Vestibular migraine is now the accepted term for a type of migraine that mainly presents with dizziness symptoms.
Migraine is not just headache!
It just so happens that the two most common types of migraine are headache varieties, Common Migraine and Classical Migraine and so people often think that migraine means headache, however there are many types of migraine that may not cause a headache at all, such as Vestibular Migraine!
Migraine is a phenomenon of altered sensation and there are many forms of migraine, of which only some involve headaches. For example, in children, unexplained nausea or abdominal pain is often caused by Abdominal Migraine and does not involve any headache at all. Leg pain in children such as “growing pains” or joint pain in adults may be migraine and Irritable Bowel Syndrome (or IBS) is now known to be a migraine phenomenon in adults, similar to abdominal migraine in children.
Vestibular Migraine is one of the most common causes of dizziness and vertigo, and is not always associated with headaches. The duration of attacks of Vestibular Migraine vary from seconds to days at a time, but attacks usually last minutes to hours at a time. Vestibular Migraines mostly occur without headaches, although many are followed by, or occur with a headache or visual changes.
This website aims to help you with your understanding of Vestibular Migraine, your symptoms and simple treatments for Vestibular Migraine that can help in the vast majority of patients overcome their migraine problems.
Symptoms of Vestibular Migraine
Vestibular Migraine typically is associated with Intolerance of movement (moving the head or watching moving images makes the symptoms worse) and dizziness.
Other symptoms during an episode of Vestibular Migraine include;
– Nausea, Vomiting, Sweating and Flushing: sometimes Diarrhoea in severe episodes
– Visual changes such as blurring, flashing lights and difficulty focusing
– Difficulty concentrating and memory problems during the episode (often described as “trying to concentrate through a fog”)
– Finding bright lights and loud sounds uncomfortable – worse during an episode is common in Vestibular Migraine
Patients most commonly feel extreme tiredness and fatigue after an episode, needing to sleep (often in a darkened room).
Causes and Triggers of Vestibular Migraine
The underlying cause of Vestibular Migraine is unknown, however, they are known to be strongly related to a mixture of environmental and genetic factors. For example, they run in families in around two thirds of cases.
Vestibular Migraine is very closely linked with anxiety, depression and other forms of dizziness such as Meniere’s disease (of which it is often confused and may co-exist). In general, however, it is well recognised that a Vestibular Migraine is set off by common triggers in almost all patients.
These migraine triggers can be controlled and serve as the basis for treatment.
The top 5 most common triggers for Vestibular Migraine are;
1) Stress and Anxiety.
2) Poor sleep – both too little, and too much!
3) Hunger and Dehydration – missing meals or not drinking enough water.
4) Dietary triggers – many common foods.
5) Hormonal changes – i.e. Periods, Menopause and in Teenagers.
Other external triggers for Vestibular Migraine can include certain forms of lighting (such as strip lighting) artificial ventilation (such as air conditioning and central heating), weather changes, smoking and strong odours (such as perfumes and aftershaves).
Vestibular Migraine Symptom Diary
One method which has been shown to be very successful in managing Vestibular Migraine is to keep a symptom diary such as that below, and this way, over a period of a few months it is common to find a pattern to your attacks of Vestibular Migraine.
This can often lead to identification of specific triggers, which when stopped, may abolish Vestibular Migraine altogether in some cases, so it is well worth the effort!
Salmon salad potatoes
Roast Turkey etc
Treatment for migraine
We live much more stressful and busy lives these days than we did years ago. This explains one reason why Vestibular Migraine is so much more common now than it ever was.
Try and keep as calm as you can and if possible, de-stress everyday with some form of gentle exercise such as;
Walking, Yoga, Swimming, Tai Chi, Pilates,
Massage and general relaxation therapies.
(Tai Chi and Pilates are especially good for problems with dizziness)
Meditation and Mindfulness techniques can be especially good for Vestibular Migraine and can even be learnt in virtual session via Skype in the comfort of your own home, through www.meditatelondon.co.uk
Regulation of your sleep pattern to avoid too little or too much sleep can help greatly. You may have noticed that your Vestibular Migraine symptoms are worse when you are tired?
Try and get the same amount of good quality sleep every night. This can be done by;
Going to sleep at the same time each night including weekends.
Getting up at the same time each morning, including weekends – lying in is just as bad as lack of sleep!
Turning off all electrical devices such as, television, radio, tablets and phones, so your body and brain can rest.
Many smart phone apps now exist to help with “Sleep Hygiene” as we call it.
The busier we are the less time we devote to treating ourselves as human beings, and humans need fuel in the form of food, which is an area we are very bad at maintaining when we are busy.
Many of us skip meals, especially lunch, as we are too busy to stop. As a result, this can trigger Vestibular Migraine attacks in some individuals.
Avoid missing meals and try and regulate your mealtimes, as well as having a well-balanced breakfast, lunch and dinner at around the same times each day, and have snacks spaced between meals to avoid hunger can regulate and keep your blood sugar levels stable.
This has been shown to help avoid attacks of vestibular migraine.
Stopping work for lunch is also a good way to de-stress!
There are many well-known dietary triggers for migraine in general, and changes to your diet alone may achieve significant resolution of Vestibular Migraine symptoms in as many as 72% of patients. Therefore avoidance of these triggers can help. This does not mean giving up all the food you like – instead just reducing the amount of any trigger foods of which you eat a lot.
Some drinks can be triggers for vestibular migraine these include-
Alcohol – especially red wine and champagne
Caffeinated drinks such as coffee, hot chocolate, tea (including some herbal teas and Green Tea) and especially energy drinks!
Carbonated drinks such as Cola
Foods that can be triggers for Vestibular Migraine are –
High Factors Wholemeal Bread, Smoked Ham, Canned Crab, Canned Salmon, Salami, Corned Beef, Salted Peanut Butter, Cottage Cheese, Cheese, Bacon, Canned Ham, Kippers, Butter, Cornflakes, Marmite, White Bread.
Professor Judd is Consultant Neurotologist, Ear, Nose and Throat Surgeon at The Royal Derby Hospital(ITV’s “Superhospital”), and practices privately at Derby Private Health at the Royal Derby hospital. He has a prestigious international Visiting Professorship in Balance Medicine, specialising in diseases of the Ear and Brain and is an expert in Balance disorders and dizziness. He has a special interest and expertise in complicated Vestibular Migraine and Migraine in general.