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Common Vestibular Issues

Vestibular Migraine Treatment Melbourne

The Vertigo Co provides treatment of common vestibular issues including vestibular migraine.
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0467 392 414

The Vertigo Co

What is Vestibular Migraine?

Vestibular Migraine is a variant of Migraine in which vertigo (a sensation of spinning) or dizziness is the most prominent feature rather than headache.  

Approximately 55% of Migraine sufferers will also suffer from attacks of vertigo or dizziness at one time or another. These symptoms may or may not be accompanied by typical Migraine symptoms (1). In addition, patients with Migraine have a higher risk of developing other vestibular disorders, such as Benign Paroxysmal Positional Vertigo (BPPV), Persistent Postural Perceptual Dizziness (PPPD), or Meniere’s Disease. 

Vestibular Migraine can significantly affect your quality of life. For a detailed assessment and treatment options, get in touch today. 

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0467 392 414
Vestibular migraines treatment Melbourne

Vestibular Migraine Symptoms

Many are familiar with the tell-tale signs of Migraine. This type of headache is characterised by the onset of one-sided severe head pain (usually throbbing or pounding) accompanied by a range of symptoms. 

Migraine and Vestibular Migraine share the same symptoms, except dizziness and vertigo are more prominent with Vestibular Migraine.

The symptoms for both include, but are not limited to: 

Headaches (these may range from dull to severe)

Vertigo (a spinning sensation) and/or dizziness (rocking, bobbing, swaying, tilting, floating, feeling like you are on a boat)

Impaired balance

Nausea and/or vomiting

Motion sensitivity (feeling sensitive to movement of the head or body)

Blurred vision or visual ‘aura’ (spots/shadows in vision)

Photophobia (sensitivity to light)

Phonophobia (sensitivity to sound)

Perceived hearing loss and/or tinnitus (ringing in the ears)

Anxiety/Panic

Migraine affects people in different ways. The above symptoms are typically experienced as part of Migraine attacks that last from a few minutes up to 72 hours. There may or may not be warning signs before an attack commences. 

For some, symptoms will resolve completely between separate attacks. Others feel a constant high level of motion sensitivity, impaired balance and visual symptoms, all of which can impair their day-to-day functioning.

What Causes Vestibular Migraine?

The exact mechanisms of Vestibular Migraine are not completely understood, however there are a number of theories on the subject. Migraine is believed to be a complex process caused by both neurological and vascular (blood flow) issues whereby for one reason or another, neural signals are spread across the brain followed by an activation of pain receptors in the brain stem, which is near the area of the brain that triggers vertigo. The release of neurotransmitters causes a dilatation of blood vessels near the scalp which in turn causes the pain experienced (2). 

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Vestibular Migraine

How Is It Diagnosed?

A diagnosis of Vestibular Migraine is usually based largely on a thorough history of symptoms, along with a number of tests to rule out other conditions which have a similar presentation.   

These tests may include (if necessary) a CT or MRI of the brain, and Vestibular Function tests such as the head impulse test, which tests the function of the inner ear.   

If you have symptoms of Vestibular Migraine, a vestibular physiotherapist can undertake an assessment and advise you whether you require further testing. Book an appointment with our team to get started. 

Book Now
0467 392 414
Migraine vertigo treatment Melbourne

Vestibular Migraine

Vestibular Migraine Treatment

Vestibular Migraine is treated using a combination of factors, from physiotherapy to forms of trigger control and medication. At The Vertigo Co, we focus on Vestibular Rehabilitation Therapy. 

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Vestibular Physiotherapy

Vestibular Rehabilitation Therapy (VRT) often helps to reduce motion sensitivity and address balance issues for patients suffering from Vestibular Migraine. It can be trialled for patients with recurrent Vestibular Migraine attacks who are symptom-free between episodes, however the evidence for this is less defined.

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Dietary Trigger Control

Diets such as the “Heal Your Headache” Diet, The Mediterranean Migraine Diet or Low Histamine/Low Tyramine Diets can be trialled for Vestibular Migraine. It is important to remember elimination diets can be a source of disordered eating and should be monitored by a Nutritionist where possible. Good resources include The Dizzy Cook Website https://thedizzycook.com and Instagram @thedizzycook along with Nutritionist Kelli Yates on Instagram @the.migraine.dietitian.

Some common food triggers include:

  • Aged or ripened cheeses: (e.g. cheddar, parmesan, feta, brie, camembert etc)
  • Smoked, cured or Processed meats: (e.g. ham, bacon, sausages salami, hot dogs, pepperoni etc)
  • Foods containing monosodium glutamate (MSG) (i.e. MSG or “flavour enhancer 621”)
  • Certain fruits (e.g. figs, avocados, raisins, red plums, passion fruit, papaya, banana and citrus fruit)
  • Hot fresh bread, doughnuts, and raised cakes
  • Excessive artificial sweetener (aspartame)
  • Yogurt/Sour cream
  • Olives, Onions and Pickles
  • Nuts, Peanut Butter
  • Caffeine: (e.g. coffee, tea, cola, chocolate, cocoa, carob)
  • Alcohol (e.g. Red wine, Beer, port, sherry, scotch, gin and bourbon)

Note: Skipping meals and dehydration can also be a trigger for the onset of Migraines.

