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Understanding Vestibular Migraine

Writer's picture: RUPALI VYASRUPALI VYAS

Lets breakdown the above diagnosis into simple terms ,


What is Vestibular ? 

The Vestibular system is a key sensory system made up of different structures and neural pathways that assist with the perception of body position, movement and balance. This complex system provides a sense of orientation, detection of head/body motions along with adjustments in eye movements and posture. A component of this system located in the brain(Central Vestibular System) involves neural pathways that respond to incoming sensory signals from the inner ear ( Peripheral Vestibular System) and provide output that make reflexes like stabilizing gaze during head motions and interacting with skeletal muscles to help with posture and balance. 

A disruption in the working of the Vestibular system causes symptoms of vertigo, nausea, vomiting, sensitivity to head and body motions and difficulty with walking.



What is Migraine ?

Migraine is a neurological condition characterized by recurrent episodes of severe headache, often accompanied by nausea, vomiting, and sensitivity to light and sound. Migraines can be triggered by various factors, such as stress, hormonal changes, certain foods, or environmental factors, and can last from a few hours to several days.

16% of US adults have reported experiencing migraines or severe headaches. 1 in 5 US adult females has experienced migraine or severe headaches. 40-50% people who have Migraine are undiagnosed.



A Vestibular migraine (VM) is a neurological disease that causes vertigo, dizziness and imbalance with or without actual headache.  Vestibular migraine is sometimes also referred to as migraine-associated vertigo (MAV), migraine-related vestibulopathy and migraineous vertigo.


The diagnostic criteria for Vestibular migraine based on the International Classification of Headache Disorders and the International Classification of Vestibular Disorders of the Barany Society , states that a current or past history of migraine is essential for the diagnosis of Vestibular Migraine. 


Vestibular migraine is considered the most common cause of recurrent spontaneous vertigo attacks. Its lifetime prevalence is 1% and 1-year prevalence is 0.9 % . 7% of the population seen in dizziness and migraine clinics experience Vestibular Migraine.


Above flowchart is taken from an article by Huang et al illustrating potential mechanisms in vestibular migraine pathogenesis, highlighting the roles of the thalamocortical network, nociceptive brainstem centers, trigemino-vascular system, and vestibular system in sensory dysmodulation and headache.

Effective management for Vestibular Migraine involves personalized treatment strategies provided through interdisciplinary medical collaboration along with Vestibular Rehabilitation. 



Lifestyle modifications can play a crucial role in reducing the frequency and severity of Vestibular migraine . By addressing key factors such as stress, sleep, diet, and physical activity, individuals can develop a holistic approach to help manage symptoms. 


A neurologic physical therapist with specialized training in Vestibular Rehabilitation can help address symptoms and assist with recovery. A Vestibular physical therapist can develop a personalized management strategy and  a comprehensive treatment plan tailored to your specific needs.

If you would like to learn more about our Vestibular Migraine program kindly email us for a free discovery call. 


References :



Casale J, Browne T, Murray IV, et al. Physiology, Vestibular System. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532978/



Dieterich M, Obermann M, Celebisoy N. Vestibular migraine: the most frequent entity of episodic vertigo. J Neurol. 2016 Apr;263 Suppl 1:S82-9. doi: 10.1007/s00415-015-7905-2. Epub 2016 Apr 15. PMID: 27083888; PMCID: PMC4833782.



Huang TC, Wang SJ, Kheradmand A. Vestibular migraine: An update on current understanding and future directions. Cephalalgia. 2020 Jan;40(1):107-121. doi: 10.1177/0333102419869317. Epub 2019 Aug 8. PMID: 31394919.



Dougherty JM, Carney M, Hohman MH, et al. Vestibular Dysfunction. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558926/



“Dizzy Spells & Migraines.” Cleveland Clinic, 1 May 2024, my.clevelandclinic.org/health/diseases/25217-vestibular-migraine.

 




 







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Congruence Physical Therapy and Wellness exclusively serves individuals with Parkinson's Disease, Inner ear related issues and other health conditions causing vertigo, falls, dizziness, imbalance, decreased mobility levels and lack of drive to exercise. Located in Milpitas CA, we service people from Milpitas CA, San Jose CA, Mountain View CA, Fremont CA, Sunnyvale CA, Santa Clara CA, Cupertino CA, Saratoga CA, Campbell CA,  & Los Gatos communities.  Our classes are held online and at 710 Lakeway Dr (Suite 150), Sunnyvale, CA 94085

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