Migraine Associated Dizziness (MAD)

Migraine is a type of headache (HA) characterized by throbbing pain limited to one side of the head and sometimes accompanied by nausea, vomiting and sensitivity to light and sound. Migraine headaches are one of the most common causes of dizziness. Dizziness in migraine may occur with the HA, prior to or after the HA or completely independent of the HA. It is common to have dizziness as the only symptom of a migraine HA. The dizziness may be vertigo (sensation of spinning), imbalance or sensitivity to motion. Ear fullness and tinnitus may also occur.

How common is MAD?

Migraines are more common in women than men, especially women of childbearing age. Approximately, one third of the migraine patients have dizziness. People who suffer from migraines with aura are more likely to have dizziness with the HA. Sensitivity to motion, as in car sickness, amusement park rides, fast moving objects, is reported in half of the patients with migraines and can be the only symptom of a migraine. In young children, typically younger than 4 years old, sudden brief episodes of loss of balance with vomiting, anxiety, and nystagmus occur that are thought to be migraine equivalents. About 50% of these children develop migraines later in life.

What causes dizziness in MAD?

There are many theories and the exact cause is not know. People who are prone to migraines, when exposed to certain triggers, likely undergo changes in the brain associated with release of certain chemicals. These changes can cause dizziness along with HA.

How is MAD diagnosed?

A detailed history about the HAs, dizziness, triggers and many other factors along with a careful physical examination begin the diagnostic process. A hearing test is performed. Migraines may cause hearing loss and tinnitus (ringing of the ears) which also occurs in other ear conditions, and so a full diagnostic audiogram is required. Other diagnostic tests, electronystagmography(ENG) and electrocochleography(ECOG) and CDP may be performed. An MRI of the brain and inner ear is sometimes performed. A symptom diary, migraine diet and observation are sometimes performed as part of the diagnostic process.

What is the treatment?

The first step in the treatment is avoiding migraine triggers. Keeping a symptom diary helps to know your triggers. Certain foods are known migraine triggers and are listed below. There are many medications used to prevent migraine and they help prevent MAD. Vestibular and balance therapy is helpful to resolve the motion sensitivity associated with MAD. (link to balance therapy)

MIGRAINE PREVENTION

BEHAVIORAL PREVENTION

  • Diet- Don’t Skip Meals.
  • Sleep- Regular to bed and arise times.
  • Caffeine/Chocolate- Gradual taper
  • Fluids- Eight (8) ounce glasses of H2O daily.
  • Exercise- Cardiovascular 30 – 60 minutes, three (3) days a week.
  • Biofeedback, relaxation therapy

MIGRAINE DIET TRIGGERS

AVOID

  • Caffeine (including chocolate).
  • Alcohol, especially red wine, and other alcoholic beverages.
  • Monosodium glutamate (MSG), may also be labeled “autolyzed yeast. Extract,” “hydrolyzed vegetables protein,” or “natural flavoring.” Possible sources of MSG include: Chinese Restaurant: broth or stock: Canned or instant soup: whey protein; soy extract; malt extract; caseinate; Barley extract; textures soy protein; chicken, pork or beef flavoring; Processed meats; smoke flavor; spices and seasonings; including season Salt; carrageenan; meat tenderizer; TV dinners; instant gravy; and some
    Potato chips and dry roasted nuts.
  • Aged cheeses such as Cheddar, Blue, Brick, Colby, Roquefort, Brie, Gruyere, Mozzarella, Parmesan, Boursault and Romano.
  • Diet sodas or other products sweetened with NutraSweet or Equal.
  • Processed meats (sodium nitrate as preservative) to include hot dogs, Pepperoni, Bologna, salami, sausage, canned or aged meats, cured meat e.g., bacon, ham or marinated meat;
  • Dried fruits treated with sulfur dioxide.

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