Many people have heard of migraine but are not sure of what vestibular migraine is all about. It is a migraine event where vertigo is the main symptom. It is one of the common causes of episodic vertigo in children and adults. Episodes can last for minutes or up to a few days.
The symptoms that people experience during an episode are:
Vertigo – a sense of spinning either the room or yourself, can be sitting still (no trigger, spontaneous) or when changing positions (triggered by positional change, head movement)
Light-headedness – a sense of ‘airy head’, almost fainting sensation
Nausea and Vomiting
Headache – during or after the episode
Disequilibrium – rocking, tilting, swaying, unstable on feet, floor under feet feels like it is moving
Visual Motion Sensitivity – feel nauseous or unwell with vision not matching up with surrounds
Anxiety – fear avoidance of certain movements of head, body. Panicked feeling, shortness of breath.
Dissociation symptoms – disconnection from your body or from the environment around you
Imbalance – unsteady walking, feel uncoordinated, bump into things
Light / Sound/ Smell Sensitivity – sensitive to light such as light coming through trees, car lights, fluorescent lights in office; sensitivity to sounds such as loud noises, busy restaurants, concerts or muffled hearing or ear pressure; sensitivity to certain smells like strong perfumes, cooking smells.
The assessment
Practitioners at Sydney Headache and Migraine Centre take a thorough medical history of our patients and then perform a physical examination of the Vestibular System, Balance and Cervical Spine.
We use specialised goggles that detect any abnormal eye movements known as nystagmus (jerky eye movements). These eye movements can mimic conditions like BPPV, Meniere’s disease or Vestibular Neuritis. These conditions can also coexist with Vestibular Migraine making it complicated.
The treatment
Treatment involves Vestibular Rehabilitation exercises to improve dizziness and imbalance. These exercises may not prevent an episode of vestibular migraine occurring, but they help reduce the symptoms and improve daily functioning.
Migraine-specific neck treatments, using the highly renowned Watson Headache® Approach, is an exceptional treatment option for headache and migraine conditions. This involves physically assessing the Upper Cervical Spine (UCS) for stiffness and pain, with particular interest in referral of pain from the neck into the head. It is particularly effective in treating those with dizziness as the main migraine symptom.
Treatment for coexisting BPPV or other vestibular dysfunction will be done based on assessment findings as well as balance training to reduce falls risk.
Management of lifestyle factors such as diet, hydration, alcohol, sleep, exercise tolerance, managing stress and anxiety can also be very useful. We have a strong referral network should patients require specialised care in more specific areas.
