dizziness

29 March 2022

Vestibular Migraine: Simply Not So Simple.

James Discoveries & Stats, Information 0

A recent panel summit on the topic of vestibular migraine brought out some of the major challenges we face trying to help patients. In short, the diagnosis and treatment of vestibular migraine simply is not simple.

Vertigo - feel like you're on a rollercoaster?

Although vestibular migraine is getting more press these days, you can feel the remaining questions in the International Classification of Headache Disorders 3 (ICHD3), where it’s placed under the heading “Episodic syndromes that may be associated with migraine”.

You can read more about vestibular migraine here, or at the ICHD3 link above, but essentially it’s diagnosed when a patient with migraine has some vertigo and/or dizziness associated with their migraine attacks. Often the “vestibular” symptoms develop many years after other migraine symptoms started.

Of course, specialists are trying to rule out vertigo/dizziness from other causes, and make a clear connection with migraine. And there certainly is a clear connection in some patients. But when it comes to diagnosis and treatment, as the expert panel pointed out in their January 2022 report, “gaps remain”.

You can read the full report here (Care Gaps and Recommendations in Vestibular Migraine: An Expert Panel Summit), and there’s lots to think about. But one of the most interesting parts was how symptoms vary and actually overlap with other conditions.

In practical terms, just because vertigo and migraine often go together doesn’t mean that they’re one and the same disease, and that treatment of one will solve the other – although that may be the case for some.

One study showed only a minority of patients who experienced vertigo during their headache phase. In fact, some patients reported vestibular symptoms up to two days before the headache hit.

Then there are different types of vertigo/dizziness. Is it induced by something you see? By head movement? Is it accompanied by nausea? Does it start out of nowhere? Any of these might qualify for vestibular migraine.

Another challenge – with so many kinds of vertigo and dizziness, how do you as a patient describe the feeling – especially if it’s new to you?

Then there’s misdiagnosis, even within migraine types. Often a patient has been misdiagnosed with migraine with brainstem aura, which may also include vertigo.

Benign paroxysmal positional vertigo (BPPV) is a very common cause of vertigo (check out this fascinating video about BPPV and the very helpful book Overcoming Positional Vertigo). Then there’s Ménière’s disease, a condition of the inner ear, and mal de debarquement syndrome. Tinnitus, heading loss conditions – all these things intersect in some interesting ways. Next come psychiatric conditions, neck problems – the researchers explain:

The symptoms of these conditions may overlap with those of VM symptoms and confuse the diagnosis of VM, especially when patients with other vestibular disorders may have superimposed, secondary migraine symptoms and not have VM as a primary cause of their symptoms. Psychiatric comorbidities, including anxiety, somatoform dizziness/chronic subjective dizziness may coexist with VM as well.Furthermore, acknowledging that patients may have more than one vestibular diagnosis contributing to their symptoms is essential to providing accurate treatment and conducting accurate research.
Care Gaps and Recommendations in Vestibular Migraine

So if other conditions can exist at the same time as migraine, or even overlap with migraine symptoms, is one somehow biologically related to the other – perhaps causing or increasing the symptoms of the other?

Surprisingly, some have suggested that migraine may actually affect the inner ear biologically – in other words, physical problems in the inner ear may actually be a “complication of migraine”.

For the doctor, just being aware of these connections can go a long way. But what about the patient?

First, it has to be admitted that the road to helpful diagnosis and treatment can be long. But don’t give up! If one condition can actually make the other worse, the best thing to do is to see a specialist and get treatment as soon as possible.

Watch your symptoms closely, and take note of the timing as much as you can. How long do symptoms last? What makes them worse/less? How do they relate in time to headache (if any – remember, it is possible to have migraine with no headache at all)? How often do you experience these symptoms?

What has been your experience with treatment and diagnosis? Your comments below will help us all learn.

16 December 2021

Migraine and Irregular Heart Beat

James Discoveries & Stats, Information 0

Patients who have migraine with aura are more likely to suffer from a certain type of irregular heartbeat, according to a recent study out of Switzerland.

The condition is known as atrial fibrillation. Atrial fibrillation occurs when the heart’s upper chambers beat out of sync with the lower chambers. You end up with an irregular, and often rapid, heartbeat.

The study does not show that migraine is causing the problem, only that the two conditions often come together. And there are a number of reasons why this may be – a medication you’re taking may increase your risk of heart problems, or obesity, or even a genetic disposition. A next step would be to try to figure out what the connection is between migraine and atrial fibrillation.

However, multiple studies have suggested that patients with migraine, and especially those with migraine with aura, have an increased risk of heart conditions. Studies like these are another reminder that migraine patients should especially take care of their heart health.

Now many people may not even notice this heart problem. If you do, you may or may not feel your heart “fluttering”. But you may notice weakness or fatigue, lightheadedness or dizziness, and maybe some chest pain.

Atrial fibrillation can be dangerous because it can lead to blood clots and stroke. The researches in this study review explain the practical steps you and your doctor may take:

In practical terms, screening for atrial fibrillation in patients who have a long history of migraine might be reasonable, whereas in patients with stroke or other disorders and migraine extensive screening for atrial fibrillation should be performed like in all patients without migraine.
Migraine and Atrial Fibrillation: a Systematic Review

In other words, it might be something you want to ask your doctor about, especially if you’re a long-term migraine with aura sufferer. If you know you have increased risk of heart disease, your doctor can help you lower your risk.

11 August 2021

This Is Your Migraine Brain. On A Roller Coaster.

James Discoveries & Stats 0

Yes, this is indeed a serious article about a clinical trial that was published in the journal Neurology this summer. What happens when migraine patients go on a (virtual) roller coaster?

