Diagnosing and treating Vestibular Migraine

Diagnosing and treating Vestibular Migraine

What is vestibular migraine?

Vestibular migraine is a sub-type of headache in which migraine episodes, typically characterised as symptoms of intense headache, light sensitivity and visual auras also include vestibular symptoms of dizziness, vertigo and/or balance difficulties. In fact, vestibular migraine episodes may not even present with any of the typical migraine symptoms at all and only present as episodes of prolonged dizziness or vertigo. Research has shown that vestibular migraine may affect up to 1% of the entire population. So why don’t we hear more about it?

Getting a diagnosis 

The link between migraines and dizziness has been a recognised phenomenon since the 19th century however a universally accepted diagnostic criteria for the condition was only established and published for the first time by the International Classification of Headache Disorders in 2014. This criterion is based on how someone’s symptoms present and not on the results of scans or tests. There is currently no gold-standard diagnostic test which can diagnose vestibular migraine however vestibular testing and brain imaging may be useful for some people to help either ‘rule-out’ another diagnosis or identify co-existing impairments. 

Recent studies using functional imaging have shown promise in helping us understand the processes which are occurring on the vascular and neural level in vestibular migraine however further research is still needed. The current recommendation for people who are suffering from these symptoms is to have a multi-disciplinary team approach to assessment including the involvement of neurologists, audiologists and vestibular rehabilitation specialists in order to help make the diagnosis of vestibular migraine. 

How can we help you?

The most effective management of vestibular migraine is thought to be a combination of medications, vestibular rehabilitation, and modifications to lifestyle. In regard to medication, there are two general groups of medications which can be effective. They are preventatives (medications you take regularly to prevent the attacks) and abortives (medications you take to stop an episode which has already started). The appropriateness of these medications needs to be considered for each individual person and should be discussed in combination with your GP or Neurologist. Lifestyle modifications relate to reducing exposure to the risk factors or triggers which may increase your likelihood of having an episode. 

Your vestibular physiotherapist here at Klint will be able to help identify the signs and symptoms of vestibular migraine, help you work through identifying your individual triggers as well as design an exercise program to address and reduce the vestibular symptoms you are experiencing. 

References: 

Lempert, T et al. 2012. Vestibular migraine: Diagnostic criteria. Journal of Vestibular Research, Vol 22, 167-172. 

International Headache Society. 2018. The International Classification of Headache Disorders, 3rd edition. Cephalgia, Vol 38(1), 1-211.

Vestibular Disorders Association. 2014. Vestibular Migraine. https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/vestibular-migraine/

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