MIGRAINE ASSOCIATED VERTIGO
Migraines are characterized by recurrent often painful headaches (often unilateral) which are frequently accompanied by visual and sensory symptoms (aura), light sensitivity, and nausea.
Vertigo is the illusion of movement of the environment or the patient in relationship to the environment.
Migraines and migraine associated vertigo are often triggered by factors including stress, anxiety, hypoglycemia, fluctuating estrogen, certain foods and smoking. However, no single hypothesis can currently explain the link between the headache and dizziness of a migraine.
Vertigo is the illusion of movement of the environment or the patient in relationship to the environment.
Migraines and migraine associated vertigo are often triggered by factors including stress, anxiety, hypoglycemia, fluctuating estrogen, certain foods and smoking. However, no single hypothesis can currently explain the link between the headache and dizziness of a migraine.
Incidence
Migraines are relatively common, occurring in 18% of women and 6% of women for a total of 25-28 million people.
Episodic vertigo occurs in 25-35% of all migraine patients, meaning that about 3.0 to 3.5% of people have episodic vertigo and migraines.
Episodic vertigo occurs in 25-35% of all migraine patients, meaning that about 3.0 to 3.5% of people have episodic vertigo and migraines.
Causes
Spreading depression theory
It may be mistaken for Meniere’s disease however Meniere’s disease does not typically last for more than 24hours, as migraine associated vertigo can.
These patients may have a history of motion sensitivity,including car, air, and seasickness.
- The most commonly accepted theory of migraine-associated vertigo was proposed by Cutrer and Baloh in 1992. They proposed that episodes of dizziness have a similar cause to aura associated with headaches.
- A chemical or mechanical stimulus produces a transient wave that suppresses central neuronal activity. The depression spread in all directions from the site of origin and causes large ion fluxes, increasing extracellular K+ and decreasing extracellular Ca2+. This results in reduction in cerebral blood flow.
It may be mistaken for Meniere’s disease however Meniere’s disease does not typically last for more than 24hours, as migraine associated vertigo can.
These patients may have a history of motion sensitivity,including car, air, and seasickness.
Diagnosis
No diagnostic test exists other than patient symptom evaluation and response to treatment. Usual diagnosis involves identfying the symptoms listed above and ruling out other possible causes.
Treatment
Treatment is similar to that for a migraine with three main medication options including:
- Abortive medication and risk factor reduction: Abortive medications which are effective for treating migraines are not effective for treating secondary dizziness.
- Prophylactic Pharmacotherapy: Prophylactic therapy should be used when migraine-associated vertigo occurs several times per month or is continuous. The exact mechanism of migraine relief from these medications is not well understood. It is possible that the medications prevent the release of neuropeptides from dural blood vessel walls because of their effect on serotonin receptors
- Dietary restrictions: Sometimes restricting certain foods such as those containing MSG, certain alcoholic beverages, aged cheese, chocolate, and aspartame.
"About Vestibular Disorders." Vestibular Disorders. Johns Hopkins Medicine. Web. 25 Nov. 2013. <http://www.hopkinsmedicine.org/neurology_neurosurgery/specialty_areas/vestibular/>.
Benson, Aaron (2012). "Migraine-Associated Vertigo." Retrieved November 24, 2013. emedicine.medscape.com.
Vestibular Disorders Association. Web. 25 Nov. 2013. <http://vestibular.org/>.
Benson, Aaron (2012). "Migraine-Associated Vertigo." Retrieved November 24, 2013. emedicine.medscape.com.
Vestibular Disorders Association. Web. 25 Nov. 2013. <http://vestibular.org/>.