What happens during an attack
With migraine, the excitability of neurons changes, as well as the functioning of systems that process signals from the vestibular apparatus, vision and muscles. When this processing is disrupted, the brain receives conflicting information about the body's position, and dizziness occurs—a sensation of spinning, tilting, or swaying, like on a deck. At the same time, sensitivity to light, sound and movement increases, so it becomes worse in transport and in stores. It is important to understand: the inner ear is usually healthy, so hearing does not decrease and remains between attacks.
- The processing of vestibular signals by the brain is impaired
- There is a sensation of spinning or swaying
- Increased sensitivity to light, sound and movement
- The inner ear often remains healthy
- Hearing does not decrease between attacks
How it manifests itself
The attacks are repeated and vary in duration: from five minutes to three days, often several hours. Dizziness can occur at rest, when moving the head, or when looking at moving objects. Nausea, less often vomiting, unsteadiness when walking, intolerance to bright light and loud sounds are often associated. Headache does not always occur, and if it does, it is usually throbbing, one-sided, and worsens with movement. Many people note that in childhood they did not tolerate travel on public transport well. Between attacks, the person feels normal, although sometimes mild instability remains.
- Attacks from 5 minutes to 72 hours
- A sensation of spinning or swaying
- Nausea, sometimes vomiting
- Light and sound intolerance
- Headache is not always present
- Poor transport tolerance in childhood
- Feeling normal between attacks
What triggers attacks
The triggers for vestibular migraine are the same as for regular migraine. Most often this is a lack of sleep or, conversely, excessive sleep on weekends, skipping meals, dehydration, stress and a period of relaxation after it, bright light and flickering screens, strong odors. In women, attacks are often associated with hormonal fluctuations in the cycle. Travel and prolonged stays in areas with visual noise, such as a supermarket, play a special role. Keeping a diary helps identify personal triggers, and eliminating them in itself reduces the frequency of attacks.
- Lack of sleep and irregular sleep patterns
- Skipping meals, dehydration
- Stress and the period after it
- Hormonal cycle fluctuations
- Bright lights, flickering screens, strong odors
- Travel and visually rich environments
How to make a diagnosis
The diagnosis is clinical: the doctor assesses the number and duration of attacks, the presence of migraine in the past and associated migraine symptoms during episodes. A diary is useful, where the date, duration, provocateurs and symptoms are noted. During the examination, vestibular tests are performed, including positional ones, to exclude benign positional vertigo. Be sure to check your hearing: its persistent decline speaks more likely of Meniere's disease. MRI is prescribed for new-onset dizziness in adulthood, neurological symptoms, or an atypical presentation.
- Assessment according to clinical criteria
- Diary of attacks
- Vestibular and positional tests
- Hearing test
- Examination by an otolaryngologist
- MRI of the brain for atypical signs
Treatment
The treatment consists of three parts. The first is eliminating provocateurs: stable sleep, regular nutrition, sufficient drinking, dealing with stress. The second is stopping the attack: the doctor may recommend anti-migraine or antiemetic drugs; Drugs that suppress the vestibular system are used short-term, since long-term use interferes with recovery. The third is preventive therapy for frequent attacks: beta blockers, some antidepressants and antiepileptic drugs are used, the choice depends on concomitant diseases. Additionally, vestibular rehabilitation helps - special exercises for balance training.
- Stable sleep and nutrition patterns
- Drinking enough, dealing with stress
- Means for stopping an attack as prescribed by a doctor
- Time-limited use of suppressive drugs
- Preventive therapy for frequent attacks
- Vestibular rehabilitation and exercises
- Diary for assessing the effect of treatment