Patients may actually feel vertigo, they may just feel lightheaded and unsteady, or they may simply feel that their head is not right. Additionally, the criteria specify that other causes have been ruled out by appropriate investigations.ĭizziness due to migraine can present in different forms. In fact, the proposed criteria for both definite and probable MV include the combination of episodic vestibular symptoms of at least moderate severity coupled with a personal history of migraine and/or a relationship between the vestibular symptoms and some aspect of migraine (e.g., triggers, response to medications). Specifically, risk factors for MV include family history or remote personal history of migraine long history of motion intolerance with tendency toward motion sickness visual motion sensitivity where visually challenging environments, such as supermarket aisles, feel uncomfortable dislike of bright lights (photophobia) dislike of loud sounds (phonophobia) and increased tendency for nausea. Like migraine and many vestibular disorders, MV is diagnosed primarily on the basis of history. Environmental factors–Changes in season, weather, altitude, or barometric pressure can prompt migraine.Sensory stimuli–Bright lights, sun glare, and unusual smells, even if pleasant, could trigger migraine.Physical activity–Heavy exertion or changes in sleep pattern can initiate migraine.Hormonal changes–Natural hormonal changes such as during the menstrual cycle or during pregnancy and menopause, as well as hormonal medications such as contraceptives or hormone replacement therapy, may worsen migraine.Stress–Stressful situations or relaxation after stress can trigger migraine.Diet–Alcohol (especially red wine), aged cheeses, chocolate, aspartame, caffeine, and monosodium glutamate (MSG), as well as skipping meals or fasting, can trigger migraine. Some of the more common triggers are detailed below: Individuals with migraine are often aware of the things that serve as triggers for them, since part of migraine management is avoidance of triggers. Various factors have been identified as being migraine triggers, including foods, stress, hormones, physical activity, sensory stimuli, and environmental factors. Typically, migraine begins earlier in life than does MV, and it is not unusual for vertigo to replace headaches in women around menopause. MV may occur at any age and has a female preponderance with a probable autosomal dominant inheritance pattern with decreased penetrance in men. As a result, the trigeminal nerve releases chemicals that irritate and cause swelling of blood vessels on the surface of the brain, sending pain signals to the brainstem. Migraine is now believed to be a genetically based neurological disorder in which certain triggers start a series of events including functional changes in the trigeminal nerve system and imbalances in brain chemicals, such as serotonin, that regulate pain. Recently, diagnostic criteria have been proposed that separate definite MV from probable MV and that conceptualize MV as an episodic vestibular disorder. Furthermore, vertigo is not included in the International Headache Society classification system as a symptom of migraine except as a part of basilar migraine, so most patients who have migrainous vertigo (MV) cannot be classified using the existing criteria. Less than half of all migraine sufferers have received a diagnosis of migraine from their health care provider. The result is that even in patients with headaches, migraine is often misdiagnosed as sinus headache or tension-type headache. The delay is due, in part, to the fact that most patients and many physicians think of migraine only in terms of headache, when it is actually an organic neurological syndrome. Unfortunately, although migraine is a common cause of dizziness, it is often not correctly diagnosed until years after the patient initially seeks medical care for complaints of dizziness. Specifically, vertigo, which is the sensation of perceived motion without actually moving, is reported by up to one third of people who have migraine, and general dizziness or unsteadiness is reported by up to three quarters of all patients with migraine. In reality, however, the cooccurrence of symptoms is much higher than that. Thus, 3%–4% of the population can be expected to experience both dizziness and migraine. Migraine is also a very common disorder, with prevalence in the general population ranging from 6%–20% in men and 17%–29% in women. Jaynee Handelsman, PhD, and Hussam El-Kashlan, MDĭizziness is one of the most common complaints in medicine and is reported to affect 20%–30% of the general population.
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