Vestibular migraine

Dizziness due to migraines is quite common. As there is no blood test or scan that can diagnose migraines with vestibular symptoms, diagnosis is always based on your experiences.

We offer various treatments that can help to effectively treat your migraines. This is usually medication such as ibuprofen or paracetamol, or advanced treatments like rizatriptan. 

Patients with frequent migraines may also be offered preventative treatment. To prevent migraines, we usually advise a course of amitriptyline or propranolol. 

Propranolol is suitable for people with hypertension (high blood pressure) or anxiety. It is not suitable for anyone with the following conditions:

• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Peripheral vascular disease
• Uncontrolled heart failure

If these do not work, then topiramate may be considered. However, treatment can be more complicated due to potential side effects.

Topiramate can result in a high-risk pregnancy. It can also reduce the effectiveness of hormonal contraceptives, so it’s not usually advised for women of childbearing age.

It may cause a burning or prickling sensation in the arms and legs. This usually lasts for the first few days only. If the patient is at risk of kidney stones, it will increase the chances to 1 in 100.

Vestibular migraine treatments work by offering you certain medication. This aims to reduce and alleviate your headaches. The vertigo symptom can be less responsive to drugs.

Treatments can include the following medication:

• Paracetamol 
• Ibuprofen 
• Rizatriptan, a type or triptan
• A combination of a triptan with paracetamol
• A combination of a triptan with ibuprofen

Nausea can be treated with Buccastem, which is also known as prochlorperazine maleate.

The main symptom of vestibular migraines is problems with your vision.

Common examples of vestibular migraine symptoms include:

• Zigzag lines 
• Flashing lights
• Numbness
• Tingling of parts of the body
• Difficulty speaking 

These can last between five minutes to an hour and then resolve. They are sometimes followed by a sensation that feels like spinning.

The dizziness can last anywhere from a few seconds to a few days. It often lasts between five minutes and three days.

Most patients experience some nausea. This can be accompanied by sensitivity to sound and light. This is known as photophobia.

Symptoms may also include one-sided pulsating headaches. This may come with a desire to lie down in a dark room. About a third of patients report a ringing in their ears, and this is known as tinnitus.

What are some of the triggers of vestibular migraines?

Vestibular symptoms may be triggered by the following:

• Foods, such as dark chocolate
• Menstrual periods
• Stress
• A lack of sleep
• Glyceryl trinitrate (GTN)
• Histamine
• Ranitidine
• Hormone replacement therapy (HRT)
• Caffeine
• Exercise
• Computer use
• Watching films
• Flashing lights

During a vestibular migraine, patients can feel like they have motion sickness. They may also experience sensitivity to flashing lights and loud sounds. Often people have a history of migraines or a family history of severe headaches.

What are the benefits of vestibular migraine treatments?

The benefits you can expect from vestibular migraine treatment depends on your personal circumstances. Your consultant will discuss these with you during a consultation.

Treating vestibular migraines with medication should help to eliminate the main symptoms. This should significantly improve your quality of life.