Migraine and dizziness
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Migraine and Dizziness: Understanding the Connection
Prevalence of Dizziness and Vertigo in Migraine
Dizziness and vertigo are common symptoms experienced by individuals with migraines. During the prodromal phase of a migraine, 9% of individuals report dizziness, and 3.3% report vertigo. These symptoms are more prevalent during the headache phase, with dizziness affecting 35.7% and vertigo 33.9% of individuals1. This indicates that dizziness and vertigo are significant symptoms associated with migraines, particularly during the headache phase.
Migrainous Vertigo: A Diagnostic Challenge
Migrainous vertigo (MV) is a vestibular syndrome caused by migraine, characterized by spontaneous or positional vertigo lasting from seconds to days, often accompanied by migrainous symptoms. MV is the most common cause of spontaneous recurrent vertigo but is not yet included in the International Headache Society classification of migraine. Conditions like benign paroxysmal positional vertigo (BPPV) and Ménière's disease (MD) are statistically related to migraine, although the exact pathogenetic links remain unclear2. This highlights the complexity and diagnostic challenges of differentiating between various vertigo syndromes associated with migraines.
Effective Management of Migraine-Associated Dizziness
Management of migraine-associated dizziness involves a combination of dietary changes, medication, and lifestyle adaptations. Studies have shown that dietary manipulation alone can provide significant relief to 100% of patients, while the addition of medications such as tricyclic antidepressants, beta-blockers, or calcium-channel blockers can further improve outcomes. Overall, 72% of patients experience a dramatic reduction in vertigo or disequilibrium symptoms with appropriate therapy3. This underscores the importance of a tailored treatment approach for managing migraine-associated dizziness effectively.
Vestibular Migraine: Clinical Presentation and Treatment
Vestibular migraine (VM) is a recognized syndrome where vertigo is directly caused by migraine. VM affects more than 1% of the general population and is characterized by attacks of spontaneous or positional vertigo lasting from seconds to days, often accompanied by migrainous symptoms such as headache, phonophobia, and photophobia. Treatment for VM includes avoidance of triggers, stress management, and pharmacotherapy for both acute attacks and prophylaxis8. This comprehensive approach is crucial for managing the complex symptoms of VM.
Comorbidity of Migraine, Dizziness, and Anxiety
Dizziness is frequently comorbid with both migraine and anxiety disorders. This comorbidity can manifest as a condition termed migraine-anxiety related dizziness (MARD), where patients experience a combination of balance disorders, migraine, and anxiety. Recognizing and addressing this comorbidity is essential for effective treatment, as the interplay between these conditions can exacerbate symptoms5. Understanding the relationship between migraine, dizziness, and anxiety can lead to better management strategies for affected individuals.
Conclusion
Dizziness and vertigo are prevalent and significant symptoms in individuals with migraines, particularly during the headache phase. The diagnostic challenge of migrainous vertigo and the effective management of migraine-associated dizziness highlight the need for a comprehensive and tailored approach to treatment. Recognizing the comorbidity of migraine, dizziness, and anxiety is also crucial for providing holistic care to patients. Future research should focus on standardizing definitions and methodologies to improve the accuracy of diagnosing and treating these conditions.
Sources and full results
Most relevant research papers on this topic
Dizziness and vertigo during the prodromal phase and headache phase of migraine: A systematic review and meta-analysis
Dizziness and vertigo are more frequent during the headache phase of migraine compared to the prodromal phase, but more research is needed for accurate measurements.
Meta-Analysis
Rigorous JournalVertigo and Dizziness Related to Migraine: A Diagnostic Challenge
Vertigo and dizziness related to migraine can be caused by migraine, other disorders, or just by chance, making diagnosis challenging.
Highly CitedMigraine-associated Dizziness: Patient Characteristics and Management Options
Effective therapy, including dietary manipulation, medication, and neurology consultation, can significantly reduce migraine-associated dizziness symptoms.
Highly CitedMedical Management of Migraine‐Related Dizziness and Vertigo
Individualized treatment approaches, including dietary changes, medication, physical therapy, lifestyle adaptations, and acupuncture, effectively control migraine-related vestibular symptoms.
Highly CitedMigraine–anxiety related dizziness (MARD): a new disorder?
Migraine-anxiety related dizziness (MARD) is a new symptom complex that combines balance disorders, migraine, and anxiety, potentially leading to new treatment options for patients with dizziness.
Highly CitedVertigo and migraine: A more than two-fold connection
Migraine and vertigo are a related co-morbidity, with a higher co-occurrence in migraine patients, but the underlying mechanisms remain unclear.
Dizziness and migraine: a causal relationship?
Migraine may be the third leading cause of vertigo, with a possible causal relationship between migraine and dizziness, but definite diagnostic criteria for migraine-related vertigo are still lacking.
Literature ReviewEpidemiology of vertigo, migraine and vestibular migraine
The actual comorbidity between migraine and vertigo is higher than expected, with 3.2 % of the general population experiencing both conditions, and vestibular migraine, a condition directly caused by migraine, affecting more than 1 % of the general population.
Highly CitedMIGRAINE AND MOTION SENSITIVITY
Migraine-related dizziness and motion sickness can be managed through trigger avoidance, antimigrainous pharmaceutical agents, and physical therapy.
The Epidemiology of Vestibular Migraine: A Population-based Survey Study.
Vestibular migraine is prevalent in 2.7% of adults in the United States, with a higher prevalence in females and those under 40, and is likely under-diagnosed.
Observational StudyHighly Cited