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.
It is characterized by sudden spinning sensations, where the patient feels as if the world around them is spinning or moving even if they are perfectly still.
Patients often feel disoriented, off-balance, nauseous, & also experience symptoms of motion sickness when suffering from BPPV.
BPPV affects about 80% of all Vertigo patients, & is also quite easy to treat once diagnosed properly.
BPPV Causes:
BPPV causes range across a variety of medical conditions. Usually, BPPV is caused by inner ear infections & problems that make it difficult for the vestibular system to send & receive balance-related signals from the brain.
The body’s vestibular system is made up of the eyes, the ears, & the brain. These three have to work in absolute harmony for the body to be properly balanced at any given time.
When the patient experiences an inner ear infection, it can give rise to BPPV symptoms.
The various inner ear conditions that can cause BPPV include:
The displacement of calcium crystals: The primary cause of BPPV is tiny calcium crystals in the middle ear getting accidentally dislodged in the semicircular canal of the inner ear, & causing problems with the detection of proper balance signals by the brain.
These calcium crystals, also called canaliths, are sensitive to motion, & help the brain detect the body’s position in space according to various motion stimulants.
When they get dislodged from their original position & get deposited inside the semicircular canal, they cause confusion between the body’s actual position & the motion stimulants perceived by the brain due to the misplaced crystals.
This confusion is what causes dizziness, nausea, & motion sickness in BPPV patients.
How it is treated:
BPPV treatment for BPPV caused by misplaced calcium crystals in the inner ear include:
Canalith Repositioning Maneuvers: Canalith repositioning maneuvers are exercises designed to help replace the misplaced calcium crystals inside the semicircular canal.
These exercises include the well-known Epley Maneuver, the Brandt-Daroff maneuver, the Semont-maneuver, & other assorted exercises.
These exercises can either be performed at home by yourself, or under the supervision of a doctor or a licensed practitioner.
They consist of easy maneuvers designed to help facilitate the movement of calcium crystals from the semicircular canal to their original location.
1. Brandt-Daroff Exercises
Brandt-Daroff exercises utilise gravity to help dislodge crystals from the semicircular canal so that they no longer pose a problem in maintaining the body’s balance.
This exercise can be performed at home in a few simple steps as given below:
Sit in the bed with your feet on the floor, then turn your head 45 degrees in the right direction.
Without changing the direction of your head, lie down on your left side on the bed. Maintain this position for about 30 seconds.
Slowly return to the starting position, & take a 30-second pause.
Now, turn your head 45 degrees in the left side, & repeat the previous steps in the right direction.
Return to the starting position & pause for 30 seconds.
Repeat this set of procedures for about five times in a single sitting.
2. Epley Maneuver
The Epley Maneuver is another popular & commonly recommended exercise for Vertigo. Most patients with Vertigo get relief from their symptoms with the Epley Maneuver.
Although the original Epley Maneuver can only be performed with the help of at least two other people, the modified Epley Maneuver can be easily performed by yourself at home.
Below is the procedure for performing the Epley Maneuver at home if you have left-ear BPPV. In case of right ear BPPV, just perform the steps in the opposite direction.
Sit on the bed in an upright position, while placing your legs straight ahead in front of you with a pillow behind you.
Next, turn your head 45 degrees to the left.
Lie on your back quickly until your shoulders are on the bed. Hold this position for 30 seconds.
Next, turn your head 90 degrees to the left without lifting it up. Hold this position for 30 seconds.
Now, turn your body & head another 90 degrees to the right & hold for 30 seconds.
Next, sit upright on the right edge of the bed.
3. Semont Maneuver
The Semont Maneuver, also known as the liberatory manoeuvre, is another exercise for Vertigo recommended for BPPV treatment. It takes less time to perform than the Brandt-Daroff exercise; however, these should best be done in the presence of a healthcare provider.
For the below set of exercises, we’ll assume that you have left-ear BPPV.
Sit on the edge of your bed in an upright position & turn your head 45 degrees to the right.
Quickly drop to your left until your head is on the bed, & hold this position for 30 seconds.
Next, quickly move your body to the right side in a single movement without changing the position of your head.
Hold this position for 30 seconds, then slowly return to the starting position.
Surgical Alternatives:
In some cases, where no other BPPV treatment options seem to be working for the patient, your doctor may recommend the canal plugging surgery to you.
