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When Migraine Starts Spinning: Vestibular Migraine Treatment, Symptoms, & Causes

Vestibular Migraine

Photo by Radvilas Seputis on Unsplash

If you’ve ever looked down from the edge of a cliffside or tall building and experienced the feeling of being pulled down, you’ve experienced vertigo. Even just these few fleeting moments of dizziness can be incredibly jarring — but for some migraine patients, debilitating episodes of vertigo are all too common and can mean putting life on hold.

This sort of recurring dizziness, known as vestibular migraine, may seem vastly different from the intense pain of a migraine headache. Nevertheless, it’s still very much a type of migraine. In this article, we’ll demystify this long misunderstood manifestation of migraine, diving into the symptoms, causes, and available treatments.

What is vestibular migraine?

While it may seem surprising, the inner ear is key to our body’s system of balance. “Vestibular” refers to the inner ear and the systems it interacts with in order to maintain a sensation of equilibrium or balance. When it’s working, we don’t notice it. When there is vestibular dysfunction, it can manifest as vertigo: a sensation of spinning surroundings or involuntary bodily movement.

Vestibular migraine (also known as migraine-associated vertigo) is the most common cause of episodic vertigo in both adults and children. Yet, although it comprises 9% of patients seen in headache clinics and 7% of patients seen in dizziness clinics, it remains vastly under-diagnosed. In fact, a recent study from a tertiary vertigo center found that 20.2% of young patients referred to the clinic had vestibular migraine, whereas referring doctors had only suspected it in 1.8% of cases. This is most likely because it wasn’t until 2012 that the International Headache Society and Bárány Society adopted universal diagnostic criteria.

In this relatively new model, a diagnosis of vestibular migraine requires:

  • Recurring vestibular symptoms (frequent episodes of dizziness)
  • A history of migraine (usually five to eight years)
  • Exclusion of other causes of vestibular dysfunction
  • Migraine symptoms and vestibular symptoms are experienced in the same window of time

What does a vestibular migraine feel like?

While experiencing a vestibular migraine attack, you may feel like everything around you is spinning or like your body itself is moving, as if you’re on a boat. Moving your head to different positions may even result in motion sickness. A small but significant portion of people with vestibular migraine can also experience what’s called Alice in Wonderland syndrome, where objects look larger or smaller than they actually are. This sort of “off-kilter” feeling is usually accompanied by other symptoms and may occur after or at the same time as a migraine aura.

You may experience any of these vestibular migraine symptoms.

It’s not all that uncommon to have a vestibular migraine without a headache — however, symptoms of vestibular migraine include the other hallmark symptoms of a classic migraine attack. A vestibular migraine may include one or more of the symptoms on the list below, even in the absence of headache. This symptomology lends itself to an important distinction between vestibular migraine and vertigo.

  • A feeling of imbalance
  • Motion sickness when you move your head
  • Discomfort when you look at moving objects
  • A sensation of involuntary movement (feeling like you’re on a boat)
  • Lightheadedness
  • Headache
  • Photophobia
  • Visual patterns or disturbances
  • Ringing in the ears
  • Anxiety
  • Nausea and vomiting as a result of motion sickness

How long does a vestibular migraine last?

These sensations are usually moderate to severe, lasting anywhere from 5 minutes to 72 hours.

Does vestibular migraine ever go away?

When diagnosing vestibular migraine, doctors usually look for a five- to eight-year history of migraine activity, which means most patients have been in it for the long haul. However, much like migraine with or without aura, vestibular migraine goes away over time in some cases — especially as triggering factors like hormones or your surrounding environment change.

A more accurate way of looking at things is to think of it as vestibular migraine going into “remission.” It may not be active, but it’s still important to manage your migraine by avoiding triggers and taking care of your body.

What is chronic vestibular migraine?

