DEAR DR. GOTT: My 15-year-old grand daughter has been diagnosed with vestibular migraines. Will you please give me some history on them, i.e.: cause and remedies. Thank you.
DEAR READER: More than 30 million Americans suffer from migraines. It is one of the most common neurological conditions, so common in fact, that some believe migraines aren’t a disease, but just a normal variant of the human condition.
Classic migraine symptoms include severe throbbing of one side of the head, extreme sensitivity to light and noise, accompanied with nausea, and vomiting. Some individuals may experience an aura prior to the headache, or even without headache.
There is a known association between migraines and the inner ear and brain mechanisms that control hearing and balance. Otic migraines can affect hearing — again with or without classic migraine symptoms and headache. When balance is affected, the condition is known as a vestibular migraine.
Sufferers describe their symptoms as occurring suddenly and feeling dizzy, as if they are standing or walking on uneven ground, and/or as if they are spinning or rocking. Light and sound sensitivity, nausea and vomiting may occur. Walking or moving may worsen symptoms. An attack can last from a few minutes to several hours and for some, chronic vestibular migraines may cause a constant feeling of imbalance. It’s been found that a majority of sufferers don’t experience the vestibular symptoms at the same time as the migraine headache and in some, the headache may not even develop.
These individuals also appear to be more sensitive to migraine triggers such as coffee and other caffeinated drinks/sodas, red wine, chocolate, stress, altered sleep habits, diet, MSG and certain cheeses.
Vestibular migraine is a diagnosis of exclusion, meaning other more common conditions should be ruled out first. These include transient ischemic attacks (mini strokes), inner ear fluid leaks, benign paroxysmal positional vertigo, vestibular nerve irritation and Meniere’s disease. That said, while the number of sufferers appears to be fairly low and this form is uncommon, it may be that some are being misdiagnosed with one of the above or even remain undiagnosed. It is more commonly diagnosed in children and teens than adults.
There is no treatment specific to vestibular migraines. The current options are those used to treat classic migraines and include anti-inflammatory medications, certain muscle relaxers, selective serotonin reuptake inhibitors (SSRIs), triptan drugs, anti-nausea medications, anti-epileptic drugs and calcium channel blockers.
I recommend that your granddaughter be under the care of a qualified neurologist familiar with vestibular migraines and that they work closely together to develop a treatment plan beneficial to her. You granddaughter will also need to take certain precautions because her risk of falling is increased. And, while she is not yet able to drive, she should speak to her neurologist about this — especially if she has frequent or chronic symptoms, as it may be unsafe for her (and others on the road) to get behind the wheel of a car until her symptoms are well-controlled.
Readers who are interested in related information can order my Health Report “Headaches” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Dr. Peter Gott, PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print an order form from my website, www.AskDrGottMD.com.
