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Food is medicine – nutrition and vestibular migraine with Kelli Yates, RDN 

Food and diet can impact how we feel, and can play an important factor when it comes to the management of certain vestibular conditions. Your doctor may recommend certain dietary guidelines based on your vestibular condition and other factors (medications, other health conditions etc).

For vestibular migraine, certain foods can provoke your symptoms or trigger a migraine depending on how “full” your migraine threshold is on a given day. (click here to learn more about threshold/bucket theory and some additional information on migraine diets). If you’re not sure where to start with changing your diet, a registered dietitian or nutritionist can be a great resource and guidance in exploring how food can be medicine.

Kelli Yates, RDN, LD, CLT is a private practice registered dietitian and specializes in migraine and gut health. She became interested in this area while pursuing her own answers to help manage her migraine beyond medication.  Kelli has self guided programs, 1 on 1 help with her personally, and great information that she shares with us all on her instagram (@the.migraine.dietitian).

Kelli sat down with Dr. Madison to discuss how food can impact our health, especially those with migraines of all types.

Kelli notes how food can be medicine as both a preventative and active treatment. In general, food is best used as a long term preventative. For migraine, this long term management of symptoms with food involves learning what foods provoke symptoms or trigger a migraine and in what quantity. Some foods may need to be avoided altogether and others you may be able to enjoy in moderation, it really depends on the person.  An elimination diet can help reduce common food triggers for migraine and then you reintroduce foods to determine if they affect you.

Food can sometimes have an immediate effect. Peppermint and ginger can help with acute nausea and initial symptoms. Food schedules can also have a more immediate change on how you feel. Regular meal times/not skipping meals, or healthy snacks throughout the day can be a small change that could impact how you feel.

Here are some tips Keilli shared with us regarding diet and migraine:

  1. Reintroduce foods one at a time. There are many ways to introduce foods and a dietitian is a great resource to help tailor reintroduction to you!
  2. Low histamine diets are a temporary solution. If a low histamine diet helps, further care is needed to get to the root cause.
  3. Do what works best for you. Listen to your body on what feels good or bad. You know your body best. Keep that in mind before trying something that is suggested you try or you were told worked for someone else.

If you want to hear more from Kelli, follower her on instagram @the.migraine.dietitian or go to her website https://kelliyatesnutrition.com/

Kelli talks more about reintroducing foods, why low histamine diets are only temporary solutions, probiotics, gut health testing and anxiety around food in her talk with Dr. Madison.

Do you want to learn how to manage your vestibular disorder holistically, through diet and more?


Click here to Manage your Vestibular Disorder Better

Disclaimer:

Remember: this post is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.

Magnesium is an incredibly important supplement in our bodies, especially if we have migraine. Many studies have found that taking daily magnesium can help reduce migraine attack frequency and intensity. Typically the dose is 400-500mg/day for prevention, and then more for an acute dose if you’re trying to stave off an attack.

Types of Magnesium for Migraine

Magnesium Oxide

Magnesium oxide is the most common form of magnesium found in most stores, and if you pick up most drug store magnesium, it will likely be oxide. This is an affordable option and it’s in Class A of supplements, meaning it’s safe during pregnancy.

Magnesium Glycinate

Magnesium glycinate is the slightly less common form of magnesium, however its still easily accessible and does not cause the stomach upset that oxide does!

Magnesium Threonate

AKA CogniMag is something that many in the Vestibular Migraine community swear by for grain fog! IT’s a slightly different make up of magnesium and helps with improving cognition.

Magnesium in Foods

Many common foods are high in magnesium, and if you’d rather just try to eat enough throughout your day, you are welcome to try. The most common foods with high magnesium are beans/legumes, nuts and seeds, fiber-rich whole grains, dairy products, and many leafy greens. Although it’s entirely possible to get enough magnesium in your diet this way, it’s unlikely enough for a person with vestibular migraine, as a person with VM is typically low in magnesium, even if they eat a well-rounded diet.

Magnesium Spray

Magnesium spray is a topical form of magnesium that can help get magnesium into your bloodstream, without ingesting it orally. Because so many people are sensitive to magnesium in their gastrointestinal system, it’s not always an option to take it orally, even if you want to. A great place to start, other than your diet, are topical options! 4 sprays of this, on your skin, provides 66mg of magnesium! Although it’s a ways to get up to 400, it’s an excellent place to start!

