Symptoms of dizziness and headache are frequently observed by neurologists. Since 1984, several studies have examined the association of vestibular symptoms and migraine in adults. Various terms have been used to describe this association, including migraine-associated vertigo , migraine-related vestibulopathy, migraine vertigo , and benign paroxysmal vertigo . To our knowledge, Dieterich and Brandt were the first to use the term “ vestibular migraine .” Vestibular migraine is now the accepted name for vestibular symptoms that have a causal relationship to migraine. The International Headache Society and the International Bárány Society for Neurology have developed a consensus document containing diagnostic criteria for vestibular migraine.
The vertigo of vestibular migraine
- Spontaneous dizziness was reported in 21-83%,
- Positional vertigo and dizziness in 17 to 65%,
- Intolerance to head movements in 31 to 77%
In a large population-based study, 67% of participants with vestibular migraine reported spontaneous rotatory vertigo , while 24% had positional vertigo. Dizziness has also been induced by moving visual objects. Additionally, in a study conducted in a headache clinic, the most common additional symptoms were unsteadiness (91%), balance problems (82%), and dizziness (57%).
The main symptom: vertigo!
Vestibular migraines do not always cause headaches . The main symptom is dizziness that comes and goes . The term vestibular refers to the inner ear , which controls hearing and balance. If you have a vestibular migraine, you may experience: • dizziness that lasts for more than a few minutes • nausea and vomiting • balance problems • extreme sensitivity to movement (feeling sick or dizzy when you move your head, eyes or body), • feeling disoriented or confused, • feeling unsteady , as if you were in a boat, • sensitivity to sound , • sensitivity to light , • sensitivity to odors .
The duration of the vestibular crisisThe duration of attacks can vary from a few seconds to several days ; however, diagnostic criteria for vestibular migraine require a minimum of 5 minutes . Attacks lasting 5 to 60 minutes and meeting the criteria for typical aura have been seen in only 10 to 30% of patients with vestibular migraine. A combination of vestibular symptoms and headache is frequently observed, but it varies from patient to patient and from attack to attack, even within the same patient.
Dizziness may precede or occur during or after the headache.
Other symptoms of vestibular migraine
A visual aura
While fewer than 50% of patients experience both symptoms with each attack, approximately 6% report isolated attacks of vertigo that alternate with symptoms of migraine headaches . In addition to vertigo, patients may mention photophobia (light), phonophobia (sound), osmophobia (smell), visual auras , and others that are relevant for confirmation of the diagnosis.
Hearing symptoms such as hearing disturbances, tinnitus and ear pressure were noted in 38% of patients, but hearing is usually only mildly and transiently affected. Mild low-frequency cochlear loss (cochlear deafness) was documented in 3 to 12% of cases and mild bilateral hearing loss in 18% of cases in a follow-up study conducted over an average of 9 years.
No symptoms between attacks
If a neurological examination is performed between episodes, in the symptom-free interval, the results are usually normal . However, central ocular vestibular motor abnormalities appear in some of the patients. A recent study showed that ocular motor abnormalities increase over time.
Vestibular dysfunction during migraine attacks
During the acute attack , a greater number of patients (70%) developed pathological nystagmus . These findings made during the acute attack represent signs of central vestibular dysfunction in 50% of cases and peripheral vestibular dysfunction in 15% of cases. The diagnosis of vestibular migraine is not always accurate.
See also, Treatments for Vestibular Migraine.