Vestibular migraine Flashcards
What are possible precipitating factors of vestibular migraine?
Ppting factors (same as migraine)
- Food: caffeine, chocolate, cheese, alcohol, salt, MSH
- Negative emotions, insufficient sleep, stress
- Hormones: Pregnancy, periods
Head motion provoked -> pts keep head straight while walking, vertigo on turning head while crossing road etc
Vision provoked
- Visually complex things, e.g. watching TV/movies (esp IMAX)
- Repeated visual stimulus, e.g. walking down supermarket aisle, corridor w repetitive patterns, spiral carpark
- Bright lights
What is the diagnostic criteria of definite VM?
5 episodes of moderate vestibular symptoms lasting 5min- 72 hour
- spontaneous vertigo including internal vertigo (false sensation of motion) and external vertigo (false sensation that the visual surrounding is spinning or flowing)
- positional vertigo, occuring after a change in head position
- visually induced vertigo, triggered by a complex or large moving visual stimulus
- head motion induced vertigo, occurring during head motion
At leas half the episodes a/ w migraine like symptoms
- headache (unilateral, pulsating, mod-severe, aggravated by physical activity)
- photophobia/ phonophobia
- visual aura
history of migraine with/ without aura
no other diagnosis
how is vestibular migraine managed?
lifestyle & personal: insomnia, stress, fatigue, negative emotions
diet: salt (<2mg), MSG, caffeine, chocolate, cheese, citrus fruits, colouring& preservatives, alcohol, others
migraine stabilisers (symptoms prevention): amitriptyline, propanolol, flunarazine (ca channel blocker)
headache & dizziness relievers (breakthrough symptoms)
- headaches: paracetamol, NSAIds, cefargot, triptans
adjunctive treatment
- vestibular therapy: focus on habituation exercise to improve tolerance to head motion and visual stimuli
- psychologist/ pschiatrist: for patients with severe anxiety
- sleep clinic: for patients with intractable insomnia
- falls clinic: for elderly with other comorbidities.