This surgery involves using a bone plug to block the portion of the inner ear that is causing the problems.
This surgery is often the last resort for patients for whom no other BPPV treatment options seem to be working.
The success rate for canal plugging surgery is about 90%, & it is a safe, long-lasting alternative for desperate situations of BPPV.
Looking for effective resolution of your Vertigo symptoms & adequate Vertigo management options? Visit www.vertigoandearclinic.com for more information about Vertigo, its symptoms, vertigo treatment options, & management process.
Migraine headaches are a fairly common condition among many people today. General migraines are characterized by moderate to severe headaches, which are pounding & throbbing in nature.
Vestibular Migraines, on the other hand, are characterized by
migraine headaches along with vestibular symptoms such as nausea, vomiting,
disorientation, & dizziness.
Some of the most common Vestibular Migraine symptoms are:
●
Severe, throbbing headache that is usually
concentrated to one side,
●
Nausea & Vomiting
●
Sensitivity towards light, smell, & sounds.
Other Vestibular Migraine symptoms:
●
Vertigo, that usually lasts for a few minutes
to hours, & in certain cases, can also last for a few days,
●
Unsteadiness, disorientation, & loss of
balance,
●
Sensitivity towards motion & motion stimuli
Certain subjective hearing symptoms, such as ringing, fullness,
& pressure in one or both ears are also common, although if you suffer from
significant hearing loss, you should go for a diagnosis of Meniere’s Disease.
Vestibular Migraines often cause a person to experience a range of
vestibular symptoms such as visual aura, or sensitivity to visual stimulation
& motion at the same, or different times. These symptoms can also occur
with headaches, or without.
Vestibular Migraine causes:
Most cases of Vestibular Migraine are hereditary. That said, women
are also more likely to suffer from Vestibular Migraine. For women, Vestibular
Migraine symptoms also tend to worsen at the time of menstruation.
Additionally, people with Vestibular Migraine experience the
following disturbances after their migraine episodes; altered sleep patterns,
MSG, disturbances in menstrual cycles, etc.
Vestibular Migraine Diagnosis:
Since a vast majority of people with Vestibular Migraine do not
experience vestibular symptoms along with migraine headaches, it can become
difficult for doctors to diagnose them with Vestibular Migraine.
The symptoms of Vestibular Migraine can also present as other
illnesses such as:
●
Benign Paroxysmal Positional Vertigo(BPPV)
●
Meniere’s Disease
●
Transient Ischemic attack, also known as a
‘mini-stroke’
It is also quite a common occurrence for these three disorders to
exist together, thus making the diagnosis even more difficult.
Vestibular Migraine treatment:
Vestibular Migraine treatment is similar to that of general
Migraines. It includes minimizing the usage of meclizine or any other medicines
that suppress the vestibular system, using them only during an active episode.
In case the patient is experiencing recurrent, frequent attacks,
your doctor may prescribe certain medications like:
●
Beta-blockers,
●
Calcium channel blockers,
●
Tricyclic antidepressants
●
Serotonin or norepinephrine reuptake
inhibitors(SSRIs or SNRIs)
●
Topiramate
Along with these medicines, patients suffering from vestibular
migraines are also advised to maintain a regular sleep & meal schedule, get
proper sleep of 8 hours everyday, reduce their intake of alcohol &
caffeine, & avoid known migraine
triggers.
Vestibular Migraine patients are also advised to engage in
activities that reduce stress, & avoid situations that can trigger an
involuntary neurological response, such as harsh lighting, loud, shrill sounds,
& engaging in activities that produce an adrenaline rush.
To know more about Vestibular Migraine & how the condition
affects a person’s everyday life, along with more about its diagnosis, new
treatment breakthroughs, & management options, visit Dr. Anita Bhandari’s
Vertigo And Ear Clinic, here.
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Vestibular Rehabilitation therapy is an exercise-based rehabilitation program that is designed by experts to help the body deal better with Vertigo attacks & dizziness spells.
Vestibular Rehabilitation Therapies have been credited with successfully helping Vertigo patients compensate for the loss in the natural balance system of the body, & for organically reducing the intensity of Vertigo & dizziness spells experienced by the patient.
