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Migraine Variant

Migraine can cause much more than headache, including episodes of vertigo, visual disturbances, and fluctuating hearing or tinnitus, sometimes with little or no head pain.

At a glance

Symptoms
Episodic vertigo, fluctuating hearing or tinnitus, visual aura, with or without headache
Common causes
Migraine brain mechanisms such as cortical spreading depression
How it's diagnosed
Detailed history, with testing to exclude other causes
Treatment
Trigger control, preventive supplements or medication, and acute treatment

Overview

Migraine variant refers to types of migraines that manifest symptoms differently from the conventional migraine headache. This condition involves a spectrum of neurological phenomena that can mimic other disorders, making diagnosis and management challenging.

Causes and risk factors

The underlying causes of migraine variants are complex and not entirely understood. Research suggests several contributing factors:

  • Neurovascular Dysfunction: Changes in the blood vessels surrounding the brain can lead to disruptions in normal blood flow.
  • Hypoperfusion Disorders: Reduced blood flow to certain areas of the brain can trigger migraine symptoms.
  • Microembolisation: Small blockages in the blood vessels may cause temporary symptoms as seen in classic migraine episodes.
  • Cortical Spreading Depression (CSD): This phenomenon involves a slow-moving wave of electrochemical activity in the brain, often linked to the sensory disturbances typical of migraines, such as visual auras.

Symptoms

Patients with migraine variants often experience:

  • Paroxysmal Episodes of Vertigo: These episodes can last from hours to days, causing significant disruption in balance and spatial orientation.
  • Transient Fluctuating Tinnitus and Hearing Loss: Some patients report changes in hearing and unexplained sounds that may accompany or occur independently of vertigo episodes.
  • Classic Migraine Symptoms: These include headaches, visual disturbances (aura), sensitivity to light and sound, and nausea.

Diagnosis

Diagnosing migraine variants involves a detailed patient history and exclusion of other possible conditions through:

  • Neurological Examination: Assessing brain and nerve function to rule out other neurological disorders.
  • Imaging Tests: MRI or CT scans can help visualize the brain's structure to exclude other causes of symptoms.
  • Vestibular Tests: Evaluating the inner ear and balance functions, especially when vertigo is a primary symptom.

Treatment

Treatment for migraine variants focuses on symptom relief and prevention of episodes:

  • Medication: Preventive medications that stabilize neurological function, such as anticonvulsants or certain antidepressants, may be helpful. Acute treatments include NSAIDs or triptans for pain relief.
  • Lifestyle Adjustments: Regular sleep patterns, stress management, and avoiding known migraine triggers can be beneficial.
  • Vestibular Rehabilitation: For those with vertigo as a symptom, vestibular rehabilitation exercises can help manage balance issues.

Living with Migraine Variant

Understanding and managing this condition require patience and a proactive approach to healthcare. Keeping a detailed diary of symptoms can help identify triggers and effective treatments. Collaboration with a healthcare provider is crucial in developing a comprehensive management plan that considers all aspects of this complex condition.

Testing that can help

Testing is chosen from your history and examination. These are the tests most often used here.

Videonystagmography (VNG)A comprehensive eye-movement test battery used to evaluate vestibular and oculomotor function.DizzyDoctor Vertigo Recording GogglesHigh-resolution infrared video goggles used to document eye movements during dizziness and positional vertigo evaluation.
Specialty care: Vestibular DisordersVestibular disorders encompass a range of conditions affecting the vestibular system, which is crucial for maintaining balance and spatial orientation.Vestibular MigraineVestibular migraine is a common cause of recurrent vertigo, in which migraine affects the balance system, with or without a headache.Meniere's DiseaseMeniere's disease is an inner ear disorder that causes attacks of vertigo along with fluctuating hearing loss, tinnitus, and a feeling of fullness in the ear.Migraine cocktailThe migraine cocktail is a daily regimen of vitamins and supplements used to help reduce how often migraines happen and how severe they are.

When to seek urgent care

Call 911 or go to the nearest emergency department if dizziness or imbalance starts suddenly together with any of the following, since these can be signs of a stroke or another emergency:

  • Weakness or numbness of the face, arm, or leg, especially on one side
  • Trouble speaking or understanding speech
  • Double vision or sudden loss of vision
  • A sudden, severe headache
  • Inability to walk or stand
  • Chest pain, fainting, or a seizure

Further reading

This article is for general education and does not replace a medical evaluation. Testing and treatment are chosen for each patient after a full history and examination.