Ask the Doctors

Dear Doctor: I have just been diagnosed with vestibular migraines. Could you give me information on the symptoms and treatment?

Dear Reader: Vestibular migraine is a relatively new diagnosis used by doctors to describe the association between vertigo and migraines. The connection itself, however, has been recognized by doctors since 1873, with the condition given multiple names, including vertiginous migraines, migrainous vertigo and migrainous vestibulopathy.

No defining test is used to diagnose the condition; instead, diagnosis is based on a person's recurrent symptoms.

The first criterion is a present or past history of migraine headaches. Second is recurring vertigo. These can be episodes in which the room seems to be spinning or in which a stationary person has feelings of movement. In vestibular migraines, the vertigo can last from five minutes up to 72 hours.

The third criterion is that more than half of these vertigo episodes occur with at least one symptom of a migraine. That symptom could be a headache that is one-sided, severe and worsened by physical activity; visual flashing wavy lines noted by many migraine sufferers; or extreme sensitivity to light and sound. Severe sensitivity to sound is especially common in vestibular migraines.

The fourth criterion is that the condition not be caused by another condition.

Based on these criteria, doctors are diagnosing more people with vestibular migraines. A population-based study found that 1 percent of Germans had vestibular migraines at some point in their lives. Other research has established that the condition occurs more often in women than in men and is diagnosed more often in children than adults. In adults, the average age of diagnosis is about 40 years of age.

The cause, however, is not known. Vertigo could act as a migraine trigger; or a neurologic or inner ear problem could cause both vertigo and migraine.

Treatments for an acute attack of a vestibular migraine include the typical medications used for migraines. Drugs known as triptans, such as Imitrex, Relpax, Zomig, Maxalt and Amerge, can be used for migraine symptoms and may ease the vertigo as well. But some doctors specifically treat the vertigo using antihistamines such as meclizine or dimenhydrinate or with benzodiazepines such as clonazepam or lorazepam.

To prevent a vestibular migraine, try to avoid those factors that increase your risk of a migraine. Because many migraines are caused by stress, limiting the amount of stress or finding ways of managing stress is a good starting point. Getting enough sleep is helpful, as is limiting caffeine and alcohol, eating regular meals, staying away from food additives and avoiding dehydration. Medications to prevent vestibular migraines include calcium channel blockers, such as verapamil; beta-blockers; tricyclic antidepressants at low doses; and the antihistamine betahistine. Physical therapy to improve balance and decrease the sensation of vertigo may also prove beneficial.

As I've learned from my own patients, symptoms of vestibular migraine can be debilitating. But there is hope: Start by avoiding migraine triggers, taking preventive medications and getting physical therapy. Those three actions should, I hope, decrease your attacks.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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