Magnesium Lotion

Magnesium lotion, similarly to spray, is another topical option for you. This way, you won’t have gastrointestinal upset, but will still be able to increase the amount of magnesium your bloodstream absorbs. Additionally, it is a great way to practice self-massage on your neck. Take some of this cream, dab it on your neck, and rub your neck and shoulders for a neck-pain-relieving massage.

Magnesium Bath Soak

Sometimes when you are having a high pain migraine day, there’s nothing better than a warm bath. Pop this magnesium bath and foot soak in a bath of warm water and relax!

Magnesium Roller

The last option for non-oral magnesium is a roller. You can roll this anywhere on your body, it can sometimes help with sleep when put on your temples, or head pain relief!

Vestibular Migraine, as I’m sure you know by now, can be incredibly challenging to manage. Between weather changes, hormone changes, food triggers, and decreasing your caffeine intake, ‘a challenge’ doesn’t even begin to describe it. There’s a new study that I wanted to bring your attention towards, Dietary alteration of n-3 and n-6 fatty acids for headache reduction in adults with migraine: randomized controlled trial. 

This article is interesting because instead of taking another thing out of your diet, it talks about something you can and should eat more of – finally!

What Food Group is Great for Vestibular Migraine?

This new study from the British Medical Journal shows that increasing Omega-3 Fatty acids, and without decreasing Omega-6’s can help decrease migraine pain, days, attacks, and other migraine-related symptoms.

The research shows that altering Omega-63s without changing Omega-6’s can decrease pain severity and frequency of attacks. However, the research did not find that there was a significant difference in quality of life.

What’s the Science between Omega-3’s and (Vestibular) Migraine?

Vestibular Migraine occurs due to a complex cascade of events that begins in the brain stem and trigeminal nerve, impacts the trigeminocervical complex, and then impacts the vestibular system. This cascade of events is what causes both pain (trigeminal nerve) and dizziness (vestibular nerve) in those with vestibular migraine. Omega-3’s are protective against that response.

As human beings, we are great at many things, however, synthesizing our own Omega-3 and 6’s is not one of them. Therefore, we can alter the number of fatty acids we have at any given time with our diet and/or supplements. And, it just so happens that these fatty acids are essential to the migraine cascade – in fact, they have a big role in pain regulation.

The nerve endings of the trigeminal nerve (the one that causes pain in migraine) are regulated by these same fatty acids, called lipid mediators. These mediators and together known as oxylipin receptors, and they’re enriched at the end of the trigeminal nerves. They regular sensitization and the release of the headache-related neuropeptide calcitonin gene-related peptide (1). This fact implies that there is a link between omega-6 & 3 fatty acids and headache etiology.

The oxylipins that come from Omega-6’s have been found to “sensitize the trigeminal nerve endings, and evoke behavioral pain responses;” this means Omega-6’s can increase pain severity and migraine frequency (1). However, the oxylipins that are derived from Omega-3’s are found to have antinociceptive properties, meaning that they reduce pain (1).

Where do I Find Omega-6’s, and Should they be Avoided?

Omega-6, the kind of fatty acid that is found mostly in the typical American diet, in fact, there is research to show that most people who eat a Western diet eat significantly more Omega-6s than Omega-3’s. Omega-6’s do play a role in our body’s function, so you should not completely get rid of this kind of fat. However, because we eat so much Omega-6, and want to try to fit in more Omega-3, it’s important to know where they come from.

Where Do I Find Omega-3’s?

Omega 3’s are to kind of fatty acids we don’t get enough of in the Standard American Diet. It’si’mportant we get more of these than Omega-6’s so we can desensitize the trigeminal nerve, decrease pain severity, and decrease pain days overall. Although it may be easier for you to take them as a supplement, it is better to get them in your food, and more affordable. However, if you do not like any of these foods, it is typically recommended to get them in supplement form (aka Fish oil). Ask your doctor before you change or start a new supplement.

 

Source:

Ramsden, C. E., Zamora, D., Faurot, K. R., MacIntosh, B., Horowitz, M., Keyes, G. S., Yuan, Z.-X., Miller, V., Lynch, C., Honvoh, G., Park, J., Levy, R., Domenichiello, A. F., Johnston, A., Majchrzak-Hong, S., Hibbeln, J. R., Barrow, D. A., Loewke, J., Davis, J. M., … Mann, J. D. (2021, July 1). Dietary alteration of N-3 and N-6 fatty acids for headache reduction in adults with migraine: Randomized controlled trial. The BMJ. Retrieved October 5, 2021, from https://www.bmj.com/content/374/bmj.n1448.

