Response to an article in The Daily Mail, dated 25th June entitled ‘The dizzy spells that are actually migraines – without the headache’ by Lucy Elkin
I was delighted to see this article in the Daily Mail last week which draws attention to the often unknown world of vestibular problems.
The condition of migraine-associated vertigo (MAV) can be very scary and disabling causing people to be off work and unable to function with day to day activities. The symptoms described in the article are what I hear in my clinic: words like “dizzy”, “nauseous”, “fatigued”, “giddy”, “off balance” and “the world is moving” are all very common. Often people are told by GP’s it will go away in a few weeks, but this may not be correct in some cases. Getting the right advice early is important to stop the stories I often hear of people having long term dizziness.
As the article points out you can have MAV with or without a headache. This might sound strange but it is the physiological process of a reduction in blood flow which gives it its name. In MAV it is the areas of the brain controlling balance that are affected by this reduction in blood flow not just the pain centre like your typical migraine.
There is an important medical and rehabilitation role in this condition and getting an accurate diagnosis is the starting point to dealing with this condition. Seeking out a specialist assessment is vital either from a physiotherapist who works in this field or an ENT consultant.
The treatment from a physiotherapy perspective is education on the triggers and a graduated retraining programme for the vestibular system. One of the big triggers is thought to be food related so cutting out caffeine, chocolate, cow products, citrus fruit and red wine can reduced the number of flare ups. While this might seem you’re having to give up all the nice things in life, this is only temporary while the balance system has time to recover, then you can slowly start adding items back in. Other triggers are when the body is overloaded, for example, facing a stressful day or very busy situation with lots of stimulation.
Along with looking at triggers I would get my patients to start an exercise programme to work on stimulating the vestibular system in a controlled way, including gaze stability and balance exercises. This helps to speed up recovery and give patients the confidence to start doing more.
Sometimes this alone is enough to bring the condition under control. However, occasionally medication is needed to stabilise the blood flow and treat the source of the migraine, which I would ask an ENT consultant to prescribe. Again, this is not long term but may last a few months in order to give the vestibular system time to recover.
This is a very treatable and under-diagnosed problem and while flare ups along the way are not uncommon during the rehabilitation process, the overriding message is to get expert advice. You do not need to keep feeling dizzy – something can be done and I am glad it is getting some publicity to inform people of the condition and its treatment.