Vertigo - Treatment Options For Vestibular Migraine

Vestibular Migraine is a condition in which people with an existing history of migraines experience recurring dizziness or Vertigo. 

The way it differs from traditional migraines is that the patients of Vestibular Migraine don’t always experience headaches.

Vestibular Migraines are known by multiple names, some of which are:

• Migraine-associated Vertigo,

• Migrainous Vertigo,

• Migraine-related Vestibulopathy,

Vestibular Migraine symptoms:

Vestibular Migraines don’t always have noticeable symptoms. The primary symptom seems to be dizziness that comes & goes.

The word Vestibular refers to the inner ear, which houses the body’s vestibular system that is responsible for controlling & maintaining the body’s balance.

If you suffer from Vestibular Migraines, you may feel one or more  of the following symptoms:

• Dizziness that doesn’t go away even after a few minutes,

• Nausea & vomiting

• Problems with balance & orientation

• Feeling dizzy when you move your eyes, head, or neck, otherwise known as extreme motion sensitivity

• Feeling confused or disoriented,

• A general feeling of unsteadiness,

• Sound sensitivity

It’s important to note that you may experience balance problems & dizziness without necessarily having vestibular migraine.

The vertigo symptoms may occur after, before, or during an episode of Vestibular Migraine.

In some cases, patients might suddenly begin experiencing Vertigo symptoms a long time after getting diagnosed with Vestibular Migraine.

Vestibular Migraine causes:

While most doctors & experts aren’t exactly sure as to what causes Vestibular Migraine, many believe it to be because of certain misfires between the brain & the various nerve cells that carry balance/movement information. 

It can be hard to figure out just how many people are affected by Vestibular Migraine, although medical researchers put it close to 1% of the entire population. This number however, could very well be higher.

Much like traditional migraines, the incidence of Vestibular Migraine is higher among women as compared to men. 

While most people begin experiencing Vestibular Migraine symptoms around the age of 40 years, it is not a hard & fast rule. The condition has also been observed in kids & young adults. 

Vestibular Migraine diagnosis:

There are no blood or imaging tests that can tell doctors for sure if a patient indeed has Vestibular Migraine. Although the International Headache Society & other related organizations have rolled out a criteria to help doctors diagnose Vestibular Migraine in patients. The same is listed below.

A patient can be suffering from vestibular migraine if:

• They have had migraines or an episode of migraine in the past,

• They have had at least 5 episodes of Vertigo that makes them feel like they are spinning or moving. The latter two symptoms are important as this feeling has to be different from general fainting & motion sickness.

• Each of these episodes last anywhere between 5 minutes to 72 hours,

• The symptoms are in the range of moderate to severe. They have to be significantly affecting the patient’s daily life & their ability to perform daily tasks. 

• The patient has experienced one of the following symptoms in at least half of the migraine episodes:  A headache that is either one-sided, pulsing, with moderate to severe intensity, & gets worse with time; sensitivity to light or sound; seeing shimmering or flashing lights in your vision, also called a migraine aura. 

Your doctors are also likely to run an MRI test on your brain & hearing + balance tests to rule out any other causes of your symptoms. These other causes can include Meniere’s Disease, which can be easily ruled out with a hearing test, &/or brainstem stroke, which requires immediate attention. 

Treatment for Vestibular Migraine:

There are no specific medications for vestibular migraines. The treatment for Vestibular Migraine focuses on abortive therapy instead of a reductive one. The various medications that are used in the treatment for Vestibular Migraine are:

• Triptans, which should be taken at the first occurrence of a headache,

• Vestibular suppressants, which  work on the balance centre inside the inner ear & reduces dizziness along with motion sensitivity. Medicines under this category include benzodiazepines like lorazepam (Ativan), anti-nausea drugs like promethazine and antihistamines like meclizine.

• For severe migraine headaches, your doctor might recommend drugs that are similar to traditional migraine preventive medicines. You need to take these regularly to reduce the frequency & severity of vestibular migraine attacks. Seizure medicines, blood pressure medicines ( including beta blockers & calcium channel blockers), & antidepressants. There is also another class of preventive medicines called CGRP inhibitors that your doctor might recommend in case any other medications don’t work. 

Additionally, certain medications might also be used as part of your treatment for vestibular migraine to provide you with a little relief from your symptoms. These include:

• Antiseizure drugs like gabapentin (Gralise, Horizant, Neurontin), topiramate (Qudexy XR, Topamax, Topamax Sprinkle, Trokendi XR), or valproate (Depakote, Depakene, Stavzor).

• Blood pressure medicines

• beta-blockers - atenolol (Tenormin), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), propranolol (Hemangeol, Inderal LA, Inderal XL, and InnoPran XL)

• calcium channel blockers; verapamil (Isoptin)

• Tricyclic antidepressants - amitriptyline, nortriptyline (Aventyl, Pamelor)

• SSRIs - citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Rapiflux, Sarafem, Selfemra), paroxetine (Paxil, Pexeva), and sertraline (Zoloft)

• SNRIs - duloxetine (Cymbalta, Irenka) and venlafaxine (Effexor)

Certain diet changes like reducing the intake of chocolate, cheese, alcohol, and foods with the preservative MSG, & avoiding common vestibular migraine triggers can also help in treatment for Vestibular Migraine. 

To read more about Vestibular Migraine, its diagnosis, treatment options, & management therapies, click here.