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Vestibular Migraine

What it is and how to treat it...

Vestibular Migraine is the most common cause of episodic vertigo in adults and children.

Studies show that almost a 3rd of all Headache and Migraine sufferers have vertigo symptoms. Vestibular Migraine is considered a migraine variant. This means that vertigo symptoms, rather than pain, are the most common feature. Vestibular Migraines vary in length lasting from a few seconds to days.

Diagnosing Vestibular Migraine is problematic and has led to poor diagnoses. It is currently diagnosed via exclusion, meaning all other possibilities are ruled out.

There is widespread agreement that Migraine is a sensory processing disorder. Information from the upper cervical spine and the head, converge in the trigemino-cervical nucleus (also known as the lower brainstem). This leads to a bi-directional pathway for pain and irritation. 

The brainstem can become sensitised when there is a constant increase in noxious information from the upper cervical spine. In other words, the brainstem can become sensitised when there is a dysfunction at the top of the neck.

The vestibular nuclear complex is situated in the brainstem. The output to the vestibular system is affected when the brainstem is sensitised.

This results in a variety of symptoms being experienced with Vestibular Migraine. These can include:

  • Vertigo (spinning, rocking swaying and imbalance)

  • Balance problems

  • Nausea

  • Dizziness with postural changes

  • Intolerance to movement.

  • Difficultly hearing low sounds or tinnitus

  • Neck pain

  • Headaches

  • Sensitivity to light, sound, smell or a visually stimulating environment

 

Many cases of Vestibular Migraine are managed with medication. Vestibular suppressants or triptans may be used, such as sumatriptan. To manage your Vestibular Migraines long-term you will need to ascertain the source of your sensitised brainstem.

Researchers consider the upper cervical spine to play a significant role in the sensitisation of the brainstem. The high incident rate of neck pain in both Migraine and Vestibular Migraine patients indicates the importance of assessing the upper cervical spine. Recent literature supports the mobilisation of the upper cervical spine, exercise prescription and postural correction in the management of Vestibular Migraine.

At The Headache Clinic, our clinicians will complete a skilled assessment of the cervical spine. This is critical when determining the role of the neck in the sensitisation of the brainstem.

 

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