Migraine-associated vertigo

A migraine is made up of several symptoms. The main symptom is a headache that lasts anything from a few hours up to a few days. The headache is usually moderate or severe and is often just on one side of the head and a throbbing pain. It can also be made worse by physical activity. Other symptoms include nausea and sickness, and sensitivity to light or sound. Approximately 10% of people with migraine experience unusual symptoms (called an aura) that affect vision, physical sensations, or speech. Visual symptoms might include blurred vision, blind spots, seeing patterns or flashing lights. Physical sensations might include pins and needles or numbness.

As well as these symptoms, the aura part of a migraine can also include similar symptoms to Ménière’s disease; symptoms of dizziness or vertigo, tinnitus and hearing loss. These aura symptoms usually last between five and 60 minutes before the headache starts (although there is also a type of migraine where these symptoms can happen without a headache). Although experts do not know what processes are involved in migraine, it is thought that the inner ear may be damaged by ongoing migraine attacks (also increasing the risk of BPPV).

Who is affected?

Migrainous vertigo is the most common cause of recurrent spontaneous vertigo and the second most common vestibular disorder after benign paroxysmal positional vertigo. It affects about 10% of all migraineurs. Migrainous vertigo may start at any age and has a female preponderance of about 3:1. Familial occurrence is not rare, pointing to a genetic origin of the disorder.

Approximately half of people with Ménière’s disease experience at least one migraine symptom during a Ménière’s attack.

Benign paroxysmal vertigo of childhood designates a variant of migrainous vertigo that starts at pre school age with brief attacks of isolated vertigo which tend to be replaced by typical migraine after a few years.

How is migraine-associated vertigo diagnosed?

Migrainous vertigo is diagnosed on the basis of patient’s history. The commonest (benign) neurological condition to mimic BPPV is a form of migraine. Attacks last days rather than weeks and are not usually associated with headache. Incidentally, migrainous vertigo can cause attacks which are not unlike those of Ménière’s and which are often misdiagnosed as such. Migraine-associated vertigo is also known as migraine-associated dizziness, migraine-related vestibulopathy, vestibular migraine, recurrent vertigo.

How is it treated?

As the migraine and vertigo symptoms often occur independently of each other, treatment tends to relate to the individual symptoms.

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