 

Migraine and Vestibular Migraine can be reduced and managed naturally with vitamins, minerals, diet, and exercise! People often ask me which vitamin deficiencies cause migraine and if you should be tested. Although your doctor can test you, that’s not a requirement as most people with migraine do have issues with these deficiencies in most research. These vitamins include Magnesium, CoQ10, D3, Riiboflavin (B2), and Omegas!

Natural migraine treatments can be paired with your medical treatment, however, be sure you tell your doctor what you’re taking as some vitamins for migraine can have an impact on your prescription medication – there are always options, so its best to be safe!. Some people use natural migraine treatment alone, without the need for  Here’s a list of vitamins and other accessible over-the-counter treatments you can try. As always, ask your doctor before you change or add anything to your treatment plan!

The most common supplements for Vestibular Migraineurs are CoQ10, Magnesium, and Riboflavin (B2). Some supplements, like Migralief have all 3 combined, which makes remembering to take it easier. However, sometimes just because it’s easier doesn’t mean it’s better – some of my patients have been very successful with taking Migralief, but others have needed to take each one separately for multiple reasons.

Magnesium for Migraine

Magnesium has so many purposes in our bodies. It helps with mental clarity, digestion, nerve function, blood sugar, and more! Taking keeping magnesium available in your body for use is called bioavailability. Different kinds of magnesium supplements help with different difficulties you may have related to migraine

Magnesium Glycinate

Magnesium glycinate is used for mental clarity and digestive health, without causing digestive issues or a crash at the end of the day. Glycinate is an amino acid that your body uses to fight inflammation and improve sleep. Magnesium glycinate also occurs in foods such as meat, dairy, and legumes. Since those on a Migraine Diet or Heal Your Headache diet may be avoiding most dairy and some legumes, glycinate may be lacking in your diet. It’s important we have all the necessary amino acids in our diets, so a magnesium glycinate supplement may be a great idea for you!

Magnesium Threonate 

Magnesium L-Threonate is when we combine threonic acid and magnesium. This form of magnesium is a formed to be easily digestible and is great for mental clarity. Studies have shown that it helped promote learning and memory, and helped prevent memory decline. Threonate is already present in some level in our cerebrospinal fluid, and the presence of extra in neuronal cultures “increased functional synapse density” (2). Really good Magnesium Threonate, like the kind form Pure Encapsulations, is really hard to come by. If you can’t find it from Pure Encapsulations on Amazon, they have another show online here.

Magnesium Citrate

Magnesium Citrate is often used for treating digestive issues, such as constipation. Magnesium citrate is the most available form of magnesium – this is the kind of magnesium that you find generically in stores. This form of magnesium is also commonly found in powder form. If you have trouble with the bathroom in general and are a person who deals with chronic constipation it might be good to take Magnesium Citrate. However, if you do not, be more cautious about this – you might spend a little extra time in the bathroom than you had intended if you take Magnesium Citrate.

For more into on forms of migraine, you can take, click here! 

Coenzyme Q10

Coenzyme Q10, or CoQ10, for migraine is used for preventing oxidative change in your brain. Migraine Brains hate change – so preventing large changes in oxidative stressors within your brain will help decrease the number of migraines in your life.  CoQ10 helps support mitochondria by creating adenosine triphosphate, which helps us with energy (3, 4). Some studies have shown that CoQ10 can help with episodic migraine prevention up to 15 episodes per month. CoQ10 is made by Pure Encapsulations, like Magnesium, in pill form which is of high quality. It is also in chewable gummies made by NOW Supplements which patients have reported is effective as well.

Riboflavin (B2)

Riboflavin, which is a form of B2 vitamin, is effective in preventing migraine (5). Migraineurs are frequently B2 deficient, so supplementing your body this vitamin can be incredibly helpful in migraine prevention. Riboflavin is generally well tolerated, affordable, and will likely make you feel better. In the study, of people who took Riboflavin for the 3 month trial, 59% reported decrease in migraine symptoms by at least 50%. Riboflavin is useful in brain function, skin cell production, gut/digestive lining, and more. People who have migraine are typically deficient in B2, so it’s a good idea to supplement it into your diet. B2 can be found in eggs, milk, meat, nuts, enriched flour, and more If you do not tolerate these foods well, especially if you’re on a strict migraine diet, it could be a good idea to supplement it in vitamin form instead of trying to eat enough throughout your day. The typical dose is 400mg/day for at least 3 months, but as always, ask your doctor for more information!

