Do you feel “hungover” but without the fun to account for it?

Sick of calling out of work or school and unable to complete household chores due to feeling miserable?

You may be experiencing a vestibular migraine.

If so, learning more about this condition, what your potential triggers may be, and how to raise your threshold level is key in management and living a more enjoyable life. We at Rebalance Physical Therapy want to help you!

What Is It?

In general, migraines are unfortunately very common, misunderstood, mis- or undiagnosed, and can be a chronic debilitating condition. Being told “it’s just a headache” just doesn’t cut it…migraines are so much more than that.

Migraine is a neurological disease that affects 39 million people in the U.S. There is no cure necessarily, but effective management of symptoms can decrease severity, intensity, and occurrence of episodes. Symptoms can vary based on the individual, but most commonly include, intense head pain, sensitivity to light and noise, nausea and vomiting, and brain fog.

So How Is Vestibular Migraine Different from Regular Migraines?

 Vestibular migraines are a specific type of migraine that primarily affects the vestibular system. The vestibular system plays a crucial role in balance and spatial orientation, located within the inner ear. When your vestibular system is not functioning correctly or optimally, it can lead to various symptoms often described as dizziness or vertigo.

Vestibular migraines are different from regular migraines for 2 main reasons:

1. Vestibular migraines have the same migraine-related symptoms (nausea, sensitivity to light and noise, possible visual disturbances) but WITH VESTIBULAR SYMPTOMS such as:

• Dizziness

• Vertigo – usually lasting minutes to hours – but sometimes days

• Unsteadiness and loss of balance

• Sensitivity to motion

2. Vestibular migraines may or MAY NOT involve actual headache/head pain as one normally thinks would dictate a migraine condition.

With a vestibular migraine, you may experience a combination of sudden vestibular symptom attacks, visual aura, or increased sensitivity to visual stimulation and motion at different times, and such can occur with or without a headache.

Hearing disturbances are also possible with vestibular migraines. You may notice hearing changes or ringing in your ears (tinnitus) during an episode.

Who gets vestibular migraines?

Vestibular migraines and migraine syndromes in general do not discriminate. Anyone can get them, but research has shown that women tend to suffer more from the condition than men, and symptoms often get worse or can be triggered around menstruation.

People with vestibular migraine often report a history of childhood motion sickness. It is also commonly linked to anxiety and depression.

So How Is Vestibular Migraine Diagnosed?

The current accepted vestibular migraine diagnostic criteria includes the following:

1.     At least 5 episodes of vestibular symptoms of moderate or severe intensity that lasts 5 minutes to 72 hours

2.     Current or previous history of migraines with or without aura

3.     1 or more of the following features with at least 50% of vestibular episodes:

a.     Headache with at least 2 of the following characteristics:

                                               i.     One-sided location

                                              ii.     Pulsating quality

                                            iii.     Moderate or severe pain intensity

                                            iv.     Aggravation by regular physical activity

b.     Sensitivity to sound and light

c.      Visual aura

4.     Not better accounted for by another vestibular diagnosis

Diagnosing vestibular migraines can be extremely challenging due to the wide array of symptoms and fact that they often overlap with other vestibular disorders. Since dizziness is not always associated with a headache, dizziness can be occurring from vestibular migraine or other vestibular diagnoses such as:

• BPPV

• Persistent Postural Perceptual Dizziness (PPPD)

• Meniere’s Disease

• Transient ischemic attack (TIA) or mini-stroke

• Vestibular Hypofunction

That is why a detailed medical history and thorough physical therapy examination is warranted to perform vestibular and neurological testing in order to tease out other potential causes of symptoms and get to the root of your dizziness. PT’s work in collaboration with headache specialists, ENTs, neurologists, and primary care providers to reach an accurate diagnosis and comprehensive treatment plan.

Keeping a migraine diary can help track your symptoms, triggers, and patterns, aiding in diagnosis.

How are Vestibular Migraines Treated?

The treatment for vestibular migraines is different for every individual depending on specific symptoms, triggers, and other coexisting comorbidities. However, treatment typically involves a multifaceted approach, including the following:

1. Lifestyle Modifications: Identifying and avoiding triggers such as certain foods, caffeine, stress, or lack of sleep can help manage your condition. Just like the rest of your body, your vestibular system needs movement for optimal functioning. Ensuring you continue to live an active lifestyle that includes at least 10-30 minutes of walking or exercise every day can aid in symptom management!

2. Vestibular Rehabilitation: Because your vestibular system has been impacted if you are having vestibular migraine attacks, your vestibular system needs to be retrained and improved! Vestibular exercises can help strengthen the firing of your vestibular system, improve balance, and reduce the severity and frequency of dizzy and vertigo episodes.

3. Stress Management: Learning stress-reduction techniques like meditation, yoga, or deep breathing exercises can be imperative since stress is a common migraine trigger.

4. Dietary Changes: Common trigger foods include aged cheeses, caffeine, alcohol, chocolate, and artificial sweeteners. Learning what your food triggers may be through journaling can help teach you what you should avoid or modify for improved relief.

5. Supplement Integration: Research has shown a positive correlation between increased intake of vitamins such as Vitamin D, magnesium, riboflavin (B2), omega-3s, and coenzyme 10 with reduction in migraine symptom intensity, severity, and frequency (Disclaimer: This is not medical advice. Always check with your healthcare provider before adding/removing medicine or supplements into your routine).

6. Medications: Your healthcare provider may prescribe medications to alleviate symptoms during an episode and prevent future ones. These may include pain relievers, anti-nausea medications, and migraine preventives.

Conclusion

Vestibular migraines can be incredibly challenging to live with due to their unpredictable nature, difficulty in establishing triggers, and the disruption they can cause in daily life. However, with proper diagnosis and management, you can find relief and regain control of your life.

Don’t continue to suffer alone. There is power in unity. Visit www.americanmigrainefoundation.org for further education, community events, monthly newsletters, and personal stories shared by others facing migraine challenges. Rebalance Physical Therapy is located in Greenville, SC. If you need assistance finding someone near you, let us know and we will help!

If you suspect you may be suffering from vestibular migraines, make sure to reach out to a vestibular physical therapist or other healthcare specialist to get tested and develop a personalized treatment plan tailored to your needs. We would love to help you along your journey – it is a journey, but you are not alone. Stay positive, there is hope for better days ahead. Click the link below to schedule an initial evaluation today!

Tired of migraine symptoms dictating your life? Schedule your initial evaluation today!

Questions?

Resources:

Hilton DB, Shermetaro C. Migraine-Associated Vertigo. [Updated 2022 Aug 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507859/

“Migraine 101.” American Migraine Foundation, 21 Feb. 2023, americanmigrainefoundation.org/migraine-101/.