Vestibular Migraine – Why the confusion?

It’s been in the news a lot lately – vestibular migraine.  You can be excused if you’ve never heard of such a thing before.  It’s not that lots of people don’t have it – in fact, I have a friend that does.  The confusion lies in the name.

Vestibular Migraine is not the official name of any type of migraine at all.  It’s better to see it as a description – a migraine with certain symptoms.  The name is used, but rarely because it’s not listed in the official list of classifications from the International Headache Society.

The word "vestibular" simply means having to do with equilibrium.  So, as you may guess, a migraine attack which is vestibular involves symptoms such as vertigo, dizziness, motion sensitivity, etc.  (more on vestibular migraine symptoms from Johns Hopkins).

So we’re not going to say there’s "normal" migraine and "vestibular" migraine, as if there are two types.  Migraine is a disease with a host of symptoms.  Often those symptoms allow us to narrow down which treatment will work the best.  Migraine disease has been broken down into many different types.

The type of migraine most commonly associated with vertigo is called basilar-type migraine (formerly called basilar migraine or basilar artery migraines).  Vertigo is common in basilar type migraine, as is ringing in the ears, unsteadiness, visual symptoms, and sometimes a decreased level of consciousness.  Another type of migraine, familial hemiplegic migraine, sometimes has similar symptoms, except with motor weakness added on.  In both cases there is usually a headache.

Vestibular migraine can also be a form of migraine with aura, when the aura is vertigo or dizziness.  In fact, many migraineurs experience dizziness, but when it becomes particularly overwhelming and severe, that’s when we start using the word "vestibular".

And remember, these types of migraine attacks involve lots of other symptoms beyond headache, vertigo and dizziness (such as the symptoms mentioned above).  Most migraine attacks can be debilitating for a host of reasons, not just because of the headache pain.  Even if there is no headache pain, the vertigo or dizziness can be frightening, and this and the many other symptoms can shut you down completely during an attack.

One type of headache that sometimes comes with dizziness is an MSG headache.  MSG headache can be a migraine or not.

If you are having vestibular symptoms, it’s important not to make assumptions.  See your doctor and have other causes ruled out first.  (Sometimes an EEG is helpful in cases like these).  Then you can investigate treatments, which generally are common to most types of migraine.

Sometimes regular migraine treatments can alleviate all the symptoms, but sometimes the vertigo remains.  It’s possible to take medication for the vertigo as well.