“Vertigo is a symptom, not a diagnosis”
Sheila Barrett, Chartered Physiotherapist and Vestibular Specialist
Read more on our Article here – Mum-of-two on battling serious Migranes: ‘I felt dizzy for five years… It was no life at all’
A Pain Free Migraine!
- Most people associate migraine with severe head pain and a period of incapacitation. However, a large portion of people with migraine don’t have accompanying pain, their predominant symptoms instead being vertigo (a spinning sensation), dizziness, disequilibrium (loss of balance), disorientation, visual distortion or altered visual clarity.
- This presentation may result in a visit to A & E, a multitude of medical professional consultations and extensive laboratory, imaging and other diagnostic evaluations – often with normal results which lends to increase confusion and anxiety on the part of the patient. In addition, vestibular suppressant medications are often given, increasing postural instability and further compounding the situation.
- Without a diagnosis, but with persisting symptoms, patients become disillusioned and hopeless. Some patients are given a diagnosis of ‘vertigo’ which is in fact a symptom – not a diagnosis. That’s why many people with these symptoms can go undiagnosed for several years incorrectly thinking that their only choice is to live with it. Like any condition, accurate diagnosis is the essential starting point and so once these patients are diagnosed with vestibular migraine, they can then be successfully managed.
How is Vestibular Migraine diagnosed?
There is no single test to diagnose vestibular migraine. Diagnosis is based on medical history and by performing appropriate tests to rule out other causes of symptoms. One such test is a Functional Vestibular Assessment using infra-red goggles. Visit www.eastcorkphysio.ie for more details.
What is Vestibular Migraine?
- The vestibular system includes the part of the inner ear and brain that processes
sensory information involved in controlling balance and eye movements. If damage occurs in any part of the vestibular system, a vestibular disorder can occur, such is the case in vestibular migraine. - Migraine weakens the vestibular system, causing a disruption in its functioning, which results in the vestibular disorder called vestibular migraine. These symptoms may be prior to, during, after or totally independent of pain.
- Approximately 40% of migraine patients have some accompanying symptoms involving disruption in their balance and/or dizziness at one time or another lending to migraine aura symptoms. Vestibular migraine is the most common cause of vertigo.
Who gets Vestibular Migraine?
- Just as migraine is thought to be an inherited disorder (60% of patients have a positive family history), so too is vestibular migraine, giving rise to a family ‘vulnerability’ to this disorder. Often vestibular migraine patients report a family history of migraine but on some occasions there is only a family history of ‘vertigo’.
- It is a significant neurological disorder that can affect all ages and both sexes in a 3:1, women to men ratio.
What are the causes of Vestibular Migraine?
The known migraine triggers such as certain foods, lifestyle, environmental, emotional and hormonal changes are also vestibular migraine triggers. On clinical presentation sufferers report symptoms that may include – but are not limited to – vertigo (illusionary spinning of the environment), dizziness (spinning or lightheadedness inside the head), disequilibrium (off balance), photophobia (light sensitivity, always liking to wear sunglasses and disliking fluorescent lights), phonophobia (sound sensitivity), motion sensitivity (may or may not feel nauseous when travelling now but very often the sufferer will have a history of being a ‘poor traveller’ as a child in the back of a car and may no longer be motion sensitive as they now drive their own car), increased dizziness with head movements, neck stiffness and ache (which can be as a result of holding their neck rigid in order to avoid provoking dizziness) a ‘muzzy’ head / ‘brain fog’ causing poor cognitive function (a most distressing symptom when trying to work or study) and anxiety / depression – who wouldn’t be with some or all of these preceding symptoms.
How is Vestibular Migraine treated?
Successful management of vestibular migraine has to be two fold, as its name would suggest. Firstly we need to stop the migraines from occurring (by avoiding dietary and lifestyle migraine triggers) and then strengthen / rehabilitate the vestibular weakness with Vestibular Rehabilitation Therapy (VRT).
What is Vestibular Rehabilitation Therapy (VRT)?
- Many research studies have scientifically proven that patients with vestibular migraine improve with VRT.
- Sufferers usually avoid head movements, moving ‘en bloc’ by holding their neck rigid, to avoid provoking dizziness and imbalance. They may limit activities such as avoiding playing sports, shopping, socialising and adopt a sedentary lifestyle for fear of aggravating symptoms. In doing so they are further weakening their vestibular system and in fact it is the exact opposite they should be doing. They need to move in order to allow the vestibular system to strengthen. The rationale for movement is based on the scientific proof that head movements which provoke the patient’s dizziness play an important role in hastening the recovery process. However, you cannot simply tell a dizzy patient to ‘MOVE’.
- It has to be in a systematically progressive manner. This is where VRT comes in which is a systematic exercise based programme. Tailored exercises which include very specific head and eye movements are given which provoke symptoms of dizziness in a mild and controlled way. These re-calibration the vestibular system. Other patients with vestibular migraine become very visually sensitive (visual vertigo) where busy environments such as supermarkets, shopping centres or travelling on escalators can provoke imbalance or dizziness. In this case tailored visual exercises can be given to desensitise the system, thus decreasing symptoms. VRT involves the active participation of the patient in a home exercise programme along with gradual increase of functional activities. These are then progressed as tolerated. Patient progression is subjectively and objectively monitored with the average duration of a VRT programme ranging from 4 to 10 weeks.
Remember
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We hope you enjoyed this blog by Sheila Barrett, Chartered Physiotherapist
This blog is provided for information purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis or treatment. Seek the advice of your doctor with any queries regarding a medical condition.
