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What is Vestibular Migraine?
An interesting occurrence that has puzzled the medical world for a long time is the simultaneous presentation of migraines and vertigo. The most common episodic vestibular disorder is called Vestibular Migraine. Episodes of this complex condition involve vertigo, aura and migraine headaches with vertigo as the main symptom. An attack most commonly lasts 5 minutes to 72 hours, but is he time period of such an attack is known to vary. There are no known biological markers for diagnosing Vestibular Migraine, which complicates the diagnosis of the condition. It is therefore essential for the patient to give a detailed history of the symptoms that they struggle with.
Factors that influence the progression of Vestibular Migraine are multi-factorial and may be genetic, epi-genetic or environmental. Some possible triggers of Vestibular Migraine include menstruation, emotional stress, lack of sleep, dehydration and certain foods.
If you suffer from Vestibular Migraine, you are not alone. Approximately 1% of the general population may be affected by this condition, although it has been speculated that the percentage should in fact be higher since the condition is regularly misdiagnosed. Even though the pathophysiology (biological mechanism) of Vestibular Migraine is not known, many studies are currently contributing to the understanding of the neurophysiological pathways involved with the disorder. Some possible hypotheses, which are based on current knowledge of migraines, include the following:
- The sensitisation of the trigemino-vascular system – the nerve-blood bundle that supplies the face becomes over sensitive.
- Possibilities of genetic predisposition with many family members experiencing similar migraines of inherited nature
- Recent reports are now suggesting that higher processing parts of the brain (like the thalamus and other regions of the brain that regulate pain) are involved, with a loss of ‘synchronisation’ seen between them
The diagnostic criteria (according to the Consensus document of the Barany Society and the International Headache Society) is essentially a vertigo episode (false perception of movement), along with a migraine (with or without visual aura). Additionally, people also suffer from photophobia (sensitivity to bright light), hearing dysfunction, nausea or vomiting, dizziness, balance disturbance and exhaustion, .. 
Brain Hub, based in Sydney, is a leading vestibular rehabilitation and brain-based therapy clinic for the treatment of people suffering from dizziness and balance disorders, including migraines with vertigo (medical and clinical neuroscience research references SUPPORTING the use of VESTIBULAR REHABILITATION for the management of VESTIBULAR MIGRAINES are included below)
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Burdens of Vestibular Migraine
People suffering from vestibular migraine are not simply patients. They are people who live in the real world and who have to carry on with their lives despite their condition. These people may not only suffer from the symptoms related to Vestibular Migraine, but also suffer from the damage that this disorder brings onto their lives. A sudden attack may be a frightening experience and the long term effects of the condition may greatly impact someone socially, physically, psychologically and financially.
Vertigo and migraine are both common reasons why people end up in the ER. The symptoms can cause great distress, especially when they occur suddenly. When you experience an attack of Vestibular Migraine it may feel like you are going to fall down or you may even suffer from debilitating headaches. Or both at the same time.
Countless cases of vertigo and migraine are dismissed as “unexplained”, which means that people may suffer from debilitating symptoms for long periods of time before finally being diagnosed. Symptoms like poor balance, nausea and excruciating headaches can become insufferable.These symptoms do not only affect patients but also have an impact on the people around them. This means that someone’s social life could suffer from the consequences of this condition.
The financial burden of Vestibular Migraine is devastating. The diagnosis of this condition is based on exclusion which means that countless medical tests have to be done before a diagnosis is reached. Medical testing can cost a great deal of money.
At some point along the line someone suffering from Vestibular Migraine may not be able to keep a job. This can be frustrating and also causes a great financial burden.
Vestibular Migraine should be diagnosed with great urgency to prevent or limit the damages that it can cause to someone’s life.
Medical and clinical neuroscience Research is SUPPORTING the use of VESTIBULAR REHABILITATION THERAPY for the management of VESTIBULAR MIGRAINES
- Celebisoy N, Karapolat H, Gokcay F, Bilgen C, Ozgen G, Kirazli T, Kose T. Establishing a “Vestibular Migraine Diagnosis Questionnaire” and Testing Its Validity. Neurologist. 2016 Jul;21(4):51-4.
