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HeadWay Issue #209 Dizziness, Vertigo, and Migraine
January 21, 2022

In this issue:

Dizziness, Vertigo, and Migraine

Say what?! Vestibular

Dizziness, Vertigo, and Migraine

If you struggle with dizziness, vertigo, or balance during a migraine attack, you're not alone. But although we've known about the connection for a long time, it's still hard to get a helpful diagnosis.

That was the topic of a recent expert panel summit, which identified "gaps" in our care of patients with these symptoms.

Vestibular Migraine is a specific diagnosis recognized by the International Classification of Headache Disorders 3. But the symptoms must be very specific. The patient must see a connection between their migraine attacks and their "vestibular symptoms". The symptoms must be temporary (lasting 5 minutes to 3 days). And the symptoms must be moderate to severe, including specific types of dizziness or vertigo:
  • head motion-induced dizziness with nausea
  • Vertigo triggered by head motion or change in head position, or visual stimulus
  • spontaneous internal/external vertigo

Vertigo or Dizziness?

What's the difference between vertigo and dizziness? Dizziness is often used as the more general term. But in medical literature, it's usually talking about a feeling of light headedness, you might say, a confusion about where your body is. This can cause balance issues.

Vertigo tends to be defined more specifically. Vertigo is a false feeling of movement. Typically, you may feel like you (or everything around you) is spinning.

So where's the problem?

There's still a lot of confusion about defining and treating vestibular migraine. First, the definition itself is still somewhat new. Second, the definition is very narrow. In other words, many patients with migraine experience dizziness and/or vertigo, and it may even be connected with their migraine attacks, but they don't quite fit in the "vestibular migraine" category.

The name given to your symptoms, or how they're all connected, will be less important to you than actually treating them. But the better we understand the symptoms, the better they can be treated.

So to make a long story short, the problem is that we don't have a lot of information about dizziness/vertigo and migraine. Sometimes they may need to be treated separately, because they're not really connected. Often, they are connected, but they may be connected in different ways. In other words, your vertigo-and-migraine may need a different treatment than my vertigo-and-migraine.

So what can we do?

We need to investigate our symptoms as much as we can, and encourage our doctors/specialists to do the same. The authors of the report mentioned above emphasized the need for doctors, researchers, and patients, to share information and work together to find answers.

In the case of vertigo or dizziness that is related to your migraine attacks, it's true that treating the migraine will usually also treat the symptoms. But if your doctor is not taking you seriously when you talk about your other symptoms, or is not asking questions to rule out other conditions, it may be time to find a specialist who will be more thorough.


If you have vestibular migraine and you're in the USA, you may be eligible to take part in a clinical trial. More information here.

If you'd like to read more about this recent report, just visit: Care Gaps and Recommendations in Vestibular Migraine

Read more about the official diagnosis of vestibular migraine at the ICHD3 (scroll down).

For more practical details about vestibular migraine, check this article.

Say what?! Vestibular

The word "vestibular" actually refers to the inner ear. Because of the inner ear's importance in balance, in medicine it has come to refer to symptoms of vertigo or dizziness, especially when related to head position and movement.

Thanks for reading!  Remember, if you have feedback or ideas for future issues, visit the HeadWay MailRoom.  Your password is nomoache.
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