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Migraine Associated Vertigo (article)

Migraine Associated Vertigo

If you all of a sudden migraines accompanied confused or Dizzy at the top of the Cantle (vertigo). From these instructions, then it is possible that you are suffering from headaches migrainous vertigo ' or ' also known as ' migraine-associated vertigo '. But to further ensure a diagnosis, of course you saw yourself we recommend to a general practitioner or family doctor.

Keep in mind, a doctor in enforcing the diagnosis will do some procedures, namely: anamnesis (ask in-depth and structured, one of them is history or travel sickness sufferers, etc.), physical examinations, examination support (when necessary and appropriate indications), make a diagnosis of the appeal, enforce a diagnosis, provide therapy and education, conduct follow up (in the form of monitoring or monitoring the effectiveness of therapy). Here we explain some of them briefly.

In literature or medical reference, terminology "migrainous vertigo" or also called "migraine-associated vertigo" often has a variety of names in the scientific journal publications, such as: benign recurrent vertigo, migraine-associated dizziness, migraine-related vertigo, migraine-related vestibulopathy, vestibular or migraine. Unfortunately the exact definitions are still not agreed formally by the experts.

Review Of Neuroscience

The relationship between vestibular nuclei, trigeminal nerve system, and thalamocortical processing centers provide basic/foundation for the development of model patofisiologis staple of migraine-related vertigo.

A study of motion sickness and allodynia in migraine sufferers it supports the importance of a central mechanism of sensitization to the case of vestibular migraine-related symptoms.

When the spinning sensation (dizziness) are not closely related to headaches, then dizziness as a result of the release of neuropeptide (ie: neuropeptide substance P, neurokinin A, calcitonin gene related peptides – [CGRP]). Release of neuropeptide has an excitatory effect on baseline firing rate of sensory epithelium in section telingan (inner ear), as well as on vestibular nuclei in the part of the brain called the pons.

CGRP and neuropeptide similar effect can produce other hormones which extended (prolonged, hormonelike effects) such as peptide-peptide is spreading (diffuse) heading into the extracellular fluid. This explains why the symptoms can be elongated in some sufferers of migraine-associated vertigo, as is the case of the typical progression of persistent spontaneous vertigo followed by benign positional vertigo and then a movements sensitivity.

Epidemiology

Episodic Vertigo is experienced by approximately 25-35% of migraine sufferers. About 3-3.5% United States people suffer from migraine and episodic vertigo.

Other references mention that vertigo is found three times more frequently in migraine sufferers than not the sufferer. The prevalence of migraines approximately 30-50% found in sufferers of vertigo. This figure is certainly still requires further research (for example: controlled study) as a confirmation.

A History Of The Disease

Before enforcing the diagnosis, then the doctor will ask about the ' history ' or previous medical history, especially with regard to:

1. diseases of system of innervation (neurological), 
2. otologis pathology (diseases of ENT), 
3. servikal pathology (diseases of the neck injury), 
4. trauma (injury, collision) head, 
5. gondongan disease (in parotitis, epidemika), 
6. syphilis (the Lion King), 
7. exposure to ototoksik (like: noisy, often hear noise, wear a walkman or earphones, it is often not wearing ear drops/medications, etc.), 
8. General medical problems, such as: hypotension, hypertension, impaired coagulation (clotting, blood thickening), hiperviskositas syndrome, a disorder of the endocrine system, with respect to autoimmune (the immune system), and cardiovascular (heart blood vessels).

Physical Examination

Medical physical examination is carried out in a comprehensive manner, including: inspection of the neuro-otologis the movement of the eye, a positional maneuvering Hallpike, investigation audiovestivuler, electrooculography, DC test calories bitermal Fitzgerald-electrical Hallpike, valuation-okulografis, otoskopi. Performed auditory brain stem response when there are indications that lead to pathology retrokoklear.

Vestibuler tests such as computerized dynamic posturography (CDP) can give a positive result to the instability of the posture, especially when used as a combination with movements of the head to a task/work.

Complementary Examinations

Examination/blood tests done according the indications and recommendations of doctors, for example: screening blood creep rate, hematology, electrolytes, liver function tests, glucose, lipid, serology lues Regency, test thyroid function, calcium, alkaline phosphatase, the study of lupus anticoagulant, autoimmune and coagulation screening (blood clotting factors). Imaging examination in the form of neuroimaging and Electrophysiology is done to enforce a diagnosis when needed.

Clinical Portrait

The diagnosis of definite migrainous vertigo upheld doctor based on the following criteria:

1. symptoms of episodic vestibuler at least with the severity of medium (both rotational vertigo, impaired the illusion or the movement of objects, positional vertigo, intolerance, namely: head movement sensations of imbalance ("illusory self") or motion (or back) of the object that is triggered by the motion of the head.
2. migraine based on IHS criteria (The International Headache Society)
3. at least one of the symptoms of migraines following that appear during at least two attacks of vertigo: migraine headache, photophobia, fonofobia, visual or other auras.
4. the causes of the other removed by appropriate investigations.

The symptoms of balance (vestibular symptoms) are defined as "light" if it does not interfere with the daily routine activities, "medium" if somewhat disturbing but not hinder daily activity, and "heavy" If the sufferer unable to continue the activity. Dizziness which is not due to impaired balance (dizziness nonvestibular), such as: orthostatic hypotension, which often occur during migraine attacks, are not included.

Orthostatic hypotension (postural hypotension, also called) is a decrease in systolic blood pressure of 20 mmHg or diastolic blood pressure decrease of 10 mmHg in three minutes while standing compared to blood pressure while on his back or sitting position (lying).

1. In practice or everyday life, generally a migrainous vertigo sufferers experience things like below:
2. vertigo which generally lasted 5-60 seconds (33%). Although some sufferers only experience vertigo for a few seconds up to 5 minutes (18), one hour, up to one day (21%), or more than one day (27%).
3. vertigo during migraine symptoms, such as:

• a. migraine headache (94%) which included always (45%) and sometimes (48%), 
• b. no headache (6%), 
• c. photophobia that is sensitive to light (70%), 
• d. fonofobia that is sensitive to sounds (64%), 
• e. visual or other auras (36%)

Migrainous vertigo ' diagnosis ' can be a thrill and challenge for doctors when the headache is not a regular companion of an attack of vertigo.

Therapy and Prevention

The drug can only be recommended by a doctor.
Migrainous vertigo sufferers are recommended to reduce or minimize (better stop while during the pain): consumption of alcoholic beverages, foods containing monosodium glutamate (MSG), cheese-chocolate (as well as the processed products or variants), and aspartame. Vestibular rehabilitation therapy is recommended when disekuilibrium found related movement. Medical therapy is preventive (prophylactic pharmacotherapy) may be migrainous vertigo when doctors recommended or migraine-associated vertigo happens several times a month, continued for more than a few weeks or a few months (months), or greatly affect lifestyle, activities, and daily routine of sufferers.

So our explanation, may be useful.

Best wishes for a healthy and successful always.
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