Vestibular Migraines: Dizziness without Headache

By Dr. John Conde, Conde Center for Chiropractic Neurology

Avestibular migraine, also called migraine associated vertigo, is a migraine which is characterized by dizziness in the presence or absence of a headache. The typical presentation of a vestibular migraine is dizziness as if the ground or the person is moving, a sensation of falling, or difficulty coordinating movement. Associated symptoms include neck pain, pressure in the head or the ear, ringing in the ears (tinnitus), partial or complete loss of vision, and visual disturbances. It may produce throbbing or pulsating one sided (unilateral) severe headache. However, there may be no head pain at all. In fact some it is quite common for individuals to report light and sound sensitivity and dizziness without headache.

Exciting current research on the cause of this dizziness is focusing on a phenomenon termed cortical (brain) spreading depression (CSD) and on dysfunction in brainstem cells that are involved in the control of balance and sense of self in space. Essentially, brain cells responsible for balance and coordination and spatial perception become very active prior to and during a migraine episode, producing symptoms such as dizziness and nausea. Basically, it can be described as a prolonged aura that just does not go away. It is theorized that this spontaneous activity of brain cells is due to an unhealthy state; a lack of oxygen, lack of appropriate food (fuel), and/or lack proper nerve activation.

Our current understanding allows us to develop a treatment plan that is multi-factorial in nature addressing the oxygen deficiencies, inappropriate nutrition, and lack of nervous system stimulation. First off, it is of paramount importance to locate the specific region within the nervous system that is dysfunctional and for this we utilize a diagnostic tool termed videonystagmography (VNG). This state of the art equipment allows for in-depth examination of eye movement pathology which is a very accurate window into neurological dysfunction. In an effort to truly target the dysfunction in the balance centers of the brain, computerized posturography utilizing the computerized assessment of postural systems (CAPS) equipment is incorporated into the diagnostic battery. This tool provides an unprecedented amount of information regarding stability and balance and helps localize the problem areas. Measurement of a subjective visual vertical, perception of what straight is for an individual, using medical virtual reality equipment allows for further diagnostic accuracy. Lastly, a neck examination should be performed to see what contribution this may have to the clinical picture.

Specific brain-based rehabilitative treatments such as a procedure termed external trigeminal nerve stimulation (eTNS) which uses a nerve stimulator to provide pin-point activation of the trigeminal nerve is key to stabilizing the dysfunction leading to the dizziness. In addition, eye movement activities (oculomotoric rehabilitation), vestibular activities (inner ear), brain-balance auditory stimulation, visual stimulation, olfactory stimulation, and chiropractic adjustments are essential in stabilizing these clusters of unhealthy cell in our nervous system. The CAPS technology and medical virtual reality technology are game changers in re-enforcing the re-mapping of the brain.

Lastly, graded aerobic activity, oxygen supplementation, and prescribed breathing exercises aimed at increasing vital capacity are essential to allow for greater oxygenation.

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