- Tjernström F, Zur O, Jahn K. Current concepts and future approaches to vestibular rehabilitation. J Neurol. 2016 Apr;263 Suppl 1:S65-70
- Momtaz S, Hajiabolhassan F, Togha M, Jalaie S, Almasi A. Quantitate oculomotor findings in migrainous patients. Iran J Neurol. 2014 Oct 6;13(4):250-2.
- Vitkovic J, Winoto A, Rance G, Dowell R, Paine M. Vestibular rehabilitation outcomes in patients with and without vestibular migraine. J Neurol. 2013 Dec;260(12):3039-48.
- Bisdorff AR. Management of vestibular migraine. Ther Adv Neurol Disord. 2011 May;4(3):183-91.
- Cha YH. Migraine-associated vertigo: diagnosis and treatment. Semin Neurol. 2010 Apr;30(2):167-74
- Shepard NT. Differentiation of Ménière’s disease and migraine-associated dizziness: a review. J Am Acad Audiol. 2006 Jan;17(1):69-80.
- Gottshall KR, Moore RJ, Hoffer ME. Vestibular rehabilitation for migraine-associated dizziness. Int Tinnitus J. 2005;11(1):81-4
- Wrisley DM, Whitney SL, Furman JM. Vestibular rehabilitation outcomes in patients with a history of migraine. Otol Neurotol. 2002 Jul;23(4):483-7.
- Cass SP, Furman JM, Ankerstjerne K, Balaban C, Yetiser S, Aydogan B. Migraine-related vestibulopathy. Ann Otol Rhinol Laryngol. 1997 Mar;106(3):182-9.
- Bronstein AM. Oxford textbook of vertigo and imbalance. Oxford: Oxford University Press; 2013. p. 231-236.
- Espinosa-Sanchezand JM, Lopez-Escamez JA. New insights into pathophysiology of Vestibular Migraine. Front Neurol. February 2015; vol. 6(12)
- Lempert T, Olesen J, Furman J, Waterston J, Seemungal B, Carey J et al.Vestibular migraine: Diagnostic criteria. J Vestib Res. March 2013; vol. 22(2012): 167-172.
- Neuhauser HK, Radtke A, Von Brevern M, Feldmann M, Lezius F, Ziese T et al. Migranous vertigo: Prevalence and impact on quality of life. Neurology. September 2006; vol. 67(6): 1028-1033.
- Headache classification committee of the international headache society. The International Classification of Headache Disorders, 3rd ed. Cephalalgia. 2013; vol. 33(9): 629–808.
- Parain D, Guerrini R, Hesdorffer D, Ryvlin P. Epilepsy and migraine. United Kingdom: John Libbey Eurotext; 2009. p. 35.
- Stolte B, Holle D, Naegel S, Diener HC, Obermann M. Vestibular migraine. Cephalalgia. March 2015; vol. 35(3): 262-270.
- Cal R, Bahmad Jr F. Migraine associated with auditory-vestibular dysfunction. Braz J Otorhinolaryngol. 2008; vol. 74(4): 606-612.
- Yardley L, Barker F, Muller I, Turner D, Kirby S, Mullee M et al. Clinical and cost effectiveness of booklet based vestibular rehabilitation for chronic dizziness in primary care: single blind, parallel group, pragmatic, randomised controlled trial. BMJ. 2012; 344: e2237.
- Neuhauser HK, Radtke A, Von Brevern M, Lezius F, Feldmann M, Lempert T. Burden of vertigo and dizziness in the community. Arch Intern Med. 2008; vol. 168(19): 2118-2124.
Solution for Migraine
Medical and clinical neuroscience research is SUPPORTING the use of VESTIBULAR REHABILITATION THERAPY for the management of VESTIBULAR MIGRAINES (see references above)
• Physical examination
• Neurological testing
• Metabolic and nutritional
• History questionnaires
• Report of findings
• Clear answers
• Options for treatment
• Solution recommended
Physical therapy and exercises
Neurological and brain-based therapy
Vestibular (balance) rehabilitation
Metabolic and dietary