Vestibular Migraine from a Patient POV

When I first began experiencing vestibular migraine symptoms, it felt as though my head were a balloon bobbing approximately five inches above the rest of my body.  The world that I perceived was warped, moving in groggy slow motion where any motion or flicker of light would thrust me into bouts of vertigo so severe that I would need to sit on the floor for thirty minutes to an hour.  

‍

My knowledge of migraine at the time was so simplified that I didn’t understand that what I was experiencing was migraine.  Because what I was experiencing had to be worse than what I believed migraine to be. I didn’t know that vestibular migraine was the second-leading cause of dizziness.

‍

No one ever had explained that migraine has many manifestations and that a migraine attack can present without head pain at all.  No one ever explained that migraine could make me feel as though I were riding the Coney Island Tilt-a-Whirl at full speed. 

‍

As my vestibular migraine and treatment progressed, I learned more about the condition.  I learned that chronic vestibular migraine meant living with a baseline dizziness that can be heavily seasoned with unexpected vertigo.  I learned that dizziness and vertigo were not the same thing.  And that, when proper medications and therapies were applied, my vestibular migraine could improve and become a livable, manageable disease.  

‍

Treating vestibular migraine was more comprehensive than my other migraine types and subtypes; however, I believe that this comprehensive program was one of the reasons that I’m now able to comfortably live with it.  Following diagnosis, I took advantage of every treatment and program that my neurotologist (neurotologists are doctors who focus on neurological-related and inner ear concerns, including balance disorders, vestibular migraine, cochlear implants, and Meniere’s disease) recommended: vestibular rehab therapy, vestibular cognitive behavioral therapy, physical therapy, balance training with a personal trainer, and steadfastly watching the Optokinetic video, adding a second or two each day, over the course of a year.  

‍

And little by little, bit by bit, the world became easier for me to tolerate.  I still will get vestibular migraine attacks but my baseline is so tolerable that I can tune it out, much like I tune out my constant head pain.  And when I do get a vestibular migraine attack, I now have the tools and training to better handle the attacks: I know how to ground myself and use circle breathing techniques to calm down my nervous system.  I rely on my core strength to help me maintain physical balance. I know what to do so that vestibular migraine isn’t as scary as it once was. 

‍

Vestibular Migraine from a Headache Specialist POV

‍

What is vestibular migraine? 

Vestibular migraine is a complicated headache condition where people experience dizziness due to an underlying migraine process in their brain.  Headache is not always present, but there usually are some symptoms that can tip you off that migraine may be at the root of this condition.  This can be sensitivities to light or sound, vision changes, exacerbation with physical exertion or nausea. 

‍

Access the formal diagnostic criteria 

‍

Migraine always implies both pain and non-pain symptoms.  The non-pain symptoms in vestibular migraine can vary, but all involve balance to some extent.  You might experience lightheadedness, a spinning “vertigo-like” sensation, or even a sensation of rocking, like being on a boat.  “Disequilibrium” is a good term to use for some of the different kinds of balance issues that might otherwise be difficult to describe. 

‍

How does vestibular migraine treatment differ from other migraine types and subtypes? 

There are some preventive treatments that are more specific for vestibular migraine, for instance a specific kind of blood pressure medication (verapamil), or a specific kind of antidepressant (venlefaxine).  Unfortunately most vestibular migraine studies are not randomized or placebo controlled, and the level of evidence isn’t as strong. Some migraine-specific treatments can help all kinds of migraine conditions, including vestibular migraine, like the CGRP class of medications, and Botox injections.  

‍

Why can vestibular migraine be difficult to diagnose?

Many different conditions can lead to very similar symptoms, so it’s absolutely essential to make sure that it really is migraine that is causing your symptoms and nothing else.  Conditions affect the eyes, the inner ears and the brain all can lead to a situation that looks very much like vestibular migraine.  Your doctor will often recommend a few tests or even a referral to other specialists to make sure nothing else is being missed. 

‍

What should a patient do when diagnosed with vestibular migraine?

Work with your specialist and care team to map out a program that integrates preventive care with vestibular rehabilitation and therapy.  The Neura Health care team is ready to support and guide patients who have vestibular migraine. 

‍

Can dizziness go away? 

The goal always is to improve quality of life and return patients to doing the things that they love.  Since migraine is a spectrum disease, it is difficult to guarantee that dizziness will entirely go away for all patients; however, vestibular migraine can be managed with preventive treatments, lifestyle modifications, and appropriate therapies. And often patients are very happy with the results.  

‍

‍