Vestibular Migraine

Welcome to our resourceful page at the clinic La Migraine dedicated to our effective treatment of vestibular migraines. This page will explain this condition and invite you to come to consult us at the clinic La Migraine for effective treatment of this type of migraines. We aim to uncover the often overlooked aspects of this bewildering affliction.

In our ongoing commitment to provide effective treatment with in-depth information on headaches and migraines, our website also features dedicated pages for the treatment of other types of headaches and migraines, including chronic migraines, migraines with aura (classic migraines), ocular migraines, and hormonal migraines (menstrual or catamenial), atypical migraines, migraines in children, as well as the headaches of Arnold’s and Horton’s neuralgia, post traumatic, post concussion and tension type headaches. Each of these pages explores our solutions for these cephalgia, their specific characteristics and a comprehensive resource for those seeking improve the different aspects of their condition.

(Some of these pages are under construction. Will follow soon.)

Clinic La Migraine – Our personalized solutions against vestibular migraines

Our clinic La Migraine holds a significant position both in the practical expertise of managing vestibular migraines and in the theoretical understanding of them in the greater Montreal area. With an impressive track record spanning over two decades, our approach has yielded positive outcomes, with a significant, on average reduction of above 70% in the intensity, frequency, or duration of these migraines. In most cases, patients notice remarkable results and often achieve complete alleviation of their vestibular migraines. Leveraging this wealth of experience, we offer tailored solutions to guide you on your journey towards symptom relief from classical migraines.

What are our treatments like?

While conventional treatments for migraines, such as pain-relieving medications and triptans, provide acute relief, at the clinic La Migraine, we are committed to going beyond immediate relief by offering personalized strategies aimed not only at managing symptoms in the moment but also at reducing their frequency and intensity in the long term. We invite you to an initial consultation to discover how our approach can become your preferred solution for comprehensive and sustainable migraine management.

Our model leverages the interconnection between nociception from the neck and the base of the head and the brain. This allows us to offer targeted interventions for you. These interventions aim to reduce neuronal interference and nociception to your brain originating from accessible tendons, ligaments, muscles, fascia, and joints with all their proprioceptive components. Through these advanced treatments, we greatly enhance neuromusculoskeletal health and foster optimal nervous system function. We thereby mitigate causes and render you much less sensitive to triggers of attacks. This reduces your migraine intensity, frequency, and duration.

That’s why you should come and see us. Call us for more information or to book an appointment for yourself, your child, or other loved ones. We accept new patients and you do not need to have a referral.

Prevention and Long Term Maintenance

Lifestyle changes such as dietary modifications (reducing or eliminating alcohol, caffeine, and other substances intake), stress management techniques, and cervical strengthening exercises can help prevent or reduce symptoms of migraines in the long term. The clinic La Migraine also provides personalized maintenance programs for this purpose.

Why choose our treatments?

At the heart of our commitment at the clinic La Migraine, we understand the debilitating impact of migraines on daily life. Our dedicated team offers exceptional solutions to free our patients from the incessant burden of migraines. We firmly believe that no one should accept living with migraines longer than necessary, and that’s why we provide much more than just momentary relief.

Personalized Approach: Each individual is unique, and our solutions are tailor-made to meet the specific needs of each person. We consider your situation comprehensively, going beyond symptoms to address underlying causes.

Reduction in Frequency and Intensity: Our goal is clear – reduce the frequency of attacks and alleviate the intensity of pain. We aim for lasting relief, offering a significant improvement in the quality of life..

Proven Experience: With many years of experience, Daniel Lachance, D.C., and his team have successfully treated various cases of migraines and headaches. Their aptitude ensures a reliable and effective approach for each patient.

Putting Your Life’s Quality First

We invite you to seize this opportunity to improve your quality of life, regain balance, and no longer be limited by migraines. You are not alone in this battle, and our dedicated team is ready to accompany you towards a future without incessant migraines. Contact us today to discuss the best approach for you, as no one deserves to suffer any longer. Your well-being is our top priority.

Vestibular Migraine: Symptoms, Causes et Diagnosis

Synonyms: migraine-associated vertigo/ dizziness, migraine-related vestibulopathy, migrainous vertigo, silent migraine

What is a Vestibular Migraine?

Vestibular migraines present a spectrum of symptoms, including double vision, intense vertigo, and balance disruptions. Often referred to as “silent migraines” (aka acephalgic migraines), they can occur without the typical headache. These episodes, affecting about 1 in 100 people during their lifetime, are more prevalent in midlife, with females five times more likely to be affected. Vestibular migraine prevalence is estimated at 1-2.7% in adults yet remains significantly underdiagnosed. The condition predominantly affects women in their late 30s to mid-40s, often preceding the onset of vestibular symptoms with a history of migraines and motion sickness.(1) Individuals who have experienced benign paroxysmal vertigo (BPV) during childhood face the possibility of developing vestibular migraines even if they have no previous history of migraine headaches.

Individuals with vestibular migraines frequently exhibit a long-standing tendency towards motion sensitivity, often experiencing car sickness in childhood and continuing to suffer from motion sickness in adulthood. The varied duration of episodes, ranging from seconds to days, contributes to the complexity of symptomatology. Amid all migraine cases, vestibular migraines affect about 10%.(2)

Symptoms of Vestibular Migraine

Vestibular migraines, characterized by disruptions in the vestibular system, present a diverse array of symptoms that significantly impact individuals experiencing them. These symptoms may include intense vertigo, leading to a profound sense of imbalance and spatial disorientation. Vision-related disturbances, such as double vision and visual aura, often accompany these episodes. Individuals may also report sensations like light-headedness, a swimming feeling, or a rocking sensation.

