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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?

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

1. Headache Classification Subcommittee of the International Headache Society. “The International Classification of Headache Disorders 2nd Edition.” Cephalalgia 2004;24:8-160.2. Fife, Terry D. “Migraine Associated Vertigo: A Common but Difficult-to-Define Disorder.” Practical Neurology, September 2009, accessed August 29, 2012, http://www.bmctoday.net/practicalneurology/2009/09/article.asp?f=PN0909_02.php. 3. “Understanding Vestibular Disorders: What is a Vestibular Disorder?” Vestibular Disorders Association, accessed August 29, 2012, http://vestibular.org/understanding-vestibular-disorder.4. “Migraine Associated Vertigo.” Vestibular Disorders Association, accessed August 29, 2012, http://vestibular.org/migraine-associated-vertigo-mav. 5. Benson, Aaron G.; Meyers, Arlen D. “Migraine Associated Vertigo: Overview of Migraines.” Medscape Reference, last updated March 29, 2011, http://emedicine.medscape.com/article/884136-overview.

Comments

  • akshata
    2 years ago

    hello, Dr. Whyte, myself mrs. akshata here from india, i have a constant dizziness without headache or sometimes with mild headaches. is it a kind of migraine or something else, i went to many dr’s and everyone is telling that some migraines are occurs without headache also but why there is a constant diziness which has distrubed my life in such a way that i had leave my government hospital job also as i was working as a staff nurse. kindly reply. i am on tab. topamax 25 mg od and tab. flunarizine 10 mg od along with combination of etizolam and propranolol.

  • Julianne
    3 years ago

    I’ve had migraines since I was 15 but just started experiencing MAV with nystagmus about 5 years ago. Went through all the tests and my vertigo was determined to be neurological, as opposed to coming from a problem with the inner ear. Effexor taken as a daily preventative has solved both problems for me. I take the lowest possible dosage and have found the ER version to be better than the “normal” one as the normal pill’s effects only seem to last for about 20 hours. If I miss just one dose, the vertigo comes back quickly.

  • Piper
    5 years ago

    My son has been incapacitated with this for several years now. Tried all of the migraine meds,( a new one each month) and ssri’s, diet, vitamins with very little change. Vestibular rehabilitation helped some. He now has an almost agoraphobic fear of getting dizzy when he is not at home. @ Not Carly, he was also working stocking shelves when this started and believes the visual and lights were a trigger. Neuro Dr. says it is just anxiety but he does get visual auras and was diagnosed with stomach migraine as a child. Don’t know what else to try? Anyone else in this boat??

  • Julianne
    3 years ago

    Has your son found something to work for his MAV? I tried a slew of drugs and Effexor has been the only one that helped me. It works really well…I’m able to take the lowest available dosage with virtually no side effects.

  • Wmianno
    6 years ago

    Have had episodic migraine since age 3, went chronic about 10 years ago. I’ve been getting Botox – which helps with the pain but have not noticed any change in the severe vertigo – which on a good day is diminished to just dizziness. I am currently fighting my STD with my employer, and have been unable to live my life, not just work, since March of this year.
    Over the many years I have tried boatloads of Rx’s, which always cause some sort of bad side effect – the worst being antidepressants, which actually make me suicidal.
    Had a bad experience at a certain migraine clinic regarding the use of these drugs. One tries to be an informed, educated patient, but if the Dr. can’t even get your basic history and current concerns down correctly…how can you trust their “plan”?
    I also have chronic back and neck pain, with several bulging discs. I am aware of MOH, so am very reluctant to take anything other than muscle relaxers. Back Dr. is concerned about giving injections because, I nearly passed out when occipital nerve block was attempted at migraine clinic.
    Meanwhile the Botox is wearing off, the weather is changing here in the upper Midwest, and life as I know it is carrying on just fine without me. Trying to hold on till Oct. 3rd when more Botox will at least calm my throbbing head.
    I will print this article, and give it to my PCP, in the hope that he will better understand what I am trying to convey to him when I describe the vertigo and confusion.
    I will hold on…(I have to cause the is atilt!)

