Migraine-related dizziness is a common but often underdiagnosed problem. In this article, neurologist Markku Nissilä explains what vestibular migraine is, what symptoms it involves, and how it can be treated.
Prevalence of Vestibular Migraine
Vestibular migraine affects about 1–3 percent of the general population, but up to 10 percent of migraine patients suffer from recurrent dizzy spells. Dizziness can be rotational, rocking, or even a continuous sense of imbalance. Sensitivity of the vestibular system often becomes apparent even before the onset of full-blown migraine. Motion sickness in children is significantly more common in individuals who are later diagnosed with migraine. This predisposition may be linked to some of the 123 currently known migraine-related genes.
Symptoms and Manifestations
Dizziness experienced in connection with migraine can be:
- Nausea and rotational dizziness related to head movements.
- Duration varies from seconds to up to three days.
- It may be accompanied by typical migraine symptoms such as headache, light and sound sensitivity, and nausea, but for some, dizziness also occurs without a headache.
- Symptoms may also include tinnitus, increased hearing sensitivity, and balance problems.
Diagnosis and Differential Diagnosis
Diagnosing vestibular migraine can be very challenging because not all attacks involve a headache. Dizziness can resemble benign paroxysmal positional vertigo (BPPV), but in vestibular migraine, attacks usually occur more frequently, and the duration of symptoms varies. In the International Headache Society's (IHS) classification of diseases, BPPV is now included as a possible migraine-related symptom complex. When making a diagnosis, it is important to rule out other possible causes, such as neurological diseases. Among the migraine patients I see in my practice, about one-third show abnormalities in balance tests. In the tuning fork test, when a tuning fork is pressed onto the midline of the forehead, the sound is heard on one side or the other, whereas normally the sound should be heard in the middle. In addition, when marching in place with eyes closed, there is a turning towards the side where the tuning fork is heard more strongly.
Treatment and Quality of Life
The treatment of vestibular migraine is similar to other forms of migraine; the most important aspects are a comprehensive symptom assessment, the use of acute and preventive medications if necessary, and addressing lifestyle factors such as stress and lack of sleep. In acute treatment, prochlorperazine has proven to be the most effective option in practice. For preventive treatment, several conventional medications for migraine with aura have been shown to be effective. With proper treatment, symptoms can often be well managed.
Summary
Migraine-related dizziness is therefore a significant and often underdiagnosed problem, but by recognizing the syndrome, the quality of life for those suffering from vestibular migraine can be effectively improved.