It is significant, however, that riboflavin has been shown to interact with some medications like antidepressants and some cancer drugs, so be sure to check with your doctor first!

Omega-3 For Vestibular Migraine

A new study found that having more omega-3’s than omega-6’s is helpful for preventing pain and migraine frequency/days. We have two main forms of Omega-fatty-acids in our bodies. The first is Omega-6 and the second is Omega-3. Omega-3 has long been known to be healthier and better to have more of in your body. You can find it in avocados, fatty fish, and other nutrient-rich foods. Its other form is Omega-6, and is known not to be as healthy. This study found that increasing the number of Omega-3’s a person had, without doing any alteration of Omega-6, decreased headache frequency. Both Omege-3 and -6 are not synthesized internally, meaning that we have to eat them to get them in our bodies, or we have to supplement them or eat them!

Melatonin for Vestibular Migraine 

New research shows that melatonin could be very helpful in treating vestibular dysfunction. MT1 receptors interact with melatonin, and are found all over the same parts of the brain that the vestibular system is! This study says “melatonin has been proposed as a prophylactic agent in the prevention of migraine attacks, a condition that can be associated with vertigo” (8). This study also states that in animal models melatonin has been found that it can be otoprotective (protective for the ear). 3mg was taken daily during this study, and it should be taken at night before you go to bed. This way you can not feel extra sleepy during the day.

Vitamin D3 for Vestibular Migraine

Vitamin D3 can be helpful in preventing vestibular migraine, but the mechanism is not clear. There is not a lot of evidence to recommend it to all patients with migraine or vestibular migraine, but it’s great to ask your doctor if it’s a good fit for you. Many people are vitamin D3 deficient, especially with migraine. There is some evidence to show that there is a decrease in migraine frequency and pain when vitamin D3 is supplemented. This is especially important when it is not sunny outside, or if you live in a particularly foggy place! We get D3 via UV waves, but if we don’t live in a sunny place, or you live in a house/apartment without a lot of light, it’s important to find a way to get it in. Supplementation is frequently the answer here!

 

Sources:

(1) https://www.healthline.com/nutrition/magnesium-types

(2) https://pubmed.ncbi.nlm.nih.gov/27178134/

(3) https://www.verywellhealth.com/coenzyme-q10-migraine-prevention-1719853

(4) https://www.migrainetrust.org/living-with-migraine/treatments/supplements-and-herbs/

(5) Schoenen J, Jacquy J, Lenaerts M. Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial. Neurology. 1998 Feb;50(2):466-70. doi: 10.1212/wnl.50.2.466. PMID: 9484373

(6)Wolff, A. (2020, April 5). The Best Magnesium Supplements for Migraine. The Dizzy Cook. https://thedizzycook.com/magnesium-supplements-explained-which-one-is-best-for-vestibular-migraine/

(7) Ramsden, C. E., Zamora, D., Faurot, K. R., MacIntosh, B., Horowitz, M., Keyes, G. S., Yuan, Z.-X., Miller, V., Lynch, C., Honvoh, G., Park, J., Levy, R., Domenichiello, A. F., Johnston, A., Majchrzak-Hong, S., Hibbeln, J. R., Barrow, D. A., Loewke, J., Davis, J. M., … Mann, J. D. (2021, July 1). Dietary alteration of N-3 and N-6 fatty acids for headache reduction in adults with migraine: Randomized controlled trial. The BMJ. Retrieved October 5, 2021, from https://www.bmj.com/content/374/bmj.n1448
(8) Joaquin Guerra, Jesus Devesa, “Melatonin Exerts Anti-Inflammatory, Antioxidant, and Neuromodulatory Effects That Could Potentially Be Useful in the Treatment of Vertigo“, International Journal of Otolaryngology, vol. 2021, Article ID 6641055, 6 pages, 2021. https://doi.org/10.1155/2021/6641055
(9) Nowaczewska M, Wiciński M, Osiński S, Kaźmierczak H. The Role of Vitamin D in Primary Headache-from Potential Mechanism to Treatment. Nutrients. 2020;12(1):243. Published 2020 Jan 17. doi:10.3390/nu12010243

Learning to live with Vestibular Migraine is a life-long process, but tips and tricks from those with Vestibular or other forms Migraine can be so helpful. However, it is sometimes hard to find an all inclusive list of things that people have found helpful in the past. This is a list, which will be continually updated, containing items that patients have found to be helpful!

