Migraines are a neurological event brought about by what is thought to be a spasm of blood vessels within the central nervous system. Although most people associate migraines with its classic presentation of debilitating headache coupled with intolerance of light or loud noise, migraines may in fact present with a wide variety of signs and symptoms. This is because migraines can affect any part of the brain and depending on which portion is involved, the symptoms vary. As a result migraines may produce frontal or facial headaches that may be confused with sinusitis, debilitating dizziness that can be confused with entities such as Meniere's disease (for a description of Meniere's disease click here), or with neurologic findings that may be confused with stroke.
Migraine's that present with balance disturbance, also known as vestibular migraine can cause unsteadiness of gait or produce true vertigo where the patient feels like room is spinning or as if they are standing on a ship. These types of attacks, like classic migraines can be preceded by what is known as an aura where the patient senses a strange odor or sees flashing lights. The patient may also experience other symptoms such as changes in hearing, ringing and occasionally, as in classic migraine, a headache. Although this is true, headache is not necessary to diagnose a patient with vestibular migraine.
The vertigo attacks that accompany vestibular migraine typically last from just a few minutes to many hours and occasionally they may last longer than a day. No one knows what definitively causes these attacks but it is widely believed that there are many dietary and lifestyle triggers which may contribute to or incite attacks. Therefore patients who are believed to be suffering from vestibular migraine will typically be instructed to first follow a low sodium diet (less than 2g day) and are asked to avoid certain common trigger foods (caffeine, alcohol especially red wine, aged cheese etc) for a period of approximately 6
weeks. If the patient experiences relief from the migraine headaches certain foods are added back in one at a time to identify specific triggers. If the patient is not able to adhere to this program, or is still suffering from symptoms, pharmacologic therapy such as certain types of antidepressants (e.g. elavil) or calcium channel blockers (e.g. diltiazam) or anti-seizure medications (e.g. topamax or depakote) may be prescribed (these are usually prescribed in conjunction with a neurologist). Medicines designed to abort migraines (e.g. imitrex or ibuprofen), and those designed to treat the symptoms of dizziness (e.g. antivert), certainly have a role in treating vestibular migraine, but should be used sparingly as they in and of themselves may play a role in perpetuating migraine attacks. When considering the diagnosis of labyrinthine migraine your doctor may order tests to rule out other problems such as an electronystagmagram (an objective evaluation of the balance system), hearing tests, and/or imaging of the brain.
If you think you may be suffering from vestibular migraine, please give us a call.
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