What is Vestibular Migraine?
Vestibular migraine, or VM, is a migraine that causes dizziness. Dizziness is a common migraine symptom, with most sufferers experiencing some form of dizziness either directly before or during their migraine.

Symptoms
• Visual issues – Flashing lines, zig-zags.
• Dizziness or a spinning sensation (vertigo) – This usually lasts several hours although can go on for days
• Nausea
• Light sensitivity
• Sound sensitivity
• One-sided, pulsing headache
• The need to lie down in a dark room
• Tinnitus – this is a less common symptom but has been reported in up to 1/3 of patients
• Less commonly, a numbness or tingling sensation in various parts of the body
• Less commonly, trouble with speech can occur, which can last anywhere from 5 to 60 minutes

Diagnosis
Diagnosis largely depends on the individual sufferer’s history as there is currently no test that can identify the condition. Your GP, ENT specialist or neurologist can run through your symptoms and family history to help assess your health.

The symptoms of VM can overlap with other inner ear conditions, such as vestibular neuronitis or more rarely Meniere’s disease, although in the latter case you would usually expect to see symptoms of hearing loss, with a documented reduction in hearing on hearing assessment, and tinnitus in most cases. In vestibular migraine, the hearing is almost always normal.

Causes
It is not always understood why a person may suffer from VM. Some of the common causes or triggers are similar to those for migraines in general, and include:
• Rapid head-turning
• Having your head in a particular position
• Certain foods or drinks (Caffeine, dark chocolate)
• Hormonal issues, such as periods or HRT
• Stress
• Lack of sleep
• Excessive use of screens – computers, mobile phones, films
• Exercise
• Flashing Lights
• Family history of migraines

Investigations
After a thorough examination, you may require some blood tests, as well as a formal hearing assessment. In some cases, a scan might be needed, such as a MRI scan of the inner ear and brain, to help rule out other possible causes.

Treatment
Painkillers can be taken to help reduce the acute headache, such as paracetamol or ibuprofen, assuming you are not allergic to them. The vertigo symptoms are less likely to respond to medications although in some instances you may need a prescription for a vestibular sedative such as prochlorperazine (stemetil) if the symptoms are very bad and/or persistent. Alternatively, an anti-sickness type medication can be helpful for more persistent, milder symptoms, for example, cinnarizine, which can be obtained over the counter in most pharmacies. Ultimately, if the attacks of dizziness are linked to migraine-type headaches, you may require specific advice to treat the current migraine attack and prevent future attacks from occurring. Your ENT specialist may recommend a review by a neurologist for further more specific treatment of the migraine.

Prevention
The best way to prevent future VM attacks is to identify the root cause. If a particular food or drink seems to trigger it, eliminate this from your diet.
Some preventative medications can be tried, such as amitriptyline and propranolol. Speak with your ENT specialist to establish which medication or form of prevention is best suited to you. There may be side effects to these medicines which should be discussed and considered.
Vestibular migraines are rarely a sign of something more serious, but your symptoms should never be ignored.

Be sure to consult an ENT professional, such as London ENT, for advice. For more information, contact London ENT on 0203 865 7225.