Caring Medical - Where the world comes for ProlotherapyVestibular migraine and spontaneous vertigo – Migraine Associated Vertigo

Ross Hauser, MD

This article continues and provides further discussion and information on cervical vertigo. Please refer to Cervical Vertigo and Cervicogenic Dizziness from more discussion, patient cases and treatment options for problems of dizziness.

When people come into our offices with a problem of Vestibular migraine, spontaneous vertigo or Migraine Associated Vertigo they talk to us about a very long medical journey that they have been on that no one can quite understand. This includes family and the medical professionals that they have seen already. If their stories are similar to your story, you will know that these people spend a lot of time looking for the triggers that cause the “silent,” headache free migraines and the sudden, spontaneous vertigo. Here are some of the things we have heard.

My doctor sent me to a nutritionist. We did allergy food testing, which I was sensitive for a few things. I was told no sugars and no caffeine because in addition to the dizziness I would suffer from sudden onset panic attacks and of course this whole problem with my health health leaves me pretty much exhausted with stress and anxiety. 

I am still on the diet, I think it has helped somewhat, but I still get these symptoms of migraine aura and then dizziness. They even come to me in my dreams. 

I have been on Verapamil, it helps a little. My doctor thinks it would work better if I had symptoms of Meniere’s Disease. I do have a sway to me. 

Treatments for me up until this point have not been successful. Things do not work for me long-term. At this point I would be grateful if something worked for me short-term. As my symptoms got worse I would get more diagnosis and more medications. I started to get confused as to whether my worsening symptoms were the result of side effects from these medications or new manifestations. 

I thank god that I am still somewhat functional and that I have a supportive husband. I am also grateful that these attacks seem to have been less dramatic and less frequent, however they are still there in the back of my mind. I wish I had answers. 

If this story sounds familiar to you and you are also searching for answers, this article will present one possible answer for you. That your symptoms are being caused by cervical neck instability and physical problems in your cervical spine manifesting themselves in vestibular migraine and spontaneous dizziness. Let’s look at supportive research.

“Vestibular migraine is the most common cause of spontaneous vertigo but remains poorly understood.”

Poorly understood is a recurrent them when it comes to patients with Vestibular migraine and spontaneous vertigo

Stat Pearls is a publication of the National Center for Biotechnology Information, U.S. National Library of Medicine. In the article Migraine-Associated Vertigo (Vestibular Migraine) (1), Daniel B. Hilton and Carl Shermetaro of McLaren Oakland Hospital write of the complication surrounding the understanding of Vestibular migraine and spontaneous vertigo. This may explain why your health care providers are looking for answers for you.

  • “Patients explain a sensation of motion when no motion is taking place or an altered sensation with normal motion to define vertigo. In a vestibular migraine, the sensation is often described as a “to-and-fro” (backwards and forwards) sensation, and this can complicate diagnosis. Simultaneous headaches do not always accompany the vestibular symptoms, thus making an in-depth history and multi-specialty evaluation pivotal in order to make a diagnosis.”
  • “Current management of a vestibular migraine consists of conventional migraine management as there is currently no accepted specific treatment for this disease. Additionally, convincing a patient of the diagnosis can prove difficult and lead to a delay in treatment or absence of treatment. This is understandable based on the fact that vertiginous symptoms are often asynchronous (happening at same time) with a headache and maybe a difficult connection for the practitioner or patient to grasp.”

A study published in October 2019, lead by researchers at Massachusetts Eye and Ear Infirmary, Harvard Medical School, and Ohio State University  examined Vestibular migraine as one of  the most common cause of spontaneous vertigo and why this problem remains poorly understood. The study was published in Scientific reports (2).

Here are the learning points:

  • “Vestibular migraine is the most common cause of spontaneous vertigo but remains poorly understood.”
  • The researchers investigated the hypothesis that central vestibular pathways (dysfunctions of the body’s system to maintain balance) are sensitized (heightened) in Vestibular migraine by  the vestibulo-ocular reflex (VOR) and vestibular and headache symptom severity.

We are going to move away from this research for some brief understanding notes and then we will return:

  • The vestibular system is the body’s sensory system that regulates balance and spatial orientation (the understanding of where you are in your environment).
    • It sits in the inner ear and works by adjusting fluid levels that act as the balance mechanism.
      • In human beings, we set our awareness of our place in space by using the ground as the constant place of orientation. We can keep our balance when we walk because we understand the ground is the constant and our vestibular system makes constant involuntary adjustments to “keep things steady,” to prevent motion from creating dizziness or sway.

Returning to the study

  • Vestibular migraine patients were abnormally sensitive to roll tilt (a misalignment of the eyes disrupting sense of gravity and space), which co-modulates semicircular canal and otolith organ activity (this is an ability to sense gravity and sense motion), but not to motions that activate the canals or otolith organs in isolation (where fluid in the ears stabilizers balance), implying sensitization of canal-otolith integration. (Something is off but it is not a Meniere’s Disease type problem.)
  • The researchers suggest a pathogenic model where vestibular symptoms emanate from the vestibular nuclei, (the the cranial center point for the vestibular nerve) which are sensitized by migraine-related brainstem regions and simultaneously suppressed by inhibitory feedback from the cerebellar nodulus and uvula, the site of canal-otolith integration.

The suggestion is simply, something is happening to the vestibular nerve which is overly sensitized to pain by the reaction of something happening to the brainstem and the process is further sent into panic by a dysregulation of the function of the balance mechanism in the ear.

Is cervical spine instability a possible cause of Vestibular migraine and spontaneous vertigo – Migraine Associated Vertigo?

We suggest one possible answer for this, not the only one. We feel and examination of cervical spine instability may lead to answer.

When there is pressure on the brain stem, and this pressure can be exerted by hypermobility of the cervical spine vertebrae, this can result is health problems or diseases of the brainstem which can result in abnormalities in the function of cranial nerves. This would be the problems we spoke about earlier surrounding visual disturbances, pupil abnormalities, vestibular and headache symptom severity, hearing problems, vertigo, swallowing difficulty, among other challenges. In our case we may explore what is happening throughout the cervical spine with attention to cervical  vertebrae where Cranial Nerve VIII (Vestibulocochlear nerve) comprised of the cochlear nerve (hearing) and the vestibular nerve (sense of space, balance) moves from the ear to the brain stem.

Continue with your research with these articles:

1 Hilton DB, Shermetaro C. Migraine-Associated Vertigo (Vestibular Migraine). InStatPearls [Internet] 2019 Jun 4. StatPearls Publishing. [Google Scholar]
2 King S, Priesol AJ, Davidi SE, Merfeld DM, Ehtemam F, Lewis RF. Self-motion perception is sensitized in vestibular migraine: pathophysiologic and clinical implications. Scientific reports. 2019 Oct 4;9(1):1-2. [Google Scholar]

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