  • Diane Minton
    6 years ago

    I agree with this study based article. I have had vertigo more than one time….. Migraines did not occur with severity until I was 53 and I had them at onset of discovery of Bipolar mania Bipolar 1 at 22. Balance problems and nausea, out of my mind experiences as per light in eyes, aura, red spots have occured. With onset of Seroquel XR at 200 mg for 6 mos then to 100 now to 75 mg. I do not experience migraines in any severe Pettern at all. I am disabled because of Migraine with Aura. My husband has been tremendously supportive even when we did not know what was happenening to me..Seroquel seems to be helping me, I do take vistaril in low dose as needed if any symptoms appear. Thank you for a most informative and well based article easy to understand and am hoping others might benefit from my experiences. People usually think someone is nuts when these attack them,,,its all hormonal and I believe inherited as is bipolar however bipolar is something that can be brought on by severe trama.

  • Linda
    6 years ago

    Has anyone else been told that their migraines (painless Vertigo related or not) are related to hormonal changes?

  • amperesand
    7 years ago

    re: sarrahvesselov question on nystagmus: Yes, I have nystagmus. I am also VERY near-sighted, and I understand those two are often associated. If I “concentrate”, I can get my eyes to “wiggle” or my ears to “thrum”; sometimes they happen involuntarily in response to loud sounds at certain frequencies. Also had an eye trauma from impact–one pupil is dilated but responsive, retinal damage, and headaches are worse. ENT says I have hearing loss which is not “physical”; it’s nerve- or brain-related. So I believe migraines, vertigo, nystagmus, hearing, and sight are all tied together. I use Topamax, Lithium, Vicoprophen, B-2, Vallium, Beta-Blocker to reduce the effects, but not stop them. I’m in the 15% that Diamond Headache Clinic hasn’t “cured”…

  • roseann
    7 years ago

    I have suffered from migraines for 25 years. Over the years they have gotten more frequent. I take Verapamil daily and that has been the only medication that has eased the symptoms and made the migraine at least tolerable when I get one. I am on my fourth neurologist and she stated that I was one of the few people that has “really tried everything.” She said unless something new comes along, she has nothing to offer me. I am left with taking viodin & phenergan when I get a migraine and trying to tough it out. I try to still do as much as I can and often work (I am a nurse) with my migraines or else be out on disability. This past weekend I had my first migraine with vertigo, dizziness, and room spinning. It was very scary as I never had these symptoms before. I was very unsteady and had trouble walking for 24 hours. I had very little head pain, more like pressure on my left side and terrible nausea. Five days later I am still dizzy. I am hoping this is a one time thing as I could not function at all. Called my neurologist but they can’t get me in until February. Upset & not happy.

  • Linda
    6 years ago

    I started to get severe bouts of vertigo in 2001. I had one every two weeks for almost a year. I saw an ENT specialist and a neurologist, (months of odd tests) who ultimately diagnosed me with “painless migraines” same syptoms, wrecked for 24 hours after vertigo attack. Neurologist perscribed a low dose of Desipramine (75MG) which has kept them under control. If I try to wean off the pill, it comes back. I have been told it may go away when I am done with menopause!

  • Julie
    7 years ago

    I get really dizzy when I have migraines, and my one ear will pop. I tell my neurologist this and he told me to have my dentist check me for TMJ, which I don’t have. But the room will spin and I’ll loose my balance, that along w/the usual visual disturbance of flashing lights, wavy lines and blind spots. But what makes the ear pop if you don’t have TMJ? Sometimes the dizziness alone will bring on the nausea before the pain even sets in from the migraine! But that’s worth a try on the vitamin B. Worth a try.

  • Not Carly Simon
    7 years ago

    Oh do I ever. I used to work retail and stock shelves constantly. Often, I’d start to black out from the up and down motion used while stocking shelves.

  • MigrainesAlwaysHaveOne
    7 years ago

    Thanks for the suggestions of the B-2 – I will def try it. I suffer from vertigo along with migraines as well. I have tried taking Tigan and Reglan (anti-nausea) medications but they are not that effective. As a suggestion for others, when I was a massage therapist, I specialized in the head and neck. I had many patients tell me I cured them of their Meniers sp? disease and dizzy spells by the deep tissue massages I performed weekly on their necks. I was able to really dig in there and break up knots and increase range of motion. For those with problems, I really made sure I did the area surrounding the ear thoroughly. Its real hard to massage myself, but if you can find a good massage therapist that does therapeutic massage (not the Massage Envy stuff), but real healing deep tissue work – it could help.

