June was Headache and Migraine Awareness Month –  the perfect time to discuss Vestibular Migraine (VM). Vestibular migraine is a condition that accounts for a high proportion of patients with vestibular symptoms. It is one of the most common causes of recurrent vertigo. Research into vestibular migraine has rapidly increased over the last two decades. Ten to twenty percent of patients presenting to headache clinics have VM.

The diagnosis for  VM is based on recurrent vestibular symptoms, migraine history, and the overlapping of vestibular and migraine symptoms. Vestibular symptoms can include spontaneous or positional vertigo, head-motion intolerance, visually induced dizziness, and dizziness with nausea. Migraine symptoms can include headache, sensitivity to light, and sensitivity to sound. It is important to note that a VM attack can be experienced with or without headache. Typically, if a headache coincides with vertigo, the headache is often weaker when compared to a standard migraine (i.e. one without vertigo).

The duration of VM episodes is highly variable. Thirty percent of patients report have episodes lasting only minutes, another 30% have attacks that last for hours, 25% have attacks lasting over several days and the remaining 15% have attacks that last only seconds. Some patients rebound very quickly; however, it may take other patients

weeks before they are fully recovered. VM attacks can be quite severe causing patients to be bedridden for a few days, where they must lie still, avoiding even the slightest head movement.

There are a variety of treatments for VM. Medications to alleviate vertigo and nausea can be given for acute and prolonged attacks.  A symptom diary, which documents frequency, intensity, and duration of attacks, is often used to help guide treatment.

In some patients, non-pharmaceutical treatments may be more effective than drugs. The identification of migraine triggers can help with self-management of VM. Lifestyle modifications, such as avoiding identified triggers, having a regular sleep schedule, getting adequate sleep, exercising, and eating well, are all key components to migraine treatment. Aerobic exercise may be as effective as drugs and regular exercise can reduce the intensity and frequency of VM. Additionally, vestibular rehabilitation is another treatment option.

If someone has a history of migraine and is experiencing vestibular symptoms, they should speak to their doctor. If  VM is present, additional investigation and assessment should be performed by a neurologist or ENT (ear, nose, & throat) specialist.

Submitted by: Curt Culford, M.Cl.Sc. Aud, Reg. CASLPO Audiologist and Owner, Culford Family Hearing

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