Vestibular Migraine

Here at Novera: Headache Center, we work with patients who have many different types of diagnoses and presentations that accompany their headache and migraine pain. Vestibular migraine in particular can be a confusing and scary diagnosis to navigate, and traditional approaches to this condition have left people feeling hopeless and lost. Below is a deep dive into what this diagnosis entails and how we treat it here at our clinic.

Symptoms/Classification

Includes traditional migraine symptoms, plus:

  • Vertigo (dizziness), usually lasting minutes to hours, but sometimes days
  • Unsteadiness and loss of balance
  • Sensitivity to motion
  • Sensitivity to noise
  • Some people also experience ear ringing or feelings of ear fullness

With a vestibular migraine, the person may experience a combination of vestibular attacks, visual aura, or sensitivity to visual stimulation and motion at different times, and they can occur with or without an actual headache. There is a distinct difference between vestibular migraine vertigo and ‘ear crystal’ vertigo. This condition can be confused with Méniére’s disease or even a mini-stroke. Patients will often bounce from provider to provider, seeing primary physicians, neurologists and ENTs with no answers. Traditional treatment for vestibular migraine has included antihistamines, anti nausea medications, and beta-blockers.

How We Treat It

After ruling out more ‘traditional’ causes of dizziness such as BPPV, vestibular neuritis, or POTS, we look to the neck and the vagus nerve. In our practice, we have found success through this approach as studies have found that neural connections between the sensory systems, which process head pain, and the vestibular systems, which establish a sense of spatial awareness and balance, could communicate during a migraine attack. These sensory and vestibular systems feed through the upper part of the neck (C1 and C2) so it makes sense that dysfunction and restriction in these areas could lead to confusion of pain and processing signals – leading to a vestibular migraine! We treat this using a few different approaches:

  • Manual physical therapy aimed at reducing restriction in the upper neck, jaw, and shoulders
  • Home exercises designed to improve ‘slide and glide’ of the joints surrounding sensory nerves
  • Noninvasive electrical stimulation to the vagus nerve through a device called the GammaCore

If you or someone you know has been diagnosed with vestibular migraine and you are searching for answers, know that there is hope! Reach out to our clinic, we will be happy to talk with you about treatment options. In the meantime, check out our podcast episode on vestibular migraine for a more in-depth discussion on this diagnosis.

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