What is vestibular migraine?

  Vestibular migraine is a progressively understood disorder in which patients present with episodes of vertigo or unsteadiness, and these patients have a history of migraine at or before the onset of the disease.  I. The prevalence rate in a large sample of population studies was 3.2%.  Symptoms: 1. Patients may present with spontaneous or positional vertigo. It usually manifests as a rotational rather than a back-and-forth oscillatory sensation, and some patients may have only or simultaneously more symptoms (e.g., dizziness, lightheadedness, dizziness, floating sensation, motion sickness-like sensation, swimming-like or swaying-like sensation of the head). Visual vertigo is another major feature of vestibular migraine, and is induced by being in a moving and changing scene (business district, movie theater).  2. The duration and frequency of vestibular migraine attacks vary greatly from patient to patient and from one patient to another. Usually, acute vertigo symptoms last for a few hours or less, while motor intolerance and unsteadiness last for several days. Overall 10% to 30% of patients have vertigo lasting as long as a typical migraine aura lasts, i.e. 5 to 60 minutes.  3. The location and severity of the headache varies. Vertigo often occurs during the migraine attack, but it can also occur during the inter- or pre-migraine phase. Some patients (about 48%) exhibit only migraine symptoms during vestibular migraine attacks. Photophobia, phonophobia, olfactory and visual or other aura are the most common concomitant symptoms of vestibular migraine, and these are extremely important for the diagnosis, which is reinforced by the presence of migraine aura in patients with vertigo. Generally, perimenopausal women with vestibular migraine present only with vertigo and no migraine symptoms.  4. Hearing loss and tinnitus are not the main symptoms of vestibular migraine patients.  5. It should be noted that about 65% of patients with vestibular migraine have psychiatric symptoms.  Prevention and control measures 1. Acute treatment of vestibular migraine can be tried with triton and vestibular inhibitors (such as promethazine). β-blockers propranolol and metoprolol, and calcium channel blockers verapamil have achieved good results in some case reports.  2. For seizure frequency of more than 1 per month, prophylaxis may be considered and flunarizine is a good choice. Migraine with combined anxiety and panic attacks can be treated with anxiolytic drugs.  3. Avoiding known clear triggers, regular sleep and diet, and regular exercise may significantly improve the symptoms of vestibular migraine. It is also important to focus on psychological relief.