment is divided into acute and chronic preventative management. In the acute phase Imigran together with vestibular sedatives such as Phenergan, anti-nausea medication, anti-inflammatories and paracetamol are used. For chronic prevention, medication such as beta-blockers, antidepressants, anticonvulsants and even magnesium supplementation is used. Obviously, the patient must avoid certain triggers and must be sure of adequate sleep, exercise, diet management and stress management.