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Migraine Trigger Control

Migraine tends to have “triggers”. A Migraine trigger can be almost anything inside or outside the body that can provoke a migraine. Each migraine sufferer has different sensitivities, so not all triggers may provoke an attack in all sufferers. These can include:

  • Environmental Triggers: such as bright lights, patterns, loud noises, strong odours, changes in weather (barometric pressure changes), changes in pressure (i.e. air travel)
  • Emotional Triggers: such as Stress and Anxiety. See our resources page online for a list of Vestibular Psychologists available to tackle these issues. Online resources also include Rooted Behavioral Education Instagram @dremilykostelnik
  • Hormonal Fluctuations: Hormonal fluctuations may trigger Migraines and can be affected by contraceptive pills, oestrogen supplements, menstrual cycles, pregnancy or menopause.
  • Sleep Disturbance: Lack of sleep, disturbed sleep, or too much sleep may trigger a Migraine.

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Medication

Vestibular Migraine is treated with the same medications as other forms of Migraine. There are three types of medications for Migraine: prophylactic (to prevent attacks), abortive (to get rid of attacks), and rescue (to mitigate symptoms associated with an attack).

  • Prophylactic:
    • Migraine Specific Drugs (such as Sandomigrain)
    • Antidepressants (SSRIs or SNRIs or Tricyclics such as Endep or Venlafaxine)
    • Anti-convulsants (such as Topamax or Epilim)
    • Blood Pressure Medications (such as Propranolol or Verapamil)
    • Botulinum Toxin Injections
    • Calcitonin Gene Related Peptide (CGRP) Injections
  • Abortive:
    • Triptans, GEPANTS
  • Rescue:
    • Benzodiazepines i.e. Valium
    • Antihistamines
    • Antinausea (i.e. Stemetil, Ondansetron)

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Supplements

There is good evidence in the literature supporting supplements for Migraine treatment and prevention. They can include:

  • Magnesium Theronate or Glycinate 500mg
  • Vitamin B2 400mg
  • CoQ10 300mg
  • Vitamin D (up to 4000IU)
  • Other supplements may include Omega 3 and Curcumin. One study showed that 500mg of ginger aborted a migraine attack as well as Sumatriptan. 

Books

  • Victory over Vestibular Migraine – Dr. Shin Beh
  • Heal your Headache – Dr. David Bucholz MD

Resources

Frequently Asked Questions

If Vestibular Migraine is chronic, that is if symptoms persist over a long period, it will typically proceed through four stages: premonitory, aura, headache, and postdrome. The premonitory stage will alert you to an upcoming attack. The aura stage may involve visual aura, such as spots or shadows in your vision. The headache stage then occurs, and tends to be the most severe. The postdrome phase may involve a feeling of exhaustion or fatigue following the headache and initial stages. 

We don’t yet have a large amount of research about the impact of anxiety and stress on Vestibular Migraine. However, one study from 2017 found that Vestibular Migraine patients were more anxious than Migraine patients without vestibular symptoms. There is also a lot of evidence to suggest that anxiety and stress can precipitate, impact or exacerbate common Migraine. Experts recommend a multi-faceted approach towards Migraine prevention and treatment, including the management of anxiety and stress and healthy lifestyle decisions relating to diet, sleep and exercise. 

Vestibular Rehabilitation Therapy is an exercise-based program designed to improve a range of vestibular issues, including common Vestibular Migraine symptoms such as vertigo, dizziness and unsteadiness. This therapy can help reduce motion sensitivity and address unsteadiness through exercises including balance retraining, stretching, and eye movement control. 

Your first appointment will last between 45-60 minutes and will include an assessment with a physiotherapist for Vestibular Migraine or other vestibular disorders. Once a cause for your symptoms has been determined, your physiotherapist will tailor a specific treatment program for your needs. If they believe your symptoms require further investigation, you may be referred to a specialist service, including a Vestibular Audiologist for Vestibular Function Testing (VFTs) or a Neuro-Otologist. 

Vestibular Migraine involves a range of symptoms also connected to other conditions, including other vestibular disorders like Benign Paroxysmal Positional Vertigo (BPPV) and Meniere’s Disease. These symptoms include vertigo, dizziness, nausea and vomiting. If you are experiencing any of these symptoms on a frequent or chronic basis, please seek advice from our physiotherapists or other trusted medical professionals. 

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The Vertigo Co

Contact Us For Quality Care

If you think you might have Vestibular Migraine, there is support available. Our highly experienced team can ensure your questions are answered and connect you with the right assessment and treatment options.  

For more information or to book an appointment, contact us today. 

Book Now
0467 392 414

the Vertigo Co

References:

  1. Savundra PA, Carroll JD, Davies RA, Luxon LM. Migraine-associated vertigo. Cephalalgia. 1997;17(4):505-10; discussion 487. https://pubmed.ncbi.nlm.nih.gov/9209771/
  2. Baloh RW. Vestibular Migraine I: Mechanisms, Diagnosis, and Clinical Features. Semin Neurol. 2020;40(1):76-82. https://pubmed.ncbi.nlm.nih.gov/31935766/
  3. Hindiyeh NA, Zhang N, Farrar M, Banerjee P, Lombard L, Aurora SK. The Role of Diet and Nutrition in Migraine Triggers and Treatment: A Systematic Literature Review. Headache. 2020;60(7):1300-16. https://pubmed.ncbi.nlm.nih.gov/32449944/
  4. Gottshall KR, Moore RJ, Hoffer ME. Vestibular rehabilitation for migraine-associated dizziness. The International Tinnitus Journal. 2005;11(1):81-4. https://pubmed.ncbi.nlm.nih.gov/16419697/
  5. Power L, Shute W, McOwan B, Murray K, Szmulewicz D. Clinical characteristics and treatment choice in vestibular migraine. Journal of Clinical Neuroscience. 2018. https://pubmed.ncbi.nlm.nih.gov/29550250/
  6. Beh SC. Victory over Vestibular Migraine: the ACTION plan for healing and getting your life back 2020.  https://www.amazon.com.au/Victory-Over-Vestibular-Migraine-Healing/dp/B08C92JB3R