Vestibular Migraine Treatment in Atlanta, GA

Dizziness accompanies many who experience migraine headaches and when a person experiences this repeatedly, they may have vestibular migraine.  Vestibular migraine can take over your sense of balance causing you to feel like you’re spinning or falling when you’re actually still - a sensation called vertigo.  However vestibular migraine may or may not accompany severe headache pain and can solely involve debilitating vertigo symptoms affecting balance, ears and vision. When the headache pain is not the main feature it can be easy to miss the signs of vestibular migraine, and so many people may not be correctly diagnosed. If this sounds familiar to what you’re experiencing, know we’re here in Alpharetta, outside of Atlanta, and can diagnose and if necessary treat vestibular migraine.  

What is vestibular migraine?

The word vestibular relates to the inner ear, the body’s balance system and is associated with symptoms of vertigo, the sensation that you’re moving, falling, or spinning when you are sitting still.  Migraine is not always just a severe headache, but also something that affects the nervous system -  which the inner ear’s vestibular system is part of - thereby explaining how migraine influences how the brain controls balance and experiences space. 

When the vestibular system does not work properly, a person commonly experience feelings of vertigo (unsteadiness or dizziness), easily triggered by movement or the perception of movement. Thus a vestibular migraine is a type of headache  causing extreme sensitivity to what a person is experiencing whether it’s sound, smell, light, and especially movement or the perception of movment. About half of migraine sufferers experience vertigo symptoms (unsteadiness or dizziness) prior to the onset of a migraine headache -  as the main symptom or exclusive symptom - and this is known as vestibular migraine.

Unlike the classic migraine with the ever present severe and throbbing headache, it’s common for a vestibular migraine to not include the traditional headache pain. However what’s always present with vestibular migraine are episodes of some form of vertigo sensations (floating, rocking, spinning, swaying, lightheadedness and or internal motion). 

What are symptoms of vestibular migraine?

Most people understand a migraine as severe head pain but a migraine can involve numerous symptoms which are not ‘fixed in place’ or experienced permanently but can come and go as well as change over the course of a lifetime.  Simply put, the migraine a person experiences in their 40’s or 50’s can be entirely different from the migraine that same person experienced in their 20’s.  Vestibular migraine episodes or symptoms can last from minutes to several days, but mostly they last from minutes to hours and as noted earlier, these symptoms often occur without traditional headache pain. However when headache pain is present, it’s often one-sided, pulsating and worsened by physical activity.  Those experiencing a vestibular migraine will have some of the following symptoms that  can vary in severity: 

• vertigo (a dizzy spinning sensation) 
• imbalance or unsteadiness
• feeling incapable of tolerate movements such as bending over, looking up, pivoting or turning the head, particularly quickly
• light and or noise or crowd sensitivity
• visual disturbance (bright and or flashing / flickering lights,  a phenomenon also known as an aura.)
• nausea and/or vomiting when moving
• reduced or muffled hearing
• tinnitus (ringing or buzzing in the ear)
• sensing pressure or fullness in the ear.
• sensitivity to light, sound, or smell
• a numb or tingling feeling
• neck pain
• feeling of pressure in the head or the ear

What causes a vestibular migraine?

While science does not fully understand the cause of a vestibular migraine, there are theories of; (1) abnormal ‘electric’ messages widen blood vessels in and around the brain setting off the brain’s pain receptors; (2)  another theory suggest that serotonin, a natural chemical of the body controlling mood, levels in the brain are low; and (3) it’s hereditary since about about 80% of migraine sufferers report a family history of the condition - thus it’s believed to be a genetic disorder impacted by hormonal and environmental influences taking years to emerge based on a person’s habits, hormone changes, stress level or sometimes spontaneously.

What triggers a vestibular migraine?

Vestibular migraine is more common in women than with men, but can affect anyone and occur spontaneously and without a trigger.  However it also can indeed be triggered by one or several of the following: 

• A history of childhood migraines, colic or motion sensitivity
• Insomnia
• Dehydration & hunger
• Stress or anxiety
• Fatigue
• Serotonin imbalance
• Hormonal changes from menopause or periods.
• Changes in barometric pressure (weather changes).
• Certain sharp movements, positioning and motioning of the head
• Driving or riding in a vehicle
• “migraine equivalents” like sinus headaches, motion sickness, brain freeze/ice cream headache
• Visually “busy” stimuli (floor or ceiling patterns, crowded environments, entertainment screens)

Certain foods are also capable of triggering a vestibular migraine and why it’s recommended those susceptible eat a diet with low levels of  amino acids,  MSG, caffeine, preservatives, and alcohol. Examples of trigger foods include:

• Aged cheeses
• Smoked or cured meats
• Food prepared with vinegar, soy sauce, or yeast extract
• Pickled and fermented foods (sour cream, buttermilk, yogurt)
• Onions, olives, pickles
• Artificial sweeteners
• Alcohol 
• Dark chocolate, peanut butter, cocoa
• Large amounts of certain fruits such as red plums, figs, bananas, raisins, citrus fruit,  passion fruit
• Excess caffeine

Once symptoms are controlled, vestibular migraine patients can gradually add back desired foods while closely monitoring symptoms. An effective method of identify triggers is to maintain a daily symptom journal with details such as bedtime, waking time, foods eaten, stress and anxiety levels, and all symptoms experienced.