Lifestyle:

Allay Lamp

The Allay lamp’s intention is to decrease migraine triggers by emitting a calming green light that is proven to decrease photophobia, anxiety, and stress. We know that there are many wavelengths of light, which make up the whole world of colors, but for those with Migraine most of those lights are intolerable. Wearing migraine glasses is one solution, but another is to use this lamp. This lamp triggers small electrical responses in your brain, instead of large electrical signals that most bands of light cause. You can dim it, place a shade on one side for decreased light overall, or change it to a whiter light that is still soothing.

Migraine Glasses

There are so many pairs of glasses my patients have found to be helpful. Migraine glasses are intended to block blue light, in addition to yellow and other waves of light. Blue light ranges from 400-750nanometers. Because it is such a wide range, different kinds of blue lights are more and less problematic for your migraine and related symptoms. Some blue light glasses block only some parts of the blue light spectrum, even the parts that are good for you. Blue light around 460-500nm is actually healthy – we use blue light to monitor our melatonin levels, which affects our sleep-wake-cycle. Blue light can even be used to treat Seasonal Affective disorder. Blue light below 430nm is the “bad” blue light. The intention for a good pair of blue light blocking glasses is to block the blue light under 430nm. Special migraine glasses, like Theraspecs and Migraine Shields, and AxonOptics glasses do just that!

TheraSpecs

Theraspecs are the pair of glasses I let patients use in the clinic. I really like them as the pink hue from the FL-41 glasses are soothing for many of my patients, and they were created by a person in the Migraine Community. According to their website, TheraSpecs wearers experience 74% fewer migraine attacks on average per month, which for people with photophobia (light sensitivity) will make a huge difference. Even if you aren’t sensitive to light, Theraspecs will make a difference!

Theraspecs work to block the harmful blue light waves, provide wrap around protection of your eyes, and focus on blocking blue light the most at 480nm, the most aggravating wavelength for those with Migraine.

Migraine Shields

Migraine Shields are the best pair of glasses if you don’t want any color distortion in your vision. Most migraine glasses have FL-41 lenses, which are tinted pink – Migraine Shields uses a slightly different technology and aren’t tinted pink. These are great for work environments, using the computer, or choosing anything where color might be important. Migraine Shields do not come in a large enough size to fit over other glasses if you have a prescription! However, Migraine Shields have just released readers. These readers come in many shapes, sizes, and are so much cuter than the ones you find at the drugstore – these really multitask and are SO helpful!

AxonOptics

AxonOptics are also a great option for Migraine relief. They are not too pink, lightweight, and come in three different tints. AxonOptics glasses have three tints for three intentions: indoor, outdoor, and transitional. Transitional lenses take a little longer to make, and they are a little more expensive. However, if you are going to purchase 2 pairs anyway, it may be worth it.

Research has found that FL-41 lenses need to be specifically made for people with light sensitivity. AxonOptics creased their specific glasses for Migraine by crafting a lens that is consistent, effective, and a nice color. Additionally AxonOptics has a plethora of frames you can choose from, and an option for contact lenses.

These can also be in the form of prescription eye glasses – if you’d like them to fill your prescription they can do that so you can still be working with these on!

Why Not Just Wear Sunglasses?

Sunglasses, while they may provide relief for your migraine in the moment, block too much light. If light is a trigger for you already, you don’t want to make it an even bigger trigger than it is already. When you wear sunglasses all day, inside and outside, it blocks many wavelengths of light, not just those in the blue light spectrum which work to block the provocative forms of blue light. If you block many kinds of light, not just the ones that typically affect migraine, you may end up sensitizing yourself too all light, making your triggers worse!

Headache Hat: 

The headache hat is a tool you can use to soothe the headache part of your Vestibular Migraine, if you have them. I have found that patients in the middle of an attack will get their headache hat from the freezer, and feel at lease some relief. I would put the entire thing in the freezer, so you don’t have to deal with putting it together when you’re in the middle of a Migraine attack. It’s an easy, natural, way to give yourself a little relief.