  • 7 years ago

    Diane, thanks for this article. Very interesting reading and highlights an area of migraine response that seems to be under “appreciated.” I’ve had issues with motion sensitivity since childhood and went through a period where I experienced severe bouts of vertigo and dizziness with my migraines a number of years ago. Fortunately those resolved when I got on a better preventive regime, but I still have issues with balance and motion sensitivity that make moving around during a migraine a real challenge.

  • amperesand
    7 years ago

    BTW, I’ve also had viral infections of the 8th cranial nerve (inner ear) which caused the same type of problem. Don’t know if they’re related or not. Doctor said those were cause by the same virus that causes “cold-sores” on your lips; it hides in the base of your nerve cells until an inflamation occurs…(so is also nerve-related like this? Don’t know.)

  • amperesand
    7 years ago

    I’ve been using 15mg of Valium each day for the last decade to control my True Vertigo, which my ENT said might go away if my Migraines ever disappeared. Then a new neurologist suggested trying 400(!)mg of Vitamin B-2 each day. It’s water-soluble; my kidneys will flush it; worth a try… It helped–down to 5mg Vallium and also a reduction in the boatload of Meds for Migraines.

  • jansims
    7 years ago

    I started using a cane this yr because of Vertigo. I have Tardive Dyskenisia and Akathisia among other challenges. I get Migraines about one a month, even tho I had a complete Hyster. in 2009. I have had so many tests this yr I could say it is a record yr. Manage Migraines with the junk the Doc give u, but when its really bad I use Medical MJ. It helps with the nausea associated with migraine and relaxes me until I can get settled. Sometimes I need to go to ER or Doc for a shot of the “Migraine Cocktail”.

  • Writermom
    7 years ago

    Oh, yes! I have had both independent episodes of severe vertigo as well as MAV. Some have hospitalized me. Usually, they begin with no warning and are immediately severe. The only thing that helps is going to bed, taking meclizine, and waiting it out. The vertigo attacks are completely debilitating. I was told by one doctor that he didn’t know what it was caused by, another doctor, and ENT, told me it was vestibular neuronitis, and my neurologist says, no, it’s the Migraine. I also have tinnitis all the time, 24/7. It has never let up for years. I try to ignor it the best I can. Vertigo, however, cannot be ignored. It is NEVER mild.

  • Julianne
    3 years ago

    If meclizine helps with the vertigo, then it’s inner-ear based (as opposed to neurologically based).

  • judithruiz-branch
    7 years ago

    Wow! This is totally me! All this time I had been doubting the whether what I was experiencing was migraines or not… Now, based on this, I know it is. Thank you so much for posting this. Does anyone have any advice on treatment? Dr Whyte, where do you practice out of? Do you know of any great doctors in the Chicago-area? Right now I am taking a natural approach to see if I get some relief, acupuncture, chiropractor & massage therapy… Needless to say, I am not very fond of doctor’s since the one and only neurologist I saw put me on ant-depressants and neglected to monitor me. I stopped after a day based on the horrible side-effects. Any advice you can give would be greatly appreciated. Thanks! Positive energy, love & blessings your way!

  • jenniferjuniper
    7 years ago

    CHICAGO dIZZINESS AND hEARING i SAW dR cHERCHI. tHEY WILL PUT YOU HROUGH TESTS FOR THE MORE ATYPICAL TYPES OF VERTIGO, BUT THEY ALSO HAVE VESTIBULAR REHAB WHICH WILL HELP WHEN YOU DO GET DIZZY. SORRY FOR THE CAPS. GOOD LUCK.

  • 7 years ago

    MANY headache specialists in the Chicago area. There is Diamond Headache Center and a lot of specialists just outside the area. I’m in Omaha.