Aural symptoms are prevalent, with more than two-thirds of patients experiencing issues like tinnitus, aural pressure, and muffled hearing during vestibular migraine attacks. Unusual aural sensations, such as bubbling, pulsating, or vibrations in the ear, contribute to the multifaceted nature of these episodes. Notably, the duration of these symptoms varies widely, ranging from seconds to days, with some individuals describing fluctuating hearing loss.

The duration of episodes varies widely. Approximately 30% of individuals experience attacks that last for minutes, another 30% endure episodes for hours, and an additional 30% face attacks over several days. The remaining 10% encounter brief attacks lasting only seconds, which tend to recur during head movement, visual stimulation, or changes in head position. For these individuals, episode duration is defined as the total period encompassing the recurrence of short attacks. Conversely, at the other extreme, some patients may require up to 4 weeks to fully recover from an episode. Nevertheless, the central episode typically does not exceed 72 hours.

The complexity and variability of vestibular migraine symptoms underscore the challenges in diagnosis and the significant impact on individuals’ daily lives. About half of those afflicted by vestibular migraines also has anxiety, depression, or other mood disorder. (3)

Causes of Vestibular Migraine

Vestibular migraines are thought to arise from a combination of genetic, environmental, and neurological factors. Individuals with a family or personal history of migraines may be more susceptible. The exact cause remains unclear, but disruptions in the vestibular system and its central connectivity signals, stemming from abnormal feedback from the neck or oculomotor system, are believed to play a pivotal role. Triggers like stress, hormonal changes, certain foods, and sensory stimuli may contribute to vestibular migraine onset. Among other factors, injuries, issues in the neck, stress and anxiety, or even prolonged head posture can contribute to the onset of symptoms.

The disturbance in the vestibular system, responsible for balance and spatial orientation, is a key factor in the characteristic symptoms of vertigo and dizziness during an attack. The specific mechanisms underlying these interactions and the initiation of vestibular migraines are complex and continue to be subjects of ongoing research. Understanding these potential triggers is important to better grasp the condition and explore appropriate management approaches.

Diagnosis of Vestibular Migraines

Diagnostic criteria according to the ICHD-3 (International Classification of Headache Disorders):

  1. A. At least five episodes fulfilling criteria 3 and 4

  2. B. A current or past history of 1.1 Migraine without aura or 1.2 Migraine with aura

  3. Vestibular symptoms of moderate or severe intensity, lasting between 5 minutes and 72 hours

    (Vestibular symptoms are rated moderate when they interfere with but do not prevent daily activities and severe when daily activities cannot be continued.)

  4. At least half of episodes are associated with at least one of the following three migrainous features:

    • Headache with at least two of the following four characteristics:

a) unilateral location

b) pulsating quality

c) moderate or severe intensity

d) aggravation by routine physical activity

    • Photophobia and phonophobia

    • Visual aura

5. Not better accounted for by another ICHD-3 diagnosis or by another vestibular disorder.

Vestibular symptoms, as defined by the Bárány Society’s Classification of Vestibular Symptoms and qualifying for a diagnosis of A1.6.6 Vestibular migraine, include:

  1. Spontaneous vertigo:

    • internal vertigo (a false sensation of self-motion);– external vertigo (a false sensation that the visual surround is spinning or flowing);

    • positional vertigo, occurring after a change of head position;

  2. Visually-induced vertigo, triggered by a complex or large moving visual stimulus;

  3. Head motion-induced vertigo, occurring during head motion;

  4. Head motion-induced dizziness with nausea (dizziness is characterized by a sensation of disturbed spatial orientation; other forms of dizziness are currently not included in the classification of vestibular migraine).

In the case of vestibular migraine, a minority of patients experience vertigo within the 5-60 minute timeframe specified for an aura symptom, and even fewer have vertigo immediately preceding a headache, as required for typical aura with headache. As a result, episodes of Vestibular Migraine cannot be categorized as migraine auras. While more than 60% of patients with migraine with brainstem aura report vertigo, ICHD-3 mandates at least two additional brainstem symptoms along with visual, sensory, or dysphasic aura symptoms for this diagnosis. Less than 10% of Vestibular Migraine patients meet these specific criteria. Consequently, vestibular migraine and migraine with brainstem aura are not synonymous, although individual patients may satisfy diagnostic criteria for both disorders.

Differentiating between Vestibular Migraines and Meniere’s Disease can be challenging due to similar symptoms like vertigo and spatial disorientation. However, key factors set them apart. Vestibular Migraine often links to a migraine history and presents with migraine features. In contrast, Meniere’s Disease involves inner ear dysfunction, leading to hearing-related symptoms like tinnitus. Meniere’s episodes are longer and include distinct changes in hearing.

Professional evaluation and diagnostic tests are essential for accurate diagnosis. Vestibular migraine remains significantly underdiagnosed, as evidenced by a study conducted at a dizziness clinic in Switzerland. In this study, vestibular migraine comprised 20.2% of the diagnoses in young patients, while referring doctors suspected it in only 1.8% of cases.

As per with any migraines, it is recommended to consult a doctor or physician in order to get an official diagnosis. It is also paramount to conduct tests with a physician at a clinic or hospital if you have recently begun having migraines for the first time in order to eliminate any serious possibilities such as aneurism and meningitis.

Sources:
1. Beh, SC. Vestibular Migraine: How to Sort It Out and What to Do About It. Eds: Digre, KB, Friedman, DI. Journal of Neuro-Ophthalmology. 2019; 39:208–219. DOI: 10.1097/WNO.0000000000000791
2. Lempert, T. Vestibular Migraines. Seminars in Neurology. 2013; 33:212-218. DOI : http://dx.doi.org/10.1055/s-0033-1354596
3. ICHD-3
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