Do Vestibular Migraines Go Away?

The reality is vestibular migraines can possibly not ever completely go away, thus it’s prudent to focus is on reducing and minimizing the severity of symptoms while working on coping skills which will enable you to continue on fully functioning and living your life.  We specialize in vestibular rehabilitation therapy and focus on treating problems with vertigo systems (balance, dizziness, unsteadiness, perceptions of motion, etc).  Our therapists structure personalized treatment plans aligned with your unique circumstances and perform exercises with you here at our clinic in Alpharetta.  Your custom tailored treatment plan will quickly enable you to effectively manage your vestibular migraine symptoms and identify your triggers so you can better maneuver through your bad days.  

What is the diagnosis for a vestibular migraine?

Though there are no clear causes for vestibular migraine, there is a definitive set of guidelines for diagnosing vestibular migraine.  According to the ICHD-3 (International Classification of Headache Disorders - 3rd Edition) the diagnosis of vestibular migraine  includes:

• You’re currently experiencing migraines or history of migraine
• You’ve experienced vestibular symptoms (dizziness, spinning or sensing motion) lasting from 5 minutes to 3 days.
• You’ve experienced at least 5 episodes of vertigo either vestibular symptoms happening alone, or alongside a migraine headache
• Your vestibular migraine symptoms range from moderate to severe, meaning  you’ve had a moment wherein they’ve stopped you from an everyday task or made it so for an extended period of time you simply cannot get anything done
• At least half of the episodes strike with 1 of the following migraine symptoms:
• A headache with 2 of these characteristics:; 1)is one-sided, 2) is pulsating, 3) feels moderate to severe, or 4)  worsens with activity
• Light or sound sensitivity 
• Seeing flashing, shimmering or flickering lights in your vision (a migraine aura)

Once diagnosed, guidance identifying triggers and managing the condition through an individualized treatment plan to improve your dizziness and imbalance is provided.  Everyone’s circumstances are unique so contact us for a more detailed outline on what to expect in “next steps” after a diagnosis for vestibular migraine.

Treatment for vestibular migraine

If you’ve been diagnosed with vestibular migraine, treatment starts with documenting and keeping a record of your triggers. It’s helpful to know what situations seem to come prior to an attack - and under what circumstances. Your triggers, like your fingerprint, can be unique to you but challenging to pinpoint, so it is extremely helpful to record all you can about them. 

• Be mindful of what happens prior, during, and after a migraine attack. 
• How would you describe your feeling?  
• Is there something that seems recurring with your migraine symptoms?  

Keeping a vestibular migraine journal is an excellent way to identify patterns, make sensible choices and minimize risk exposure of an attack.   Symptoms of vestibular migraine can be reduced with lifestyle changes and avoidance of triggers. This looks like:

• eating a healthy diet
• getting enough sleep every night
• trying to reduce stress
• exercising regularly
• avoiding alcohol and any food that may be a trigger

Medications might be helpful to prevent episodes if avoiding triggers is ineffective in controlling symptoms. Preventative medications range from beta-blockers to calcium channel blockers and more, tailored to your existing medical conditions. Once symptoms are under control, medications can be weaned down and not necessarily part of a long term vestibular migraine management regimen.

Vestibular rehabilitation therapy can help enormously in managing the vertigo symptoms and includes exercises to stabilize the gaze and improve the ability of the eyes to track movement.  Research has proven physical therapy to be effective in managing the complications of vestibular migraine such as: 

• Returning confidence in the patients balance system
• Reducing the patient’s level of anxiety with respect to their condition 

Other research has proven vestibular rehabilitation therapy effective in reducing dizziness and anxiety in patients coping with vestibular migraine. 

Vestibular rehabilitation therapy will train the brain to desensitize itself to common sensory triggers and incorporate tasks to improve balance and hand-eye coordination. The regimen of therapy is typically gradually increased in its intensity and broadly varied to combat the varying triggers covering visual perceptions, movement, and posture instability. For instance habituation exercises are based on the understanding that repeated exposure to a trigger, such as quick head movements, in a therapeutic setting under the guidance and instruction of a therapist can lead to a reduction of the motion-provoked symptoms.  In this case the exercise will be used to reduce dizziness however in other situations, a gait and balance exercises will be aimed to decrease the risk of falling.  

Exercises to Treat Vestibular Migraine While vestibular migraine treatment plans we structure are individualized and tailored to fit the goals of the patient,  they tend to fall into 1 of 4 categories.

• Balance exercises to reduce instability and dizziness
• Habituation exercises to reduce dizziness  and  positional vertigo related to intolerance to head movement
• Specific maneuvers and exercizes for benign paroxysmal positional vertigo (BPPV), frequently associated to vestibular migraine
• Visual  (oculomotor) exercises using eye movements

Length of treatment varies broadly as all circumstances are unique, however having said that,  positional vertigo is generally treated in a few sessions but, for balance, it’s commonly a few weeks before  improvement is observable.    Again, all patients circumstances are unique so call us for a more comprehensive conversation on what exactly you’re experiencing, we’re here to help.  At FYZICAL Therapy & Balance Centers - Alpharetta, our team of experienced therapists is dedicated to helping our patients diagnose and alleviate the causes of vestibular migraine to achieve optimal health and wellness.