Migraine Comorbidites: Migraine Associated Vertigo

For many people living with migraine disease, it's not uncommon to experience dizziness, an inability to tolerate any kind of motion, vertigo attacks often accompanied by severe nausea and vomiting, disorientation, or confusion. All of these symptoms can be part of something known as Migraine Associated Vertigo.

Migraine Associated Vertigo (MAV) is a vestibular disorder. The vestibular system includes the parts of the inner ear and brain that deal with control of balance and eye movement.

Migraine Associated VertigoAbout 35% of migraineurs are thought to deal with MAV at some point during their lives with migraine disease. Migraine patients are three times as likely as patients with tension type headache to deal with vertigo and three times more likely to deal with vertigo than what is expected by chance. MAV attacks can occur in association with a patient's migraine attacks, but often occur independently, too. Vertigo is not considered part of the migraine aura.

Confusingly, the International Headache Society's classification system, ICHD-II, the bible of diagnosing headache disorders, does not recognize Migraine Associated Vertigo. Instead, the ICHD-II addresses dizziness and vertigo under the basilar-type migraine label. Basilar-type migraine is a type of migraine with aura characterized by the presence of certain neurological symptoms, such as vertigo and tinnitus. Some researchers who observed that the only difference between basilar-type migraine and MAV was the severity of the dizziness and other neurological symptoms experienced by patients with basilar-type migraine do not believe the two are separate conditions. Instead, they think basilar-type migraine is at the severe end of the spectrum of MAV.

Patients thought to be living with MAV are typically put through a battery of tests, including those related to hearing, vision and the vestibular system. Diagnosis is made by eliminating other possible explanations for the patient's symptoms. Doctors should also assess the limitations imposed on the patient due to the burden of MAV.

Avoiding the same triggers that lead to a patient's migraine attacks is considered the best way to avoid MAV episodes. Researchers have observed a large overlap between migraine triggers and MAV triggers, even when the MAV episodes occur independently from migraine attacks. Vestibular rehabilitation programs have also been shown to be significantly helpful for many patients dealing with debilitating MAV attacks.

Do any of you deal with migraine associated vertigo? Is it especially debilitating for you? How do you cope?

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