What seems to be the most under-recognized, yet most common cause of dizziness or vertigo is not an inner ear condition at all – it is migraine. This condition is known as “vestibular migraine” or “migraine-associated dizziness” or “migrainous vertigo”. The main reason it seems to evade diagnosis is that many suffering from this condition are not having headaches at the time they are dizzy. In fact, many patients haven’t had a headache in years or even decades. Patients usually (but not always) have a history of what sounds like migraine headaches, but they will often refer to headaches as “sinus” headaches.
Symptoms of “vestibular migraine” are quite variable, being different from one patient to another and different within the same patient over time. Dizziness and/or vertigo may be reported with a duration of seconds to decades. Patients often have difficulty in describing their symptoms. Morning predominance of dizzy symptoms and visual motion sensitivity are typical. Visual motion sensitivity might include activities such as driving and shopping for items on shelves (especially in big box stores), or being bothered by patterns on clothing or carpeting. Light and/or noise sensitivity are only sometimes present.
Diagnosis of vestibular migraine includes ruling out other causes by vestibular function evaluation (Videonystagmography or VNG, Rotary Chair, Vestibular Evoked Myogenic Potential or VEMP, and an Audiogram). MRI and CT scans or blood tests are rarely necessary.
In the past, many patients suffering from spells of vertigo without hearing loss had been diagnosed with “Vestibular” Meniere’s. However, “Vestibular” Meniere’s is no longer considered a valid diagnosis. The vast majority of these patients were (and likely still are because low salt diet, diuretic, and/or inner ear surgery aren’t helpful treatments for migraine) suffering from “Vestibular” Migraine.
Treatment of vestibular migraine includes recognizing and avoiding trigger factors, and depending on frequency and/or duration of symptoms, preventative migraine medications. In some cases, in particular when motion sensitivity is prominent, a specialized form of physical therapy (PT) known a Vestibular Rehabilitation Therapy (VRT) can be helpful.