Vestibular Rehabilitation Therapies can be categorized into two primary types:
Physical Therapy for Vestibular Hypofunction,
Canalith Repositioning Therapy for Benign Paroxysmal Positional Vertigo(BPPV)
Peripheral Vestibular Hypofunction is characterized by damage to the inner ear nerve which is responsible for carrying the nervous inputs from the inner ear to the brain.
This can occur either in a single ear or both.
This can lead to dizziness, Vertigo, unsteadiness, lightheadedness, falls, & disorientation among other things.
Physical Therapy for Vestibular Hypofunction includes four different types of exercises that are performed under the guidance & supervision of experts.
These exercises are:
Gaze Stabilization Exercises: The primary goal of these exercises is to improve the patient’s vision during head movements. These also have been shown to be effective in reducing dizziness & improving unsteadiness in a patient.
This exercise is carried out under expert supervision, & involves the patients performing various head movements while maintaining their gaze on a fixed object.
Doing these exercises multiple times daily helps rehabilitate the patient’s sense of head-eye coordination & reinstate balance.
Habituation Exercises: The primary goal of these exercises is to reduce dizziness and Vertigo spells. These include the patients watching things that move rapidly, or perform certain head movements that bring about dizziness.
Once the patient performs these exercises multiple times over a length of time, these feelings of dizziness & Vertigo go away overtime, & the body learns to compensate for this loss in setting balance.
Balance & Gait Exercises: The goal of these exercises is to improve the body’s steadiness & prevent falling over while standing or moving activities.
These exercises include a variety of customized balance & posture exercises to help the body maintain a steady balance while performing certain exercises.Endurance walking or aerobic Exercises: These exercises are important as in most cases of Peripheral Vestibular Hypofunction, patients are told to avoid walking, running, or jogging to avoid the dangers of a fall or an injury due to dizziness.
These exercises involve the patients generating natural endurance & stability for walking & performing other aerobic exercises, so that overtime, their body compensates for the loss in balance automatically.
Patients who experience difficulty with their vision during certain head movements, should perform the gaze stability exercises at least three times per day, each session lasting at least 12-20 minutes.
Canalith Repositioning Maneuvers are used to treat Peripheral Vertigo arising from Benign paroxysmal Positional Vertigo(BPPV).
BPPV occurs when the calcium carbonate crystals in the inner ear mistakenly get deposited in the semicircular canal, causing problems with sending accurate balance signals to the brain causing dizziness & Vertigo.
Canalith Repositioning Maneuvers target these dislodged crystals in the semicircular canal & reinstate them to their original position in the inner ear.
Canalith Repositioning Maneuvers include well-known Vertigo exercises like the Epley Maneuver, the Semont-Foster Maneuver, the Semont-Toupet Maneuver, the half-somersault maneuver, the Brandt-Daroff exercises, among others.
Epley Maneuver:
The Epley Maneuver is a highly recommended & effective exercise for Vertigo.
To perform it, follow the below mentioned steps:
Sit on your bed, place your legs straight ahead & put a pillow behind you.
Turn your head to the left 45 degrees.
Quickly lie back placing your shoulders on the pillow, & hold for 30 seconds.
Turn your head to the right 90 degrees without lifting it up, & hold for 30 seconds.
Turn your head & body another 90 degrees to the right without lifting it up, & hold for 30 seconds.
Now, sit straight on the edge of the bed.
Perform the maneuver three times a day, repeating everyday until the symptoms cease.
These steps are for when you have left-ear BPPV. In case of right ear BPPV, perform these steps on the opposite side.
Semont Maneuver:
The Semont Maneuver is also called the liberatory maneuver, & is another highly recommended Vertigo exercise.
To perform this maneuver, your doctor will make you follow the below mentioned steps:
Sit on the edge of your bed & turn your head 45 degrees to the right.
Quickly drop to your left side until your head is on the bed, & hold for at least 30 seconds.
Now move your body to the right side in one movement, without changing the angle of your head.
Hold this position for about 30 seconds, & slowly return to your original position.
In case you have right-ear BPPV, turn your head in the right direction & start on your left side.
This maneuver should provide relief after performing only once.
Looking for Vertigo, ear, & dizziness experts around you? Visit Dr.Anita Bhandari’s vertigo & Ear Clinic today.
Know more about them here.
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