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Dizziness and Migraines: The Forgotten Symptom

When you think of a migraine, many symptoms may come to mind: incapacitating pain, sound sensitivity, light sensitivity, nausea – just to name a few. However, one potential symptom of migraine is often overlooked: dizziness (also known as vertigo). According to Dr. Timothy Hain, professor of Neurology, Otolaryngology, and Physical Therapy/Human Movement at Northwestern University’s Feinberg School of Medicine, only 372 research articles concerning migraine with vertigo have been published since 1952 (this number was attained from the National Library of Medicine’s search engine, PubMed, in 2008). “This indicates that while migraine associated vertigo has not been ignored, it has not elicited nearly as much attention from the research community as other disorders,” writes Hain in his report entitled “Migraine Associated Vertigo (MAV).”

MAV is quite a common symptom for migraine sufferers. Studies suggest that nearly 30 million people in the United States suffer from migraine and about 27-42% of them experience an element of vertigo during migraine attacks. Moreover, approximately 36% of these patients experienced vertigo even during headache-free periods. MAV can last anywhere from a few minutes to several days, making daily tasks near impossible.

Unfortunately the underlying cause of MAV is still unknown. Oftentimes, vertigo comes from an underlying motion-sickness symptom that is common among migraine sufferers. Hain’s research indicates that 50% of patients with migraine have motion sickness, compared to about 5-20% for control groups. Some researchers also believe that the vertigo may have to do with a gene-related pain control (one that is activated during migraines), as well as with the neurotransmitter serotonin. Current diagnosis of MAV is done by examining clinical histories, if available, or testing for vertigo immediately before, during and/or after a migraine attack.

Because causes of MAV are unknown, treatment is limited to trying to reduce the prevalence of the actual migraine and its associated symptoms. We recommend avoiding certain food triggers such as cheese, chocolate, alcohol and products containing MSG. For some patients, treatment with verapamil, or a long-acting beta-blocker such as propranolol or a tricyclic medication such as amitriptyline has shown promise. Verapamil and amitriptyline are especially helpful because of their anticholinergic properties, which may help control vertigo independently of whether they help with migraines, Hain’s report states.

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