Patients with balance disorder are very common in our day to day practice which accounts for one fifth of referrals to ENT clinics. It is sometimes a challenging situation to make out the correct diagnosis due to overlapping of symptoms. Vestibular migraine is such a challenging cause of dizziness to diagnose which usually presents with or without migrainous headache. Migraine headache is characterized by moderate to severe throbbing or pounding headache lasting 4 - 72 hours usually affecting one side of the head which is aggravated by routine physical activity.
It may or may not be associated with visual aura. It is usually associated with nausea and vomiting. Patients may have sensitivity to light, sound and smell. Around 50% of vestibular migraine attacks are associated with these migraine features. Some may have a history of migraine in the past. Vestibular symptoms include dizziness lasting 5 minutes to 72 hours. Majority of patients feel it like unsteadiness or loss of imbalance unlike the true rotatory vertigo in inner ear disorders.
Patients can have symptoms like ringing, fullness of ear. It is important to rule out Meniere’s disease. Trigeminovascular reflexes which are responsible for the migraine attacks can cause dizziness. One theory suggests that vasospasm of the vessels supplying the inner ear can cause ischemia and result in cochleovestibular dysfunction resulting in dizziness. The diagnosis of Vestibular migraine is mainly clinical. It is important to rule out other causes of dizziness like BPPV, Meniere’s disease, and TIA with the help of proper history taking, vestibular function test, audiological evaluation and imaging.
It is common for vestibular migraine, Meniere’s disease and BPPV to coexist which can make the diagnosis and treatment even more challenging. The treatment of Vestibular migraine is similar to that of migraine headache. If the patient is getting frequent attacks of dizziness, he/ she has to be started on prophylactic medications like beta blockers, Tricyclic antidepressants, Ca channel blockers, Serotonin/norepinephrine reuptake inhibitors. The use of labyrinthine sedatives to suppress the vestibular system should be minimized and used occasionally as needed during attacks.
In addition to medication, lifestyle modifications such as avoiding triggers, maintaining a regular sleep pattern, and reducing stress can also be helpful in managing vestibular migraine. Vestibular rehabilitation therapy can also be used to improve balance and reduce symptoms. It is important for patients to work closely with their healthcare provider to find the best treatment plan for their individual needs. Regular follow-up appointments may be necessary to monitor symptoms and adjust treatment as needed. With proper management, many patients with vestibular migraine are able to control their symptoms and maintain a good quality of life. Ascent Hospital is the leading provider of migraine treatment in Kerala.
It is also important for individuals with vestibular migraine to educate themselves about their condition and to seek support from others who may be going through similar experiences. Support groups, online forums, and social media can all be useful resources for connecting with others and learning about new treatments and coping strategies. Taking an active role in managing one's health can also help individuals with vestibular migraine to feel more empowered and in control of their condition. By working closely with their healthcare providers, making lifestyle changes, and seeking support from others, individuals with vestibular migraine can lead fulfilling and productive lives.