Headache along with dizziness suggests vestibular migraine but vestibular migraine attacks may happen without headache. The diseases of these patients are often problematic to diagnose. It is easy to diagnose patients with attacks which start with dizziness and typical aura lasting for 5-60 minutes and turning into headache. However, very few patients with vestibular migraine experience headache after dizziness.
Headache can occasionally be added to dizziness that often lasts for days. In some patients, recovery can take weeks after attacks. Some of the attacks may be accompanied by headache or not. Some patients with vestibular migraine have never suffered from headache. Vertigo may be accompanied by light and sound sensitivity, visiual disturbances, impairment of perception and numbness in these patients. Indeed, dizziness symptom is very common in migraineurs. The proportion of patients with vestibular migraine in population is between 3-4%. Most of the patients have stories of migraine. Having migraineurs in the family or car sickness experience in childhood are also striking findings in these patients.
If headache is not a prominent symptom, these patients can be evaluated as ‘peripheral vertigo.’ It is linked to the deterioration of the function of the inner ear and the treatment is carried out accordingly. The disease is treated in two different parts by an ENT specialist for dizziness and a neurologist for headache.
How is Migraine occuring with dizziness diagnosed?
For the diagnosis, patient should have migraine diagnosis and it must be proved that vertigo attacks do not have other underlying causes. For definite vestibular migraine diagnosis, repeated moderate headache attacks accompanied by sound and light sensitivity experienced at least twice and migraine type headaches accompanied by visual and other auras should occur. Migraine triggers iniating attacks (such as wine, nuts and menstrual period) also supports the diagnosis. In addition, more than 50% of migraine medication responding to attacks is evaluated as vestibular migraine.
Stories of Patients From The Book An Approach to Migraine Solutions
“Tinnutus starts in my right ear and gets worse and worse and dizziness starts. And I start to have a severe headache with throbbing sensation. When my headache gets severe, my dizziness and tinnutis diminishes. I take my medication and go to sleep. The next day I feel a bit tired and dizzy but still can manage to go to work. My attacks started in the second year of university. I used to have them 3-5 times a year. I started to work this year. I have a very stressful job. I am not satisfied with my work environment at all. I have started to have 1-2 attacks a month.”
“Basilar migraine attacks seen mostly in adolescent girls are also evaluated in this group. Along with dizziness, double vision, severe imbalance and speech impairment can be seen. Eleven year old daughter of my patient with chronic migraine who is a pyschologist had dizzy spells and fainted at school. Doctors couldn’t find the cause and sent her back home. She was still feeling ill. There was no problem detected in her neurological examination. I thought she was having a kind of migraine attack due to her wisdom teeth trying to come in. In the dental x-ray it could be seen that her wisdom teeth was very big, inside the jaw bone and in horizontal position.
In the following period, she had two or more similar attacks with two or three months intervals. My patient was advised to take her daughter to a counsellor. She didn’t have any psychological problems. She didn’t experience any attacks apart from the year when she was growing so fast. When she was 16, her wisdom tooth was removed due to the damage it caused on other teeth. She doesn’t experience dizziness or even mild headache anymore.
The Treatment of Vestibular Migraine
As in all migraine types, firstly the causes should be detected. Apart from the problems in the ear and in the brain directly related to all types of vertigo, treatment can be provided by determining the causes with Emel Gökmen Approach. Dental-jaw complex which has an important role in both migraine occuring with dizziness and vertigo can be one of the main causes. Long-standing dizziness and headache can be solved by the treatment carried out with this approach.