Migraine associated Vertigo has only been recently recognised, just in the last few years, but affects a large number of patients, who until recently had few recognised treatment options. Clinical trials are underway, but pooling patient experience may help others find treatments that help them.
Filling in the polls at the end of the page may help establish a database of what works for which patients.
Summary Information about Migrainous Vertigo
Around 30-50% of patients with migraine experience at times an abnormal sense of motion, at times clearly vertigo (a sense of spinning), at others a more non-specific sense of imbalance. This may be accompanied by other migraine symptoms, such as photophobia (discomfort with bright light) or headache. An increased sensitivity to motion, particularly to movements of the head, or fast-moving objects are often part of the attack. Patients with migraine and certainly with migrainous vertigo have increased likelihood of motion sickness.
It is said that up to 1% of the population of Western countries suffers from this disorder. It is estimated that whilst 60% of vertigo patients seek medical attention, as few as 20% of patients are correctly diagnosed with vestibular migraine. Women are 1.5-5 times more likely than men to be affected.
The mechanism at this stage is unclear, but an increased sensitivity to balance stimuli or a failure of integration of different types of balance stimuli are at this stage possibilities.
Migrainous vertigo is often well controlled with certain migraine (especially preventative) medications. Clinical studies have shown a reduction in duration, severity and frequency of the episodic vertigo with preventative medications in these patients.
It has only been recently recognised by the International Headache Society as a separate disorder and research into the area is growing rapidly.
Results of MAV survey
I performed an online survey to get more information from real patients about MAV and the links to the results are below, in two parts:
Results of MAV survey 1 and Result of MAV survey 2.
You can compare this to the (little) evidence that exists in the medical literature for treating Vestibular Migraine.
Treatment options in vestibular migraine (from Obermann et al).
| Acute treatment | Dosage | Trial (Reference) |
|---|---|---|
| Zolmitriptan | 2.5 mg oral | Randomized controlled trial (RCT) (29) |
| Rizatriptan | 10 mg oral | RCT, motion sickness (30) |
| PROPHYLACTIC TREATMENT | ||
| Metoprolol | 150 mg oral | Retrospective cohort analysis (31) |
| 100–200 mg oral | Retrospective cohort analysis (33) | |
| Propranolol | 160 mg oral | Retrospective cohort analysis (31) |
| 40–160 mg oral | Retrospective cohort analysis (32, 33) | |
| Valproic acid | 600 mg oral | Retrospective cohort analysis (31) |
| 600 mg oral | Cohort study, vestibulo-ocluar reflex (34) | |
| Topiramate | 50 mg oral | Retrospective cohort analysis (31) |
| 50–100 mg oral | Open-label, chart review (44) | |
| Butterbur extract | 50 mg oral | Retrospective cohort analysis (31) |
| Lamotrigine | 75 mg oral | Retrospective cohort analysis (31) |
| 100 mg oral | Retrospective, open-label (41) | |
| Amitriptyline | 100 mg oral | Retrospective cohort analysis (31) |
| 10 mg oral | Retrospective cohort analysis (33) | |
| Nortriptyline | 25–75 mg oral | Open-label, chart review (44) |
| Flunarizine | 5 mg oral | Retrospective cohort analysis (31) |
| 5–10 mg oral | Retrospective, open-label (33) | |
| 5–10 mg | Open-label, post-marketing (36, 37) | |
| Magnesium | 400 mg oral | Retrospective cohort analysis (31) |
| Clonazepam | 0,25–1 mg oral | Retrospective cohort analysis (33) |
| Cinnarizine | 37.5–75 mg oral | Retrospective, open-label (35) |
| NON-MEDICAL TREATMENT | ||
| Vestibular rehabilitation exercises | 5 therapy sessions over 9 weeks | Uncontrolled, observational trial (43) |
| Caffeine cessation | 4–6 weeks | Retrospective, observational trial (44) |
Now your turn…
Your feedback will be valuable to help characterise the range of symptoms and effective treatments you have found to share in bulk with others.
Once sufficient answers have been compiled, I will share the overall responses with commentary. To keep in touch, please submit your email address below: