Vestibular migraines are a lesser-known yet significant type of migraine that affects a person's balance and can cause dizziness. Unlike typical migraines, which are often characterized by severe headaches, vestibular migraines primarily impact the vestibular system, which includes parts of the inner ear, central nervous system that help control balance and eye movements. Individuals who suffer from vestibular migraines may or may not experience the actual head pain of a migraine. This varies highly on the individuals.
What Are Vestibular Migraines?
Vestibular migraines, also known as migrainous vertigo, are a subtype of migraine with vertigo. They can occur with or without a headache and typically involve episodes of vertigo or dizziness that can last from a few minutes to several hours. These episodes can be sporadic or frequent and are often accompanied by other migraine symptoms such as nausea, sensitivity to light and sound, and visual disturbances.
Why does this happen?
Migraine is caused by an individual's genetics that code for neurons in the brain stem. These genes code for how the ions flow in and out of the neuron. When these neurons are hyperexcitable it causes a migraine event to occur. The brainstem has multiple functions such as vestibular function, eye movements, autonomic function, jaw musculature, pupil function, respiratory function and much more. This is a very small but important part of the brain and it can be impacted by migraine. Depending on the individual, genetics can determine which neurons in the brain are affected. Individuals who suffer from vestibular migraines experience dysfunction within the vestibular system.
Symptoms of Vestibular Migraines
The symptoms of vestibular migraines can vary widely among individuals but often include:
Vertigo or Dizziness: A sensation of spinning, swaying, feeling like on a boat, visual of things spinning and swaying
Balance Problems: Difficulty maintaining balance, leading to a feeling of unsteadiness
Nausea and Vomiting
Head Pain: Though not always present, some individuals experience typical migraine head pain
Visual Disturbances: Including sensitivity to light, seeing spots or flashes of light, and visual aura
Ear-related Symptoms: Tinnitus (ringing in the ears) and hearing changes
Anxiety: Vestibular dysfunction can cause unexplained anxiety
Four Contributing Factors of Migraine
It is important to identify which of these four factors are contributing to each case. For more detailed information regarding the four factors that contribute to migraines please follow this link to our other migraines blog posts.
Neurological Factors: Migraine in any form is a neurological event. It is due to an underlying neurological dysfunction. It is important to identify this dysfunction and treat it.
Hormonal Factors: Fluctuations in sex hormones, thyroid hormones and cortisol hormones can contribute to migraine.
Biomechanical Factors: The visual system, vestibular system and biomechanics of the head and neck all play an important role with individuals who suffer from migraines. Dysfunction in the biomechanics of the head and neck can contribute to the development of a migraine.
Dietary/Metabolic Factors: Certain foods and drinks, environmental factors, blood sugar regulation, toxin build up, inflammation, etc. can all be factors to the development of a migraine.
Treatment Options
At Carolina Functional Neurology Center, our approach to migraines is to evaluate all of the four factors contributing to migraines. We figure out which of these factors are causing our patients migraines and address them simultaneously . Not every individual suffering from migraines will have the same factors causing their symptoms.
It is important to remember that migraine is a neurological event at its core. By evaluating where the dysfunction is in the nervous system we can create neuroplasticity with targeted and individualized neurological rehabilitation to address the underlying dysfunction. Oftentimes individuals suffering from vestibular migraines have an underlying vestibular dysfunction. This can be located in the inner ear or the central nervous system.
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CFNC'S Approach
At CFNC, we evaluate our patients as a whole. This means looking at how the nervous system is interacting and being affected by other systems (endocrine system, cardiac system, digestive system, immune system. etc.).
By primarily addressing the neurological factor and then simultaneously the other contributing factors, this is where we help our patients reduce the frequency and severity of their migraines naturally. This is incredibly important when treating and having success with migraines.
References/Additional Information Links:
Lempert, T., Olesen, J., Furman, J., Waterston, J., Seemungal, B., Carey, J., Bisdorff, A., Versino, M., Evers, S., Kheradmand, A., & Newman-Toker, D. (2022). Vestibular migraine: Diagnostic criteria1. Journal of vestibular research : equilibrium & orientation, 32(1), 1–6.