A term that is being used more commonly is vestibular migraine. The common factors are dizziness or vertigo with a headache, or at least some migraine associated symptoms. Basically, if you have a headache and are dizzy you must have vestibular migraine.


WebMD describes vestibular migraine as a “nervous system problem that causes repeated dizziness (or vertigo) in people who have a history of migraine symptoms. Unlike traditional migraines, you may not always have aheadache.” (link)


A vestibular migraine is a nervous system problem that causes repeated dizziness (or vertigo) in people who have a history of migraine symptoms.Unlike traditional migraines, you may not always have a headache.” WebMD


I have a question for all of us. Does this explanation help us treat this patient? What I feel lacking here is data. There is a failure to ask and attempt to answer the question ‘why’.  We have seen many patients with this diagnosis and each of them had a treatable cause for their dizziness. Whether it was positional vertigo that had been previously missed or a lack of coordination between the visual system and the neck causing dizziness.


WebMD goes on…


What Causes Them? Doctors aren't sure. Like migraines, there are a lot of theories. But how it really happens is poorly understood. They credit it to misfires between nerve cells in your brain.”


So, we don’t know what is causing these symptoms. Lack of data?


Who Gets Them? It's hard to tell how many people are living with this condition. The symptoms mimic a lot of other diseases. Researchers think they affect about 1% of the population. But that number could be higher.”


It’s hard to tell. The majority of clients that we see with this ‘diagnosis’ are missing data. Only some testing has been done. There tends to be a lack of communication or coordination of care between the professions that have already evaluated and attempted to treat these symptoms.


Causes of Dizziness


There are many things that can cause dizziness. I have found over the years that no one profession holds all the answers in understanding why a person might be dizzy. It is imperative that the disciplines of medicine work together to provide a better understanding of why a person or patient is dizzy and has headache or migraine symptoms.


Questions we must ask


Has there been imaging to assess the inner ear or semicircular canals?

Has ocular muscle coordination and testing been done?

Do we know if there is a cervical component or problem present?


Tests to conduct


Video oculography (VOG) or Video Nystography (VNG)

Caloric Testing

Convergence Testing

Maddox Rod

VOR testing and eye coordination and tracking

Superior oblique palpation to the deep cervical muscles

Seated C1-2 rotational test

Multi-system testing for vision, balance, and head motion


These tests need to occur to have a better understanding of someone’s dizziness and headaches, and what might be the cause. If you notice, each of these tests span different professions and specialties. Optometrists, ENT’s, chiropractors, balance physical therapists, manual physical therapists, neurologists and family medicine. This is also ignoring other forms of dizziness that could be cardiovascular in nature and circulatory. What about endocrine and metabolic?


Types of dizziness


There are two main forms of dizziness. One is a spatial relational dizziness where the person does not know their place in the world. The world is fine but they are moving. The other is what we typically call vertigo. The person knows their place in the world or room but the room is spinning or moving. The first, spatial orientation dizziness, is more visual and cervical in nature. The second, the room is spinning, is more vestibular and positional vertigo in nature. This can help you with your diagnosis on what might be the generator of the dizziness symptoms. It has been our experience that dizziness is a lot of times a problem of a number of systems not working and the combined problems are causing dizziness. The neck is stiff and tense and there is vision suppression occurring due to ocular muscle trigger points pulling one or both eyes off center while trying to function with a left horizontal canalithiasis positional vertigo that is chronic. This makes it much harder to diagnose without a multi-disciplinary approach.


Most chronic dizziness is a multi-system problem.


For more on vertigo, check out this link for a better understanding of where vertigo comes from and how to treat it.




Big Idea


The take home is this. The term vestibular migraine is misleading and can cause an end to evaluation because we have a ‘diagnosis’. Based on our experience at Cornerstone, when we have seen this label there has been a reason for their dizziness and headache symptoms. We can do better as medical professionals and “cross the aisle” when attempting to diagnosis and treat tough conditions and chronic symptoms.


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