  • Docha
    7 years ago

    I’m wondering how anyone deals with the unexpected attacks of vertigo, balance problems that go along with it. Add the stoned look of a migraine coming on, along with speech disturbances and it doesn’t make a nice picture.
    I’ve had people make comments about being stoned? Really? Drunk? At times, I was not dizzy but had balance problems, ears felt full? and combined with the stoned look, trouble with speech not to mention that I was not aware of this going on…not good.
    If I have to live with the many faces of migraines, then I would like to have some kind of warning before hand, as I’ve usually had with most of my migraines. How do you deal when you are not aware? and still be responsible when it comes to driving or working with machinery? Just a tad dazed and confused.

  • 7 years ago

    I can understand how that can be difficult to deal with. That’s why I always try a great preventative (or 2…or 3) and a medicine that works quickly like subcutaneous sumatriptan to get rid of symptoms early. (If it’s migraine-related of course)

  • Miss Kim
    7 years ago

    Ditto! There are only a certain few at work that know about my migraines just in case something happens otherwise I’m a singer and can only imagine what must run through people’s minds when they see me with an attack…you know the old saying “s-x, drugs and RnR!”. It pisses me off. Now for the last couple of days I haven’t been feeling well after having my 24/4 chronic migraine episode and have been very dizzy, slurry my speech and have to joke about it during work. I read these articles and am now wondering if the dizziness is coming from the migraine which if yes, makes me feel a whole lot better in a weird way because at least I know others are going through this and I don’t feel half as scared. Thanks for posting and feel better!

  • Kim Bourner
    7 years ago

    THIS IS ME!!!! I am SO very glad to see it in writing! Thank you, thank you, thank you! I’ve sworn that sometimes my migraine is with one symptom: vertigo. What happens when I fly? Vertigo. When I get a cold? Vertigo. Thank you!

  • bobnanski
    7 years ago

    I’m a 3rd or 4th generation migraine victim, and the symptoms have changed over the years, but this last cluster included Vertigo. Had CT Scan to rule out Stroke. Clusters last a week to as long a month, and I get 3 or 4 sessions per year. My Neurologist prescribes 200 mg. Topamax and Magnesium, but after 3 years and very little improvement, I may have to take his advice and get Steroid shot(s) in the Occipital Nerve. Ouch!

  • Kim Bourner
    7 years ago

    I have moved on from the occipital nerve shots to the rhyzotomy (sp?). It hurts like the dickens for a couple of weeks, but provides much longer relief. Up to four months so far!

  • terri
    7 years ago

    Okay, here’s a monkey wrench for the works.

    The only time I’ve ever taken a migraine to the emergency room was the time I had (in addition to the headache) dizziness or vertigo so bad I couldn’t stand or walk, and crawling was iffy at best. When I got there, they of course treated me as if I was a drug addict, but they coughed up with the shot in the thigh anyway and examined my ears. The ER doc decided i had an inner ear infection and added a strong antihistamine to the mix and said it would be 3-4 days before I could walk. I do remember being frightened to walk and definitely couldn’t drive for at least that long.

    This last adventure in migraine was accompanied by tinnitus in one ear, walking into walls, and tight/spasm muscles all around my head down to my shoulders. Seems crazy, but it felt as if the muscles around my right ear tightened up so much that it was squeezing my ear shut. 4 days later, the headache is gone, balance is back, and the ear isn’t blocked up anymore, but it is sore.

    There’s nothing simple about this stuff.

  • 7 years ago

    Diana, nice article but if you don’t mind, I would like to elaborate a little bit. I love dealing with dizziness as well as migraine because there is such overlap. Let me clarify from my own anecdotal experience.

    1. Vertigo is a symptom, not necessarily a diagnosis

    2. It can be part of migraine or the entire migraine (I have even seen “cluster vertigo” in my practice)

    3. Because one name for the problem is MIGRAINE-associated vertigo, I think it’s not a vestibular disorder, but a MIGRAINE-related problem so I treat it as if it’s migraine

    4. Vertigo is the sensation that you are moving/spinning when you are not. Some migraine patients have “dizziness” that is not vertigo and is sometimes called migraine-associated DIZZINESS. Many times I think this is manifested as visual motion sensitivity (like car sickness)

    In summary I like to treat all these symptoms that come from the brain/brainstem as MIGRAINE and it works well.

