Vestibular migraine is the second most common course of episodic vertigo. It is 10 times more common than Ménière’s disease although it is often misdiagnosed. 

It occurs in women 70% of the time and the average age of onset is 40 years old. There have however been reports of onset as late as 72 years old. There is a relationship to motion sickness in over 50% of migraine sufferers.

 Patients present with symptoms of dizziness or vertigo lasting hours to days. Generally there are no other neurological symptoms and there may not even be headaches with the vertigo. Other symptoms include imbalance, nausea, head motion intolerance, visual blurring, lightheadedness and sensation of rocking or tilting. There may also be sensitivity to light or noise and less frequently tinnitus or fullness in the ear. 

The vertigo may occur with or without migraine headache and visual aura. Trigger factors may exist but are often hard to identify. Anxiety has been found to be commonly associated with VM maybe due to the similar chemical pathways they share to the brain such as serotonin.

 It is typical for a pattern of migraine headaches to precede the development of vestibular migraine often by several years. Migraine may become vestibular post menopause. It may also be related to time of menstrual cycle in some cases as with regular migraine. 

The cause of vestibular migraine is not yet fully understood. It is thought that an over sensitive brain stem and labyrinth may contribute to symptoms. This means that you have a lower threshold before your brain responds to various stimuli including motion sickness, light, sound and smells. Sometimes this can be related to  a motion segment dysfunction in some of the joints in your upper Cervical spine. 

If you are examined while not episodic neurological and vestibular examinations may be normal. Sometimes the oculomotor examination may show some nystagmus but this is of a different quality to that produced in other vestibular syndromes.

Your therapist may need you to get a medical referral for MRI of your brain to exclude possibility of brain stem disease that could cause similar symptoms. You may also be asked to get a hearing test. In most cases these tests are not necessary.

 Vestibular migraine has been demonstrated to respond well to therapy that would be used for regular migraine. This is likely to be a combination of physiotherapy, medications if required and often lifestyle changes.

Physiotherapy may include manual therapy of the upper cervical spine and treatment of soft tissue spasm or restrictions. It may also include postural education, advice and a specific exercise program. Regular moderate intensity cardiovascular exercise for 30 minutes 3-4 times per week has been shown to be helpful.

For patients who have related motion sensitivity a Vestibular Rehabilitation program may be required to desensitize to different visual, head or body movements.

Medical management may include preventer medications as well as medications to be used during an attack and for symptom relief such as pain and nausea. Your GP or neurologist may be involved in helping you with prescriptions.

There is some evidence for various over the counter medications and supplements such as high dose Magnesium, Riboflavin, co-enzyme Q10 or specific medications developed for migraine such as Reme-D or Migraine Care (Bioceuticals).

Book now with our Vestibular Physiotherapist, Alison Underwood!

Alison Underwood

Alison Underwood

Vestibular Physiotherapist
Alison Underwood
Vestibular Physiotherapist
Alison has over 20 years of physiotherapy experience in sports, pilates pre and post natal and community based physiotherapy.  In recent years Alison has undergone specialised post graduate training in vestibular physiotherapy and has joined with us at DMP specialising in balance, vertigo, dizziness and imbalance.
Alison will perform a detailed assessment to determine which part of your vestibular system is not functioning.  To enable most accurate diagnosis you will be assessed with infrared video googles and force platform as part of your examination.
So if any of these symptoms are disrupting your life, put up with them no longer, relief may only be a treatment away.
In her spare time, Alison enjoys being outdoors and can usually be found cycling, kyaking, canyoning, slacklining or on a multi day hike with her family or friends.

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