Vestibular Migraine

Yes, individuals can experience both the more common types of migraine (with or without aura) and vestibular migraine. These conditions can overlap, with patients experiencing headaches along with vertigo or dizziness.

No, vestibular migraine does not always present with head pain. Diagnostic criteria include having vertigo or dizziness with at least one migraine feature, such as:

• Headache
• Light or noise sensitivity
• Visual aura

While some episodes may come with headaches, they are not mandatory for a diagnosis.

To diagnose vestibular migraine, patients must meet the following criteria:

• At least five attacks of vertigo or dizziness.
• At least half of these attacks must be accompanied by one or more migraine features (headache, light/noise sensitivity, or visual aura).

Vestibular migraine can be managed with similar treatments used for other migraine types:

Preventive Treatments:

• Medications: Anti-epilepsy drugs, beta-blockers, antidepressants, and CGRP blockers.
• Neurostimulation: Devices like gammaCore that help manage migraine symptoms.

Rescue Treatments:

• Medications: Triptans, non-steroidal anti-inflammatory drugs (NSAIDs), and newer CGRP blockers.

Similar to other types of migraine, vestibular migraine can be triggered by:

• Stress
• Lack of sleep or sleep changes
• Hormonal fluctuations (e.g., menstrual cycle)
• Weather changes
• Diet

• Specialists to Consult: Neurologists or ENT (ear, nose, and throat) doctors can diagnose vestibular migraine. ENT doctors often see patients with vertigo and can differentiate between inner ear disorders and vestibular migraine.
• Tests and Diagnosis: Vestibular testing, hearing tests, and thorough examinations help rule out other conditions like Meniere’s disease or benign paroxysmal positional vertigo (BPPV).

• Meniere’s Disease: Causes asymmetric hearing loss and is more likely if there is low-frequency hearing loss on one side. Meniere’s disease can coexist with vestibular migraine.
• Benign Paroxysmal Positional Vertigo (BPPV): Often confused with vestibular migraine, but BPPV causes brief episodes of vertigo related to head movement and is treated with specific maneuvers, not migraine medications.

You should consult a healthcare provider if you experience:

• Frequent or severe episodes of vertigo or dizziness, especially if they disrupt daily activities.
• Vertigo or dizziness accompanied by other migraine features, such as headache, light or noise sensitivity, or visual aura.
• Symptoms that worsen over time or do not respond to typical migraine treatments.
• Unusual or concerning symptoms, such as hearing loss, persistent ear ringing, or any changes in vision or balance.

Seeing a neurologist or ENT specialist can help diagnose vestibular migraine accurately and differentiate it from other conditions.