Food and Beverages for Vestibular Migraine:

Imperfect Foods Subscription: 

Imperfect Foods is a weekly delivery of produce, meat, dairy, and snacks that is completely customized to your liking. You can choose what you’d like to go into the box, and they’ll deliver it to you on a set day for your whole neighborhood. I love Imperfect Foods, as they deliver the food that would normally be thrown out by grocery stores – your produce sometimes looks funny or misshapen, but is perfectly consumable!

They have options for organic or non-organic, and many other fun products that will make your life easier for when you really don’t want to go to the grocery store!

Click the link above, or here, for $20 toward your first week! 

Ritual Zero Proof:

Ritual Zero Proof is a whiskey, tequila, or gin alternative that tastes like the real thing, but without the alcohol! It really does taste like the real thing, but has no alcohol, no hangover, and no migraine! This was started by three people who do drink but wanted an additional way to enjoy a cocktail that wouldn’t give them the tipsy feeling. Although not intended for a vestibular migraine diet, it fits perfectly into your lifestyle!

PureWine Wands: Sulfite Removers

Sulfites and histamines can be part of your trigger load. Because wine, and other food & beverage categories, can contain quite a few sulfites finding ways to avoid, or remove, the sulfites is helpful! PureWine Wands remove the sulfites from the wine, which are produced by the grape skins during fermentation, and naturally occur in almost all, if not all wines. Removing these will help, but make sure you follow the directions as they do have to sit for a while to be effective.

You can use the wands, for a glass of wine

Or the wave for an entire bottle! 

Books for Vestibular Migraine:

There are a few books that Migraine patients should read, whether you have Vestibular Migraine or another kind of migraine. These will all help you understand Migraine and how to manage your symptoms

Victory Over Vestibular Migraine: 

This book is by well-known neuro-otologist, Dr. Shin Beh. He goes through the steps from finding out you have Vestibular Migraine to learning what to do next in order to manage your Vestibular Migraine symptoms. This is an absolute must-read for all vestibular migraine patients – either if you have a new diagnosis or you’ve been managing your symptoms for a long time.

The Migraine Brain:

This was the first Migraine book I read when I started treating patients with Migraine. It really helped me understand the vastness of triggers a person can have, how to manage the symptoms, and what a migraine actually is. It’s around 300 pages, but it’s a quick read and it has charts in the back to help you analyze your migraine!

Heal Your Headache (The 1-2-3 Program for Taking Charge of Your Headaches)

This book will give you a step-by-step guide for dietary recommendations for migraine and vestibular migraine. It will take you through the elimination and reintroduction of foods into your diet for a successful migraine lifestyle!

This is a short list of many Vestibular Migraine Hacks that will help make your lives easier! Check back soon for more helpful products and tips as this list grows!

Migraine is a genetically induced hypersensitivity to internal or external stimuli within central nervous system neurons (1). When a neuron that is primed to a migraine, and is triggered by a stimulus either inside or outside of your body, the neuron reacts through a migraine (1). There are treatments for both acute and chronic migraines episodes as well as prevention methods an individual can use to reduce the number of migraines that occur. Migraine is generally considered a headache, however not everyone with migraines experience headaches. Some people get migraines in the form of vertigo, called Vestibular Migraine or Migraine Associated Vertigo. It is estimated that about 1% of the population has Vestibular Migraines (2). Vestibular Migraine often goes undiagnosed or misdiagnosed for a while before an individual receives a diagnosis of Vestibular Migraine. Some of the symptom and diagnosis criteria will be helpful to pinpoint exactly what’s going on for you specifically. Once you or a loved one is diagnosed with Vestibular Migraines, there are many ways that they can be treated. There is not a quick fix formula for Vestibular Migraine, and finding what works for you may be a process. 

Symptoms & Diagnosis

There are many symptoms of Vestibular Migraine and it can present differently in each individual. Using your symptom history and some objective tests to rule out other vestibular disorders, your clinician should be able to come to the diagnosis of Vestibular Migraine if it is right for you. It is important to recognize and remember that many vestibular disorders present similarly, and that migraine could present one way in you, and another in someone else. Logging your symptoms before and during your treatment is a good way to work with your healthcare team toward the right diagnosis. The symptoms include, but are not limited to:

The symptoms listed above are not the only symptoms patients experience, and you do not need to have headaches to be diagnosed with Vestibular Migraines. Because there are so many ways you can feel dizzy, and sometimes it can be hard to describe to the doctor, I recommend starting a list and showing it to your provider when you have your appointment. This can help you and your healthcare team decide if this is the diagnosis for you.

