By Joni Doherty, MD PhD
Migraine-associated
vertigo (MAV) refers to dizziness and/or vertigo that is commonly thought to be
related to migraine. Many patients diagnosed with MAV do not have headaches, or
have chronic non-specific headaches that don't fit into the migraine
classification developed by the International Headache Society. MAV was
previously rarely diagnosed, but is now showing up as one of the most common
causes of chronic dizziness and/or recurrent vertigo.
Patients with MAV often report chronic dizziness, a "rocking"
sensation when still, recurrent episodes of rotational vertigo, chronic daily
headaches, migraine headaches, light sensitivity, sound sensitivity, poor
visual acuity, nausea and more. Patients usually do not have all of these
symptoms—many of those with chronic dizziness often do not experience
acute rotational vertigo or even a migraine headache. Sometimes, MAV occurs in
individuals with a history of classical migraines, and they may or may not
experience these type of migraines any longer.
The
cause of this condition is unknown but progress is being made through clinical
experience and genetic research. Migraine susceptibility may be inherited, as
it seems to run in families. Diagnosis is difficult because many of these
symptoms cannot be objectively documented, and physical and neurological
examinations are often completely normal. Diagnostically, one must determine
whether the dizziness and headaches are independent or related to each other,
and in particular, whether they are a manifestation of migraine. MAV is often
misdiagnosed as Meniere's Disease, Vestibular Neuritis or as a psychiatric
disorder. However, unlike these conditions, migraine disorder is extremely
common, affecting 10 to 20 percent of the population in the United States.
Treatment of migraine-associated vertigo is the same as the
treatment for migraine in general: medication, and identification and avoidance
of “triggers” such as chocolate, cheese, alcohol, and MSG during food
preparation. Additional triggers include an interruption in sleep patterns (too
much or too little), stress, or inflammation. Neck tension or tension headaches
can even exacerbate a migraine in susceptible individuals. If
you are suspect you are suffering from MAV, consult a specialist such as an
otologist, a physician subspecialist within the specialty of ENT.