Migraines are one of the most common neurological disorders. When most people think of migraines, they imagine terrible headaches, usually worsened by light or bright noise. In some cases of migraine, unusual patterns may appear in front of the migraneur's eyes, or they may get unusual sensations of numbness or tingling. Migraines can cause many other kinds of neurological problems, though, including dizziness.
In some ways, the idea that dizziness accompanies migraines isn't surprising. After all, nausea commonly occurs during migraines, and it is often accompanied by a feeling of motion-sickness. These symptoms occur in at least 54 percent of patients with migraine, compared to only 30 percent of people with tension headaches. Feelings of vertigo (an illusory sense of motion) can trigger migraines, further suggesting a connection between migraines and dizziness.
Diagnosing Vestibular Migraine
The term "vestibular migraine" means dizziness that results from migraine phenomena. To make this diagnosis someone needs to have episodic symptoms suggestive of balance problems that sometimes, but not necessarily always, come with other migrainous symptoms like throbbing headache within a few hours. There must also be no other cause of dizziness found. Episodes of dizziness can range from a few seconds to a day in duration.
The disorder usually occurs in people with an established history of migraines. Like other forms of migraine, vestibular migraine is more common in women than men.
Basilar migraine is a related type of migraine that also causes vertigo, but usually resolves by early adulthood. The term basilar refers to the basilar artery that supplies much of the brainstem with blood, including centers for balance. Unlike vestibular migraine, basilar migraine can cause other symptoms such as double vision, slurred speech, hearing changes, clumsiness, sensory changes, and even loss of consciousness. Many experts have questioned whether basilar migraine should actually be considered a separate syndrome from vestibular migraine, and it may be removed from the list of neurological diagnoses by 2014.
Meniere disease is a disorder of the inner ear that causes both vertigo and tinnitus. Meniere disease may be confused with vestibular migraine. Furthermore, it's not uncommon for someone to have both disorders. About 45 percent of people with Meniere disease have at least one migraine-type symptom during attacks of vertigo, and there's an increased risk of migraine in people with Meniere's. This suggests that the two conditions may be closely linked in origin.
People with migraine have a 16 percent lifetime chance of developing a panic disorder, which is four times higher than people without migraine. Both conditions can give a sense of dizziness. Panic attacks can also cause chest pain, chills, nausea, a feeling of choking, sweating, numbness, tingling and more. In fact, it's not uncommon for people to have all three conditions: migraine, anxiety, and problems with balance. This is called migraine-anxiety related dizziness.
People with migraine of all type are also more likely to suffer from motion sickness, again suggesting a connection between the vestibular system and migraines.
The Cause of Vestibular Migraine
The causes of migraine are generally not well understood, and vestibular migraine even less so. The belief is that abnormal brainstem activity spreads to change how we normally interpret our senses, including pain, as well as altering blood flow through the arteries in the head.
Genetic studies of people with vertigo and migraine have revealed an increased chance of genes like the CACNA1A gene, a cause of episodic ataxia type 2. Other genes that are connected with both vertigo and migraine include ATP1A2 (also involved with episodic ataxia) and SCN1A. All of these genes are related to ion channels that control how electricity spreads in the brain.
The treatment of vestibular migraine is similar to other migraine therapies. Mainstays of treatment include avoiding anything that triggers the migraine (such as certain foods, sleep loss, or bright lights). Visual motion may sometimes trigger vestibular migraine. Other recommendations include using antimigraine medication, nausea medication, and physical therapy to help with instability while walking. People with vestibular migraine are in good company, as many people have to find ways to cope with migraines every day. There is a large community of people who can turn to each other for tips and advice.
Furman, JM, Marcus DA. Migraine and Motion Sensitivity. Continuum Lifelong Learning Neurol 2012;18(5):1102-1117.