After a thorouogh history taking, likely from a few practitioners, you will undergo a series of tests. These will differ depending on the individual case, but are generally we are looking to distinguish between multiple vestibular diagnoses. Some combination of vestibulo-ocular, gaze stability, calorics, audiological, positional, functional balance, gait, VNG, and VEMP testing will be employed. A thorough review of all of these tests will tell your providers if you have another vestibular diagnosis that could better account for your symptoms. If no other diagnosis is the most logical, and you fit the International Classification of Headache Disorders criteria, you will receive the proper diagnosis of Vestibular Migraines. 

The International Classification of Headache Disorders criteria currently consist of: (4)

    1. Headache with at least 2 of the following characteristics
    2. One-sided location, pulsating quality, moderate or severe pain intensity; photophobia or phonophobia
    3. Visual aura

All healthcare providers have access to this diagnostic criteria, and if they can’t find it on the internet, you can always come back and find it here! If you have gone through the diagnostic process and this is you, it’s time to start treating the cause of your symptoms. 

Treatment

Once you receive the Vestibular Migraine diagnosis, both prevention and acute treatments become important! Treating your migraines acutely means decreasing symptoms when you have a migrainous episode. Alternatively, treating your migraines preventatively is going to be a constant process and involves dedication from you and your healthcare team. There is no specific protocol for treating Vestibular Migraine, but both anecdotally and in research we have found effective tools for managing symptoms. The combination of acute and preventative treatments, as opposed to doing one or the other, is the most effective way we have found to treat Vestibular Migraines.

Acute treatments are what we call abortive — the concept is to get rid of the attack right as it is happening so it has a decreased impact on your life. These treatments are usually medications.  (2, 3, 5)

** please remember that medication overuse headache exists, and herefore meds like triptans, NSAIDS, and others in this list can cause rebound attacks!**

These acute treatments are used in response to the onset of a migraine or Vestibular Migraine symptoms. They all work differently, and you should treat your symptoms based on the treatment you find to be most effective with your healthcare team. You may use one, you may use more than one, but these are all tools that you should have around that you likely won’t be using daily. Daily treatments and prevention are going to be specific to you as well, and will become part of your daily routine.
Chronic prevention of your migraines, and treatment of symptoms that are left over from previous attacks, consist of diet modifications, physical activity, and vestibular therapy. Modifying your food and fluid intake is the most valuable and controllable tool you have to prevent migraines and avoid vertiginous symptoms. You can find out more about items to avoid on a migraine diet in a post I wrote here. However, the basics include decreasing sodium, eliminating caffeine, and eating fewer processed foods!
Other preventatives for migrainous symptoms are medications like beta-blockers, anticonvulsants, and SSRI’s (3). Combining diet changes, lifestyle modifications, some medications, and vestibular therapy will help you reduce symptoms and get back to the activities you love most!

Physical Therapy

Physical therapy for Vestibular Migraine is a gradual process of reintroducing irritating stimuli in a way that your brain can recover from quickly. Like most vestibular therapy, your PT will help determine what stimuli your brain has trouble processing and then help you relearn how to process the stimulus. I find that individuals with Vestibular Migraine frequently struggle with patterned carpets, fluorescent lightning, visual tracking, and quick head movements. All of these stimuli can be very irritating, and it’s your therapist’s job to slowly reintroduce them in a way your brain learns is safe and calm. Adhering to your home program is going to be imperative to your success in vestibular rehabilitation. Your brain  is very malleable, and you will heal from this given time and proper treatment!

Sources:

(1) Rothrock, J., MD. (2020). What is Migraine? Retrieved September 02, 2020, from https://americanmigrainefoundation.org/resource-library/what-is-migraine/

(2) Tepper, D. (2015, November 12). Migraine Associated Vertigo. Retrieved September 02, 2020, from https://americanmigrainefoundation.org/resource-library/migraine-associated-vertigo/

(3)Kramer, J. (2020, August 21). Vestibular Migraine. Retrieved September 03, 2020, from https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/vestibular-migraine/

(4)Hilton, D. (2020, June 07). Migraine-Associated Vertigo (Vestibular Migraine). Retrieved September 03, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK507859/

(5) Wolf, A. (2020, May 08). Acute Treatments for Vestibular Migraine. Retrieved September 03, 2020, from https://thedizzycook.com/acute-treatments-for-vestibular-migraine/