Migraine and vertigo

Is there a link between migraine and vertigo?

The short answer is yes. There is increasing recognition that people with migraine experience ‘dizziness’ and vertigo more commonly than non-migraineurs and it was first written about in medical literature in 1873. The association between migraine and vertigo is variably termed ‘migrainous vertigo’, ‘vestibular migraine’, ‘migraine related dizziness’ as well as older terms such as ‘benign recurrent vertigo’.

Vertigo can also occur as part of the aura of migraine when it is termed basilar type migraine as there are other associated transient neurological symptoms such as slurred speech, double vision, unsteady walking, impaired consciousness and collapse or bilateral simultaneous sensory aura symptoms, i.e. pins and needles or numbness in both arms and/or legs simultaneously.

Migrainous vertigo may affect between a third and a half of all people with migraine at some time during their life. In young children recurrent attacks of rotational vertigo (termed benign paroxysmal vertigo of childhood) can be the first indication that they will develop typical migraine with headache in later life. Migrainous vertigo can however occur at any age with or without headache and is reportedly most common amongst people aged between 25 and 45.

The vertigo of migraine may be a sense of rotational movement “the room spinning like on a roundabout” or less often an illusion of self-movement. Nonspecific unsteadiness, postural imbalance and dizziness are even more common. Vertigo symptoms may be intermittent i.e. attacks similar to episodic headaches. They may arise spontaneously (without an identifiable trigger) or be provoked by positional change, e.g. rapid head movement and less commonly by identifiable migraine triggers such as menstruation.

The duration of attacks is highly variable both between and within individuals and may vary over time. Most commonly attacks of vertigo last minutes to hours with non-specific unsteadiness for days.

Migrainous vertigo may occur without headaches in up to 50% of individuals who experience such attacks and progressive deafness should be absent, but other features of migraine such as light or noise sensitivity or tinnitus (ringing in the ears) may be present. If discrete attacks of rotary vertigo occur especially if there is deafness then ear disorders should be considered as a condition called Menieres Syndrome can also cause similar symptoms. If there is doubt then your doctor should help to distinguish between these entities.

The best treatment is unclear. If vertigo is acute then symptomatic medications taken for a short period (less than two weeks) can prove helpful (prochlroperazine or promethazine). If attacks are frequent or recurrent the same medications used for migraine prophylaxis have been advocated, but there are no prospective trials on best treatment.

If in doubt it is best to consult your doctor to determine if the cause is definitely due to migraine.

Answer provided by Dr Brendan Davies, Consultant Neurologist