Frequency of vestibular migraine attacks will vary from person to person. Those who experience vertigo at least 15 days out of the month are considered to have chronic vestibular migraine, according to research published in the Journal of Neurology in 2018.

What causes vestibular migraine?

A solid physiological understanding of how vestibular migraine works remains elusive, much like migraine with aura and migraine without aura. One hypothesis, published in the Journal of Vestibular Research, suggests that it could be relatively similar to migraine, as neurochemical information from both vestibular processing and pain processing may converge in the same pathway. The same paper also notes that some of the neurotransmitters involved in the development of migraine, such as calcitonin gene-related peptide and serotonin, control the central and vestibular peripheral nerves. It goes on to say that these nerves are likely involved in the onset of vestibular migraine, so the activity of neurotransmitters like CGRP could be as well.

Interestingly, a separate study published in 2005 found that electrical stimulation of the trigeminal nerve, which is believed to play a central role in migraine, triggered vestibular imbalances in 80% of migraine without aura patients. Yet in control (non-migraine) patients, the same stimulation didn’t elicit vestibular symptoms in a single participant. This suggests that the trigeminal system may play a pivotal role in vestibular migraine. 

How do you treat vestibular migraine?

Vestibular migraine treatment is generally consistent with treatment for other types of migraine. There are actions you can take and medications that your physician may prescribe to help minimize the pain and frequency of attacks. Since any pharmaceutical intervention should be discussed with your physician, we’ll speak to some of the management techniques that are shown to be effective without or in addition to a prescription.

Avoid vestibular migraine triggers as much as possible.

In the absence of a cure or fool-proof treatment strategy, the best treatment for vestibular migraine is to understand and avoid your triggers. Keeping track of your sleep, stress, diet, and migraine attacks in a migraine diary can help you pinpoint those triggers, as well as which of them seem to be the most prominent for your migraine.

Generally, triggers of vestibular migraine are very much the same as classic migraine triggers - including vertigo itself, according to a 2009 study published in the Journal of Neurology. Researchers used rotation to induce vertigo in participants of the study and compared the effects on a healthy control group against the effects on a test group made up of migraineurs. 49% of the test group experienced a migraine within the time window of the study, whereas only a single participant in the control group experienced a migraine.

These findings are important, because vertigo could trigger a potentially exacerbative cycle similar to stress and migraine (e.g., vertigo triggers a vestibular migraine, which then brings on a longer episode of vertigo). Aside from vertigo, these common vestibular migraine triggers are worth trying to avoid:

  • Stress
  • Lack of sleep
  • Dehydration
  • Flickering, strobing, or pulsating light
  • Certain foods
  • Certain beverages
  • Weather changes
  • Hormonal changes (menstruation)
  • Caffeine 

Use a narrow-band green light daily.

New research shows that green light therapy actually reduces the frequency and intensity of migraine headaches, making it a potentially powerful preventative treatment. To execute the study, the team recruited seven episodic migraine patients and 22 chronic migraine patients. These participants were exposed to white light emitting diodes for one to hours daily over 10 weeks, followed by a two-week rest period, then a 10-week period of daily exposure to green light emitting diodes. During the green light period, 63% of chronic migraineurs and 86% of episodic migraineurs reported an astonishing 50+% reduction in the number of headache days they experienced per month.

This research builds on the original foundational research from Dr. Rami Burstein, who discovered that a specific, narrow band of green light actually soothes photophobia and other symptoms during a migraine attack. While harnessing the therapeutic and preventative benefits of narrow-band green light won’t happen by going out and buying a green light bulb, it is possible and more accessible than ever thanks to The Allay Lamp. Developed in collaboration with Dr. Burstein, The Allay Lamp is a portable, chargeable narrow-band green light that you can take virtually anywhere. It’s effective in soothing migraine activity during an attack, but can also be used daily as it was in the pain study described above (we recommend an hour before bed each night to help wind down!). Perhaps most importantly, it’s 100% safe with zero negative side effects.

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