Basic Facts
What is Vestibular Migraine?
Vestibular migraine is a variant of Migraine where vertigo and other vestibular (inner ear balance organ) symptoms are the prominent feature.
There does NOT always have to be an accompanying headache with the dizzy episodes.
How common is it?
Migraine itself is felt to affect approximately 14% of the adult population. Vestibular Migraine is believed to affect 2-3% of the population.
It is one of the most common conditions seen in a specialist dizzy clinic.
It is the most common condition I diagnose in younger adults and children with episodes of vertigo.
What are the main symptoms?
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- Recurrent episodes of vertigo or other vestibular symptoms, with each episode lasting minutes to several days
- At least half of episodes are accompanied by either a migraine headache, light and sound sensitivity, and / or visual aura (e.g. zigzag lines in vision)
However, as with much of life, things are not always black and white, and people don’t always present with all the ‘classical’ symptoms. Most people have a past history of more classical migraines, or travel sickness, and there are often other family members with migraine.
How is it managed?
Lifestyle Modifications
I cannot stress enough how important these ‘healthy habits’ are in reducing the frequency and severity of dizzy episodes for long term Migraine management. Additionally, these lifestyle changes will improve other aspects of your health and wellbeing.
I am an unwavering advocate for HOLISTIC medical management.
What are these ‘healthy habits’?
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- Always stay well hydrated, with water
- Stick to a CONSISTENT eating schedule, and have a balanced diet
- Avoid or minimize any individual dietary triggers (see note below)
- Maintain a consistent sleep schedule, with adequate hours. Look into Sleep Hygiene for tips on giving yourself the best chance of a good night sleep. (I’ll cover this in more detail in a future post)
- Engage in regular, moderate exercise. Aside from improving Migraine, this will also improve your overall physical and mental health
- Try to improve stress management. THIS IS EASY FOR ME TO SAY, AND HARD FOR US TO DO. Although stressful triggers cannot be simply ‘taken away’, we can try to manage them more EFFECTIVELY. Practice relaxation and breathing techniques, meditation, mindfulness, exercise… and even making time for hobbies can be helpful
- Limit ‘screen time’ and take regular breaks to reduce eye strain and visual load
Note: Although some doctors may advise certain foods HAVE to be avoided at all costs, I take a more pragmatic approach, and advise minimizing triggers if it is something you particularly enjoy. Identifying your individual triggers is hugely valuable, as it can instruct you WHEN you chose to eat that food, and when it should definitely be avoided, e.g. avoid if you are particularly sleep deprived or stressed.
Prophylactic (Preventative) Supplements
These are supplements which you can buy over-the-counter and include Riboflavin (Vitamin B2), Magnesium and Coenzyme Q10.
Prescribed Prophylactic (Preventative) Medication
There are now many different prescribed medications which can help to manage Migraine, including Propranolol, Amitriptyline, Topiramate, Nortriptyline, Candesartan, Pizotifen, Venlafaxine, and others.
‘Rescue’ Medication
These are tablets you take when you have your Migraine or Vestibular Migraine attack. Medications include Prochlorperazine, Cinnarizine, Promethazine, etc, for vertigo, and Paracetamol, Ibuprofen, Sumatriptan, etc, for headaches.
Please note the tablets for vertigo should NOT be taken for more than a few days, as prolonged usage will slow down recovery and lead to more chronic imbalance.
Other Treatment Options
Specialist clinics will also have access to other treatments including Greater Occipital Nerve Blocks, Botox, CGRP Monoclonal Antibody Therapy (e.g. Ajovy – Fremanezumab), Transcranial Magnetic Stimulation.
Vestibular rehabilitation may have a role in trying to help with desensitization and habituation, by helping motion induced dizziness and visual vertigo (these symptoms will be covered in more depth in a future blog post).
Psychological Interventions are UNDER-UTILIZED and better managing anxiety and low mood is hugely beneficial in Migraine management.
DISCLAIMER: This blog is meant for medical education purposes ONLY and does not constitute individual clinical advice. ALWAYS seek medical advice from your treating doctor, when managing health conditions. If you would like to arrange for a private medical consultation with Dr Shaw, Consultant Audiovestibular Physician, then information on booking an appointment can be found at TheDizzySpecialist.com/contact. Face to face and virtual consultations available.
Dr Benjamin Shaw | Audiovestibular Consultant Physician | TheDizzySpecialist.com
I am an Audiovestibular Consultant Physician, based in London. I am a highly experienced and specialised Medical Doctor, who accurately diagnoses and effectively manages dizziness, vertigo, balance disorders, hearing loss & tinnitus. I am also a committed advocate for patients with these debilitating symptoms and create healthcare-related educational content, with the aim of empowering patients to better understand and manage their conditions.