You may be thinking – why would someone with migraine go on a roller coaster anyway? You can set your mind at ease. Not of these patients was actually having a migraine attack at the time. Which is the whole point.

Migraine brains are simply different – even between attacks.

This was a small study with 40 people, 20 of whom suffer from migraine. During the roller coaster ride, migraine patients did experience more discomfort. They were:

far more likely to experience motin sickness
far more likely to be dizzy

…and their symptoms were more intense and lasted longer than the control group.

Researchers also measured brain activity of the people in the clinical trial and found that they were able to “see” differences in brain activity between the migraineurs and the controls. Some of the differences in brain activity matched what we already have seen in migraine, and parts of the brain that regular movement were also affected.

Study author Dr. Arne May discussed the purpose of the study:

People with migraine often complain of dizziness, balance problems and misperception of their body’s place in space during migraine. By simulating a virtual roller coaster ride, our study found that some of these problems are not only magnified in people who experience migraine, but they are also associated with changes in various areas of the brain. By identifying and pinpointing these changes, our research could lead to a better understanding of migraine which could in turn lead to the development of better treatments.
Arne May, MD, PhD quoted in ScienceDaily

We’ve already seen connections between motion sickness and migraine, and dizziness and migraine – and of course there’s vertigo and cyclic vomiting syndrome. Motion sickness may be a warning sign for other conditions later in life, and should never be ignored. And, of course, we’ve talked about vestibular migraine before.

This study is another reminder that migraine affects all of life, not just those times when the patient is having a migraine attack. It also strengthens the link between migraine and other motion-related conditions.

For those who do suffer from dizziness, or motion sickness, but not from migraine – be sure to talk to your doctor. These symptoms may be a sign that you’re more susceptible to migraine. Paying attention and even finding treatment early on may be a major help later in life.

For more, read the study abstract here: Brain Processing of a Visual Self-Motion Study in Patients With Migraine: An fMRI Study

19 March 2021

Cyclic vomiting syndrome is on the rise in adults – and it may be Migraine related.

James Discoveries & Stats 0

A review recently published in Headache: The Journal of Head and Face Pain discusses treatment of cyclic vomiting syndrome, as well as a surprising rise in adult cases.

The connection between migraine and vomiting and nausea is not news. Cyclic vomiting syndrome (CVS) has also long been connected to migraine – in fact, some have suggested that it may be a subtype of migraine.

But there’s still a lot we don’t know about CVS. In fact, as the Mayo Clinic puts it, “Cyclic vomiting syndrome is characterized by episodes of severe vomiting that have no apparent cause.”

Which is why doctors first need to rule out other conditions when (usually children) develop CVS. For example, a part of the intestine may not be developing in the right position (intestinal malrotation). A swelling of the kidneys (hydronephrosis) might also be a cause. So some tests will be required when someone is diagnosed. Anxiety or panic attacks may also bring on problems, in both adults and children.

CVS in adults may also come from certain diseases related to the gallbladder or liver.

Though the nausea/vomiting connection is the most obvious link to migraine, there are other symptoms that some patients get that make the link even stronger. For example, abdominal pain (abdominal migraine is more common in children, but adults get it as well), dizziness, photophobia (sensitivity to light), and, of course, headache.

Why is CVS on the rise in adults? Increased anxiety? Environmental factors? Dietary problems?

What’s the connection to migraine? Is it a gut-brain issue? Are there genetic factors? Lifestyle commonalities? Once more, we’re not sure.

However, the study recommends that we further our research into the CVS-migraine link, and try to diagnose CVS as early as possible. Early treatment, as with migraine, can lead to better results. And in the case of children, we often have the opportunity to catch both early, and so can avoid many problems later in life.

But doctors and patients need to look carefully for migraine-type symptoms, because migraine treatments may be able to conquer both issues.

Report abstract (and link to full report): Cyclic vomiting syndrome: A narrative review and guide to management

3 September 2020

Women with Migraine: Different Symptoms?

James Discoveries & Stats 0

So we all know that the risk of migraine is higher in women, and that the difference is often blamed on hormones (although it’s likely more complex than that). But what about symptoms? Do women experience different symptoms than men?

A study published last year is saying “Yes”. Here are some of things that seems to be worse/more intense for women than for men:

Attacks tend to last longer
Nausea/vomiting
Vertigo/dizziness
Sensitivity to odours (osmophobia)
Allodynia
Higher disability from migraine (based on the MIDAS test)

As mentioned above, women were more sensitive to smells during an attack. Interestingly, they were also more likely to have an attack triggered by odours.

There were also more comorbid conditions – conditions that tend to go along with migraine – in the female group. Depression and allergy were the ones that stood out.

You might ask, because of the common hormonal hypothesis, whether these differences go away after menopause. The answer is mostly no. The differences were still significant, with the exception of nausea. After menopause, the nausea was about the same in both male and female groups.

Of course, these are more descriptions of the attacks. Attack frequency does tend to be less after menopause, although that is not always the case.

What about the Men?

So what items were more significant in the male group? Although generally other factors were the same in both groups, or someone worse for the women, one trigger stood out in the male group. Excessive sleep was more likely to trigger an attack for the men.

Of course this study is not saying that Emily’s migraine attacks are necessarily worse than Jacob’s, but there is a general trend here. We’re fighting against migraine for everyone. However, it’s good to know the areas in which the women tend to suffer more, because it can lead to better understanding and treatment.

To read the full study and the comments of the authors, click here: Sex Differences of Migraine: Results of a Nationwide Home-based Study in Turkey