Migraine Associated Vertigo

Symptoms

The manifestations of migraine-associated vertigo are quite varied and may include episodic true vertigo, positional vertigo, constant imbalance, and/or movement-associated dysequilibrium. Symptoms can occur prior to the onset of migrainous headache, during a headache, or, as is most common, during a headache-free interval. As such, many patients who experience migraine dizziness have vertigo or dizziness as the main symptom rather than headache.

At the time of presentation to the doctor, dizziness symptoms may have been present for a few weeks or for several years. Symptoms may last for a few minutes or may be continuous for several weeks or months. In women, dizziness may often occur during the menstrual cycle.

Patients with migraine-associated vertigo often have a long history of motion intolerance during car, boat, air travel, or all three.

Diagnosis

Currently, no tests exist to make the diagnosis of migraine-associated vertigo. The diagnosis is made by clinical history. That is, the diagnosis is based upon the patient's symptoms as well as the patient's past medical and family history. The following are the most commonly accepted guidelines for the diagnosis of migraine associated vertigo (1).

Definite Migraine Vertigo

•  Episodic vertigo of moderate (or worse) severity AND:

•  History of migraine headache AND:

•  1 or more of the following during 2 vertigo episodes:

•  Migrainous headache

•  Photo or phonophonobia (sensitivity to light or sound)

•  Visual or other aura

•  Other causes excluded

Probable Migraine Vertgio

•  Episodic vertigo of moderate (or worse) severity AND:

•  At least 1 of the following:

•  History of migraine headache

•  Migrainous symptoms during vertigo

•  Migraine specific precipitants of vertigo

•  e.g. specific foods, sleep irregularities, hormonal changes, response to antimigrainous drugs

•  Other causes excluded

Treatment

Various treatments are available for migraine vertigo. These treatments include either one or a combination of: diet modification, prophylactic medication or physical therapy. For more information regarding migraine vertigo, please see the Emedicine article by Dr. Battista: migraine vertigo.

(1) Neuhauser, et al. The interrelations of migraine, vertigo, and migrainous vertigo. Neurology 2001;56:436-441.