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What is a vestibular migraine diagnostic criterion?

What is a vestibular migraine diagnostic criterion?

Vestibular Migraine is a relatively common neurological condition. Vestibular Migraines differ from general migraines in that vestibular migraine symptoms include severe, throbbing headaches, along with symptoms such as Vertigo, migraines, nausea, & vomiting.

Vestibular Migraine Symptoms:

Vestibular Migraine symptoms can occur in individual signs or a combination of the following signs:

  • Migraine symptoms like severe, throbbing headaches

  • Headaches that occur on one side of the head
  • Nausea & vomiting,
  • Sensitivity to light, smell, & sounds

Other vestibular migraines symptoms include:

  • Vertigo & dizziness that lasts for minutes to hours, also sometimes days,

  • General unsteadiness & loss of balance,
  • Sensitivity to motion, lights, & sound

A certain level of subjective hearing loss is common for patients with Vestibular Migraines, although significant hearing loss coupled with ringing or buzzing sounds in the ear, & pressure in the ears should raise suspicion for Meniere’s Disease.

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Vestibular Migraine patients may experience a variety of vestibular symptoms such as visual aura, or sensitivity towards visual stimulation & motion at similar or different times, & can occur with or without an actual headache.

Vestibular Migraine causes:

Doctors aren’t really sure as to what exactly are Vestibular Migraines causes. Most times, it is hereditary. Another reason could be certain miscoordination between nerves cells & your brain.

Medical researchers believe Vestibular Migraine affects about 1% of the population, although the incidence could be higher. This is usually due to the fact that vestibular migraine symptoms resemble those of other vestibular disorders like BPPV Vertigo as well, thus making patients prone to misdiagnosis. Also, like traditional migraines, vestibular migraines are also more common among women than in men.  Although Vestibular Migraines are more common in middle-aged adults over 40 years of age, kids can get it too.

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Vestibular Migraine diagnosis:

Although there are no specific blood or imaging tests that tell for certain if you have Vestibular Migraines, the International Headache Society & other medical organizations have come together to devise certain diagnostic criteria for Vestibular Migraines.  These are a set of criteria that the patient must meet in order to be diagnosed with Vestibular Migraine. According to these guidelines, you can be diagnosed with Vestibular Migraine if:

Your doctor will determine that you have a vestibular migraine if:

  • You have had migraines attacks in the past.

  • You have experienced a minimum of 5 episodes of vertigo that come along with spinning or moving sensations. However, this differs from motion sickness symptoms or feeling faint & woozy.
  • The symptoms last anywhere between 5 minutes to 72 hours.
  • The symptoms are in the range of moderate to severe. Which essentially means that you’re incapacitated in the duration of an attack, & are incapable of performing tasks to the full of your capacity?
  • At least half of the Vestibular Migraine episodes occur along with one of the following migraine symptoms:
    • A headache that is one-sided, pulsing, moderate to severe, or gets worse with activity. If any two of these fits the description, then you might be suffering from Vestibular Migraine.
    • Sensitivity to light or sound, also known as photophobia & phonophobia
    • Seeing shimmering or flashing lights in your vision, also called a migraine aura or a visual aura

Since Vestibular Migraine symptoms also resemble those of other vestibular disorders like Meniere’s Disease & Brainstem Stroke, doctors are likely to recommend MRI tests to rule out those & any other disorders from the list. They are also likely to give you hearing & balance tests to check for any issues with the vestibular system.

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You yourself can also rule out Meniere’s Disease & Brainstem Stroke by simply observing the symptoms every time a stroke occurs.

Meniere’s disease: When you are suffering from Meniere’s disease, you experience fullness or pressure in your ears before feeling dizzy. You might also experience ringing or buzzing in the ears, along with partial or complete hearing loss. These symptoms are not present in Vestibular Migraine, hence, can provide helpful information regarding the same.

Brainstem Stroke: If you experience brainstem stroke, you might experience numbness, weakness, trouble speaking, & other stroke symptoms along with usual Vertigo signs.
It is important to consult your doctor right away &/or visit the Emergency Room immediately if you experience these symptoms.

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Vestibular Migraine Treatment:

As of yet, there are no specific medications that can treat Vestibular Migraines successfully. Your doctor will most likely prescribe you certain medications to stop an attack when it happens, a line of treatment also known as abortive therapy.

These medications include:

  • Triptans, which should be taken at the onset of headache symptoms,

  • Vestibular suppressants, which target the balance center inside the inner ear & help ease your dizziness & sensitivity to motion. Your doctor might prescribe Vertigo medicines including benzodiazepines like lorazepam(Ativan), & anti-nausea drugs like promethazine, along with antihistamines like meclizine, medicines which are also used in BPPV Vertigo treatment.
  • Drugs that are used to treat traditional migraines like seizure medications, blood pressure medications that include beta-blockers & calcium blockers, along with some antidepressants. If any of these medications are unable to provide relief with your vestibular migraine treatment, then your doctor might prescribe CGRP inhibitors. These are a new class of preventive medicines that are used to prevent & reduce the intensity & severity of Vestibular Migraine symptoms.

Your doctor might also prescribe you drugs that are useful for treating traditional migraines like:

  • Antiseizure drugs like gabapentin, topiramate, or valproate,
  • Blood pressure medications like beta-blockers & calcium channel blockers,
  • Tricyclic antidepressants,
  • SSRIs like Citalopram(Celexa), Escitalopram(Lexapro), Fluoxetine(Prozac), & Sertraline(Zoloft)
  • SNRIs like duloxetine(Cymbalta, Irenka), & Venlafaxine(Effexor)

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Aside from these medications, some of which are also Vertigo medicines, Vestibular Migraine treatment might also consist of some of these devices:

  • Cefaly, which is a small headband device that stimulates a nerve linked with migraines, by sending electrical pulses through the forehead,
  • SpringTMS or eNeura sTMS, which is a device that gives off a magnetic pulse when held at the back of the head during a Vestibular Migraine episode,
  • gammaCore, which is a hand-held carry around a device that also serves the purpose of a non-invasive vagus nerve stimulator. It sends small electric stimulations to the nerve’s fibers to ease the migraine pain.
  • Another device called Nerivio which is electrical neuromodulation is also used for Vestibular Migraine treatment. However, its use is not approved for the prevention of Vestibular Migraine.

Along with all of these devices & medications, patients can also make certain changes in their diet like avoiding alcohol & caffeine, quitting smoking, & including more healthy items in their daily diet.

Maintaining a list of all migraine triggers & taking care to avoid those is also important on the road to recovery from Vestibular Migraine.

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Author Biography.

Abhinav Puri
Abhinav Puri

Content Writer

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