Migraine Vertigo

Migraine vertigo can be one of the most disabling symptoms of the migraine process. Estimates are that 25 to 70% of all migraineurs have some vertigo associated with their headaches.

If you are having a new onset of vertigo with your migraines and have never had this before, please call your doctor. This is what we call a "flag" and you may need a CT or MRI of the brain. This is to rule out the possiblity of a stroke or rarely a brain tumor.

Very rarely these symptoms cna indicated a vertebral artery dissection (the artery lining is splitting open) and it may rupture. This is quite rare, but you need to let your doctor know about your concerns.

The sensation of vertigo with migraine is that the room is spinning and it can be accompanied by nausea and even vomiting. Some with have trouble walking and feel like they have to "hang on to the walls."

It can occur just before, or during a migraine. It may also last after the headache is gone.

There may be some tinnitus (ringing or buzzing sound) and slight loss of hearing. The symptoms can occur before, during or after a migraine.

There has long been a debate that migraine vertigo or vertiginous migraines may be linked to Meniere's disease. Meniere's has the triad of severe vertigo, tinnitus and unilateral (one side) hearing loss. Today, most professionals do not believe the two conditions are linked as Meniere's is usually not associated with headache.

Table 1. A Comparison of the Symptoms of Migraine-Associated Vertigo and Meniere's Disease

Symptom	Migraine-Associated Vertigo	Meniere's Disease
Vertigo	Episodes may last >24 h	Episode lasts about 24 h
Sensorineural hearing loss	Very uncommon; when present, often low frequency; very rarely progressive; may fluctuate in cases of basilar migraine	Nearly always progressive; most often unilateral; may be bilateral; fluctuation is common
Tinnitus	May be unilateral or bilateral; rarely obtrusive	May be unilateral or bilateral; often of significant intensity
Photophobia	Often present; may or may not be associated with dizziness	Never present unless a concurrent history of migraine exists
Headache	Usually present and migrainous	Not present

Things That Provoke Or Worsen Symptoms

Many people are unaware of the connection between the brainstem and migraine. This is the part of the brain where migraines are generated and although we know many migraine triggers, we do not know just how they provoke a migraine.

What else besides known triggers? Well things that rattle or jostle the brain could also be a problem. Here are some examples:

Airline flying with cabin pressure changes
Rollar coasters and other amusement park rides
Motor vehicle accidents with whiplash injury
Multiple head injuries from sports (football!)
Riding in a car for over an hour
Sudden change in altitude (i.e. going from Death Valley to Denver)
Skindiving

You get the idea. Anything that could suddenly or continuously jostle the brainstem can bring on or worsen existing migraine vertigo.

Treatment of Migraine Vertigo

Fortunately, there are some excellent medications for migraine vertigo. Unfortunately, this is NOT one of those conditions that responds well to holistic treatments such as herbs or vitamins. Additionally, many doctors make the mistake of treating the vertigo with one of the medications used for just plain vertigo..meclezine. This has very little benefit in this particular condition.

One of the best medications for for this condition is elavil.
Elavil (or amitryptiline) is a great medication to use for this type of problem, as it has anti-cholinergic properties that calm down the brainstem. This is the part of the brain responsible for vertigo. It also treats the headache too!

An additional medication that is excellent for this condition is verapamil. This is an anti-hypertensive but really works well for vertigo and again will help treat the headache too. Like cluster headache, we may end up using varying doses to get the vertigo under control. You cannot take this medication if you become very lightheaded and your blood pressure drops. Although this happens only about 10% of the time, it is something to keep an eye on. Constipation may also occur and again, if severe you will have to stop the drug.

A final medication that could be considered is a beta-blocker like propranolol. Again, lightheadedness may be a side effect and the same cautions apply as above.

All of the other lifestyle changes still apply to migraine vertigo as this is still considered a migraine condition.

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