  • jenniferjuniper
    7 years ago

    My MAV started in February. I was feeling fine, when the room started spinning and I got nauseous. I got up and started to stumble around when I noticed that everything in the room appeared to be moving instead or me (or so my brain thought.) I went to see my GP who gave me meclazine which helped enough to keep the room from spinning. I was incappacitated for a couple of weeks. When I went to see a neurologist, she decided it was migraine related given that I have a history of migraine with visual disturbances. I was given cortizone which made my head feel as if it would explode. I also went to vestibular therapy which out of everything was the most helpful. Sill not great as I was dizzy and could not bend down, turn my head or look at anything patterned. Using a target while walking or doing anything really helped me. Just find something to focus on. My PT recommended Chicago Dizziness and Hearing. I have been on a very low dose of vistiril and klonopin which really help.

  • Diana-Lee author
    7 years ago

    Alphabet, while I do understand wanting to try to find the right label for your symptoms, at the end of the day there is so much overlap with these various conditions that what really matters is that you have tools to cope with and, if possible, stop those symptoms.

  • Diana-Lee author
    7 years ago

    Leslie, I would recommend talking to your doctors about two things: (1) As Dr. Whyte mentions above, treating that dizziness as you would treat any other migraine attack, ideally with a triptan to abort it; and (2) a vestibular rehabilitation program. I hope this helps!

  • alphabet
    7 years ago

    Hello,Is there a way to distinguish Meniere’s from MAV? A migraine sufferer since the 70’s, I had a lobectomy, thyroidectomy and radiation treatment for Thyroid cancer in 1999. One of my first symptoms was vertigo, the episodes were so severe they dropped me to the ground, sometimes blacking out entirely. While my thyroid issue has long been stabilized, my migraines are worse and have been since 1999 and the vertigo is sporadic with maybe only 1 or 2 severe episodes a year but I frequently have days or weeks where the world is turning slowly and I am walking off to the right and am slightly nauseated. My hearing in my right ear has greatly decreased and tinnitus is constant. The specialist I was seeing could not determine whether I had Menieres as a by-product of the cancer or MAV. I have 2-3 migraines per week,normally 24 hr episodes but this year some of them have become 48 hr events and the Relpax, Fiorinal and Phenergan does nothing for them. I was seeing a neuro who tried everything in the book but Botox and the chip implant, I am still experiencing Parosmia 5 yrs after stopping the Zonegran. I am currently looking for an acupunturist who has had success with Migraine.
    Wishing everyone a pain free day.

  • lssnyder
    7 years ago

    Hello all thank you so much for posting this article. I have been diagnosed with mav and have not found much information on this. I have been dealing with pretty much non stop vertigo for just over a year now. I am unable to drive,the dizziness is more of a back and fourth motion. I do have nystigmus, ringing in ears, fullness feeling in ears, my eardrum bounces(bumps up and down constantly) confusion and most of the time i don’t have pain with the migraine. I do have a history of painful migraines but mostly i have been dealing with the dizziness. I am on 100mg of amitriptline and take diazapam and meclizine as needed. I am also on B2…. I am so tired of feeling this way and just wish i could wake up and feel better. I have not been able to work or drive for a year now. Any other advice would be great. Thanks Leslie

  • sarrahvesselov
    7 years ago

    I am in a bit late on this conversation but I felt the need to ask. Has anyone here experienced nystagmus with vertigo as part of a migraine attack? I have had chronic migraines since the age of 9 and it wasn’t until this year I began experiencing vertigo. Often the vertigo happens with no other symptoms of migraine so at first I wasn’t really sure if it was part of the migraines. Shortly after the development of the vertigo symptom I began to experience what I believe is nystagmus. First it was every once in a while, usually while reading. My eyes would suddenly dart back and forth horizontally. This progressed into a daily occurrence while reading or any type of focused work. It will happen during a migraine attack and while I am migraine free. It has also progressed from a back and forth motion to an eye rolling around of sorts. My migraine attacks have intensified greatly this year with these odd symptoms as well as others (audiphony, aphasia, extreme fatigue). I have an appointment with a neurologist for the first time since I was in my twenties. I am hoping he can help.

  • Diana-Lee author
    7 years ago

    Thanks for your comments, Dr Whyte. From everything I understand, treating the vertigo as a symptom of the migraine is a very successful approach for most patients.

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