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.)

Dear Doctor: Can a hot bath really burn as many calories as a brisk walk? If so, give me the hot bath any day!

Dear Reader: For readers who missed this story, scientists at Loughborough University in England were concerned about people who can't (or won't) exercise. They wondered if there might be a passive alternative, like a long soak in hot water, with similar health benefits. To find out, 14 men were split into two groups -- those who were lean, and those who were overweight. All were healthy non-smokers with no signs of cardiovascular disease. None of the men did more than 90 minutes of physical exercise per week, so all were considered inactive. The researchers targeted changes to markers of chronic inflammation, insulin resistance and glucose control, which are key factors in metabolic syndrome, an indicator of potential heart disease, diabetes and stroke.

The men were assigned to one of two activities -- relaxing in a 104-degree bath for one hour, or riding a stationary bike set at pre-determined resistance and speed for one hour. In the hours after the trial, the men ate similar meals. Blood was drawn several times, both before and after each trial. Changes to core body temperature and muscle temperature were monitored.

It's not all that surprising that the men assigned to an hour of stationary cycling burned significantly more calories than the bathers. However, it was discovered that while lounging in that hot water, the bathers burned 140 calories, or the equivalent of a 30-minute walk. Even more intriguing was the fact that while both groups had similar blood sugar trajectories before, during and after a subsequent meal, the blood sugar levels among the bathers peaked at a level that was 10 percent lower than among the cyclists. And when it came to anti-inflammatory response, which is one of the immune system's first lines of defense, the passive bathers did as well as the active cyclists.

The idea that a hot bath can offer benefits similar to those of exercise sounds counterintuitive, but the results of a couple of other studies suggest that passive heating is an important new area of research. In 2015, scientists in Finland saw a connection between the frequent use of saunas, an important part of Finnish culture, and a decrease in the risk of heart attack or stroke in men. A year later, researchers at the University of Oregon found passive heat therapy resulted in lowered blood pressure and decreased arterial stiffness in both women and men.

But don't trade your running shoes for an inflatable bath pillow just yet. Two of the three studies looked solely at men, so whether that research translates to women is not yet known. And all three studies had fairly small sample sizes. While the area of passive heat is indeed exciting and appears promising, we need more information to corroborate the existing findings.

Our take is it's a good idea to stick to the goal of at least 30 minutes per day of physical activity, which offers a host of long- and short-term physical and mental health benefits. And as you relax in a long, hot bath afterward, know that it is more than just an indulgence.

(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.)

Dear Doctor: Does depression run in families? That is, is it inherited? Enough to make a person suicidal?

Dear Reader: The short answer is, yes, depression can run in families. But first some background: Depression is quite common in the United States. About 17 percent of the population will have an episode of major depression at some point -- one that lasts at least two weeks and is marked by a depressed mood most of the day, decreased pleasure in doing activities, poor concentration, feelings of worthlessness or hopelessness, fatigue and possibly the desire to commit suicide. Another 3 percent will have persistent depression, in which symptoms are fewer but last longer.

Genetics do appear to play a role. Studies of identical twins have found that if one twin has a depressive episode, the other twin has a 37 to 38 percent chance of depression. These twin studies show a stronger correlation in women than in men (42 percent versus 29 percent), and a Swedish study found a greater chance of major depression if the other twin had depression early in life (from ages 13 to 23).

The genetics of depression are not simple. No one gene has been implicated. Multiple genes could be involved, and they could vary based upon race. Further, some trigger in the environment (a stressful life event or isolation) could cause a gene to be turned on, leading to depressive symptoms.

Suicide appears to be a separate issue. Suicide clearly has, in part, a genetic connection. The genes involved, however, may be more related to impulse control than depression. One study found that among identical twins, if one twin commits suicide, the other twin has a 14.9 percent risk of suicide. This was much higher than the 0.7 percent rate seen in non-identical twins. Another study found an even stronger connection -- that if one identical twin commits suicide, the other twin attempts suicide 38 percent of the time.

The risk of suicide goes beyond twins. A 2003 Swedish study found that suicide rates are twice as high in families of suicide victims compared to those families without a suicide victim. This data was independent of depression. Other studies have shown that rates of suicide among adolescents are much higher if a first-degree relative has committed suicide.

The issue appears to be one of an aggressive impulse, which can lead to a suicide attempt. Although a depressed person might think about suicide, a person who has a close family history of suicide might have a greater impulse to actually attempt it. The combination of both depression and a family history of suicide will thus increase the likelihood of a suicide attempt.

As we've established, the genetics of depression and suicide are not fully understood. Additional risk factors might include exposure to abuse, an unstable home environment and economic instability. So, although a family history of suicide and depression can increase the risk of these same ailments, a nurturing home life, economic security and personal well-being will mitigate this risk.

If you're showing signs of depression or having thoughts of suicide, please seek professional help as soon as possible.

(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.)