Migraine-associated vertigo is dizziness that is associated with a migraine headache condition. Dizziness is one of the most common reasons people present to the doctor. Migraines are common as well. The job of the diagnostician is to determine whether the dizziness and headache are related and then, whether the dizziness is a manifestation of migraine, or whether they co-exist by chance.

SYMPTOMS OF MIGRAINE-ASSOCIATED VERTIGO

Published, peer-reviewed journal articles will describe migraine-associated vertigo using words including: episodic rotational vertigo with or without nausea and vomiting, positional vertigo, constant imbalance, movement-associated disequilibrium, illusory self or object motion, head motion intolerance, and/or
light-headedness, photophobia, phonophobia, osmophobia, and/or visual or other auras.

A HEADACHE IS NOT REQUIRED TO MAKE A DIAGNOSIS OF MIGRAINE-ASSOCIATED VERTIGO.

Having suffered with migraine-associated vertigo myself, (see my testimonial) and having been connected with other suffers, let me put this into plain language. A migraine can cause too many bizarre symptoms to list. MAVers typically report the following: Symptoms may go on 24/7 for many years. I know a woman who has had migraine-associated vertigo for 23 years. Common are crushing fatigue, brain fog, surrealism, as if looking through a coke bottle, visual snow so dense it’s hard to make out people’s faces. Then there are the symptoms related to dizziness: rocking motion, true vertigo, bed swings, feeling as if the floor or bed is moving, and floor drops.

This is a wicked illness to live with – it’s not just dizziness, which would be bad enough – it is a debilitating, life-robbing illness.

What’s frustrating is that friends and family think you are just dizzy. They don’t understand why you “won’t” eat the chocolate cake they made you, or “won’t” get out of bed and get some sunshine and meet you for lunch.

HOW TO TREAT MIGRAINE-ASSOCIATED VERTIGO

Prophylaxis is the ONLY way to treat migraine-associated vertigo, otherwise you will get rebound. First line prophylactic approach is strict adherence to the “Migraine Diet.” David Buchholz, M.D., formerly of Johns Hopkins, in his Book, Heal Your Headache, gives a comprehensive version of the diet.

If after three months, there is no clear difference in your migraine-associated vertigo, the patient will move onto the next step. If, however, there is significant help with the removal of trigger foods, the job is to add back foods, one at a time, to find out which food(s) is the culprit. Most people find definite food triggers which make a big difference in how they feel.

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NEXT STEP: MIGRAINE-ASSOCIATED VERTIGO PROPHYLAXIS

CSD Blockers: Anticonvulsants

Topiramate is about 75% effective for migraine-associated vertigo. The starting dose is 25 mg and therecommendation is to titrate as needed, in weekly 25 increments, up to 150 mg. Side effects include, but are not limited to, weight loss, hair loss, speech disturbance, difficulty in word-finding and tingling in the hands and feet.

Neurochemical modulators: antidepressants

Venlafaxine (Effexor) is 80% effective for migraine-associated vertigo. Mechanism is notvery clear. Effexor is an SNRI and SSRI. It is very useful in managing the sensory amplifications seen in migraine. It is inexpensive. The starting dose is 12.5 mg, increasing slowly to a maximum of 75 mg. Side effects are minor.

However, Effexor has a difficult withdrawal syndrome.

Tricyclics – amitriptyline/nortriptyline. They work as central antihistamines,
and on norepinephrine and serotonin receptors. They accumulate in the body. A weight gain of 25 pounds is not unusual when using these medications.

Mysterious mechanism agents: beta blockers and L-calcium channel blockers

These work 75% of the time for migraine-associated vertigo.

Any beta blocker will work for migraine-associated vertigo: propranolol 60 LA, metoprolol 50 XL, or atenolol50-100 mg a day. Side effects include fatigue, slow pulse and hypotension. It takes one month for them to work.

L-channel calcium channel blockers include verapamil. The mechanism is not well understood, although it possibly blocks TNC or possibly relates to the calcium channel gene. The therapeutic dose is 120-240 mg SR. It takes two weeks to work. The main side effect is constipation. If the patient is not constipated
after two weeks, he/she may increase the dose.

SUPPLEMENTS:

Supplements are regularly taken for migraine-associated vertigo and anecdotally many find them quite helpful.

Riboflavin has been rigorously studied and has demonstrated a reduction of migraine days and hours by 44%

The common recommendation for migraineurs is the following:

riboflavin 200 mg a day

magnesium 180 mg a day

CoQ-10 100 mg a day

fish oil 2000 mg a day

IN SUM, FOR THOSE SUFFERING WITH MIGRAINE OR MIGRAINE-ASSOCIATED VERTIGO…

Yes, you are dealing with a serious condition. It will not go away on its own. It will become disabling – read my testimonial. If I could get well so can you! – Please take action – NOW!



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