Rule Your Migraine The Functional Medicine Way!

VESTIBULAR MIGRAINE

Migraine is one of the most debilitating chronic health care disorders. For far too many, it is an everyday occurrence. Often these people go from healthcare provider to healthcare provider without finding lasting relief. The key to migraine treatment lies in identifying the underlying mechanism of onset and developing a unique, personalized treatment plan for that person. However, there are many mechanisms and variables to consider. In this post, I will discuss one of the most misunderstood and largely underdiagnosed mechanisms – vestibular migraines (VM).

Approximately 40% of migraine patients have some accompanying vestibular syndrome involving a disruption in their balance and/or dizziness at one time or another. The dizziness can occur prior to, during, after, or totally independent of their migraine event. VM is the most common cause of episodic vertigo in adults as well as in children. Migraine and vertigo (illusionary sensation of spinning) are two very prevalent conditions in the general population. Having both is a significant clinical challenge, since it is not always possible to understand whether they are causally related or associated by chance, requiring different diagnostic and therapeutic approaches. The clinical presentation of vestibular symptoms that often correlate with migraine includes—but is not limited to—dizziness; motion intolerance with respect to head, eyes, and/or body; spontaneous vertigo attacks (often accompanied by nausea and vomiting); diminished eye focus with photosensitivity; sound sensitivity and tinnitus; balance loss and ataxia; cervicalgia (neck pain) with associated muscle spasms in the upper cervical spine musculature; confusion with altered cognition; spatial disorientation; and anxiety/panic. The following are the diagnostic criteria for VM classification as determined by The International Classification of Headache Disorders (3rd edition):

ICHD-3 Beta Diagnostic Criteria of Vestibular Migraine

  1. At least five episodes filling criteria (C) and (D)
  2. Current or history of migraine, either with or without aura, considering the International Classification of Headache Disorders (ICHD)
  3. Moderate or severe vestibular symptoms, lasting 5 minutes to 72 hours4
  4. At least half of the episodes are associated with at least one of these migrainous features:
    1. Headache with at least two of the following characteristics:
      1. Unilateral location
      2. Pulsating quality
      3. Moderate or severe intensity
      4. Aggravation by routine physical activity
    2. Photophobia and phonophobia
    3. Visual Aura
  5. Not better accounted for by another ICHD-3 diagnosis or by another vestibular disorder

Causes of Migraine

One proposed explanation is parallel activation of vestibular (inner ear) and cranial nociceptive (pain) pathways. Sensory fibers from the vestibular system (inner ear) converge with several brain areas that play an important role in modulating the sensitivity of pain pathways. Sensory fibers are also involved in the formation of anxiety responses, explaining some aspects of the comorbidity of balance disorders, anxiety, and migraine. Various studies have shown increased vestibular excitability in migraine patients. This increased excitability is linked to increased motion sensitivity, even motion sickness; and reduced perceptual thresholds of dynamic head movements.

A number of other factors can also play a role in migraine including:

  • Hormonal changes in women. 
  • Foods. 
  • Food additives. 
  • Drinks. 
  • Stress. 
  • Sensory stimuli. 
  • Changes in wake-sleep pattern. 
  • Physical factors. 
  • Changes in the environment. 
  • Medications. 

How we treat it:

Vestibular rehabilitation training is effective in VM patients as an add-on treatment to medical therapy or as a stand-alone treatment option. The goal of treatment is to re-establish appropriate sensory integration within this system as it relates to the patient’s condition. At Functional Endocrinology of Ohio, we use cutting-edge diagnostic equipment and in-depth physical examination to find the appropriate intervention for each unique patient case.

Dr. Joseph Little, D.C.
July 19, 2017

Functional Endocrinology of Ohio
Akron: 2800 S. Arlington Road, Akron, Ohio 44312 (330) 644-5488
Cleveland: 6200 Rockside Woods Blvd., Ste. 100, Independence, Ohio 44131 (216) 236-0060
Dr. Keith S. Ungar, Dr. Andrew Kender, Dr. David Hardy, Dr. Joseph Little, Chiropractic Physicians

To schedule an appointment, click here.

Dieterich, M., Obermann, M., & Celebisoy, N. (2016). Vestibular migraine: the most frequent entity of episodic vertigo. Journal of Neurology, 82-89. Retrieved July 10, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4833782/.

Luzeiro, I., Luís, L., Gonçalves, F., & Martins, I. P. (2016). Vestibular Migraine: Clinical Challenges and Opportunities for Multidisciplinarity. Behavioural Neurology, 2016, 1-11. doi:10.1155/2016/6179805

Vestibular Migraine (a.k.a. Migraine Associated Vertigo or MAV). (2015, December 28). Retrieved July 10, 2017, from http://vestibular.org/migraine-associated-vertigo-mav

http://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/dxc-20202434

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