vestibular migraine

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.

3 February 2022

What’s New With Galcanezumab (Emgality)? (You Might Qualify For These Trials)

James Medications, News 0

Emgality, also known as galcanezumab, is a CGRP inhibitor for both migraine and cluster headache, is the subject of a lot of study right now, and you may qualify to be involved.

For migraine, galcanezumab is taken once a month, as a preventative. For cluster headache, it is also taken once a month at the start of and during a cluster period. Although most people aren’t fans of injections, the fact that injections are so far apart is certainly a selling point.

But now galcanezumab is being tested for other conditions. Most notably, vestibular migraine, small fiber neuropathy, and fibromyalgia.

The vestibular migraine study is a study in the USA for adults with vestibular migraine or probably vestibular migraine. You can check out the details and see if you qualify here: Galcanezumab for Vestibular Migraine

The second study covers both small fiber neuropathy and fibromyalgia, and is also in the USA. Find out if you qualify here: Anti-CGRP for Inflamation and Pain Modulation in Small Fiber Neuropathy/Fibromyalgia

Researchers also continue to investigate the general function of galcanezumab, including further studies to see how it works with migraine. Other general studies you may qualify for include:

Novel Insight Into Migraine Pathophysiolgy and Galcanezumab Mechanisms of Action (looking for adults with migraine)
A Study of Galcanezumab (LY2951742) in Adult Participants With Episodic Migraine (CHALLENGE-MIG) (adults with migraine)

There are also a couple of studies happening for teens and children:

For more information on Emgality in general, as well as savings programs, visit their official US site here. For Canadian patients, a pdf summary here. England, Scotland and Wales information here.

13 July 2021

For “Heal Your Headache” Fans!

James Resources 0

Heal Your Headache: The 1-2-3 Program for Taking Charge of Your Headaches by Dr. David Buchholz is one of the most popular books on migraine treatment. For over 15 years it has helped many migraine patients fight their headaches.

Because the book has been around so long, you may not be aware of some of the “fans” that are out there. And if you don’t know about the Dizzy Cook, you’re certainly missing out.

Yes, the Dizzy Cook is a person – Alicia Wolf, who, as you might guess, has chronic vestibular migraine. Having great success with the Heal Your Headache system, she decided to provide resources for others who are in the same boat. And so, out came The Dizzy Cook: Managing Migraine with More Than 90 Comforting Recipes and Lifestyle Tips, available in paperback, hardcover, and eBook. Add this book to Dr. Buchholz’ work and you’ll have a lot of resources and updated tips – and, of course, my favourite, more recipes!

I love a cook book I can hold in my hand, although I use eBooks as well. But there are also resources on Alicia’s website. A sampling of fun and colourful recipes, to start with. Lots of tips for people with migraine, and especially vestibular migraine (of course). And some clever products, such as “Kiss the Dizzy Cook” aprons, and an MSG kitchen towel (MSG stands for Migraine Super Goddess, of course!).

But, for those who know they need to eat better, but can never remember how to cook an egg, Alicia even provides group or one-on-one consultations to help you plan a meal or learn some cooking tricks.

So anyone with migraine, especially if you are a fan of Heal Your Headache, and especially especially if you suffer from vestibular migraine, needs to check out The Dizzy Cook, and grab a copy of Alicia’s cookbook here.

24 August 2020

Just Car Sickness?

James Discoveries & Stats 0

We’ve talked about the connection between migraine and car sickness or motion sickness before. Many migraine patients suffered from motion sickness as children.

It’s interesting to look back to see possible roots of our migraine condition in childhood – but what about children who have motion sickness now?

A study published this year in the European Journal of Paediatric Neurology reviewed the cases of 23 patients who suffered from motion sickness under the age of 18. Almost half were diagnosed with migraine (47.8%). (Abstract: Severe motion sickness in infants and children)

But there were other issues as well. Recurrent/chronic otitis media was diagnosed in 39.1%. There was a history of motor delay in 30.4%. And “vestibular deficits” were diagnosed in 23.5%.

Otitis media refers to an inflammation or infection of the middle ear, which can come from a variety of causes.

Motor delay refers to childhood development. The most commonly discussed is the age at which someone learns to walk – if there’s a delay beyond a certain typical age, that’s a motor delay.

Vestibular deficits are issues with the vestibular system in particular, which can lead directly to dizziness or balance problems.

The study was not trying to necessarily find the cause of motion sickness. It simply points out connections between motion sickness and other conditions.

Sometimes these are hard to diagnose. In fact, patients who have vestibular conditions have often been referred to a psychiatrist. Why? Because of the way these disorders can make it difficult to function. For example, they may become anxious in a crowd, or in wide open spaces (an interesting discussion here – Visual Preference and Vestibular Deficiency).

So what do we learn from the study? Although we cannot prove direct causation here, we can see that there are a variety of things that may be connected to – and may cause – motion sickness.

It’s easy to just say, “Well, Emma gets car sick, but Aiden doesn’t. It’s just the way they are.” But in fact, car sickness may be a clue that can help us diagnose a condition early, before things get worse.

Of course diagnosing migraine early can make all the difference – and that includes what is sometimes called vestibular migraine. Infections of the ear are, of course, very important to treat. And other vestibular problems can cause long term issues because of the way the body may try to compensate for the issue. Motor delay as well can come from a number of causes, but it’s likely to be the issue that parents are most aware of already.

So don’t ignore motion sickness in children – especially if it’s severe or consistent (we’re not talking about too much candy on a 5 hour trip while playing Minecraft upside down). It can actually help avoid more problems throughout life if we use it as a clue to solve a mystery.

25 March 2019

Is My Vertigo Related to Migraine? (video)

James Information 0

Migraine and vertigo or dizziness (two different symptoms) are a common combination. We saw this confirmed again in a poll several years ago (see: Do you experience vertigo or dizziness during a migraine attack?).

Migraine and vertigo - what's the cause?

Here’s a quick video describing the basics of migraine and vertigo, from the Mayo Clinic. We’ve talked about these things in more detail before, so if you’d like to learn more about your dizziness or vertigo symptoms after watching the video, check out Vestibular Migraine: What’s New.