How is dizziness caused? In fact, dizziness is caused by migraine headaches, which is medically called migrainous vertigo. Why does migraine cause dizziness? Some substances secreted by the nerve cells excited by migraine can change some cells that manage the balance function, and these changes in the cells located in the vestibular center of the brain can cause a spinning/drinking/seasickness-like sensation. Since this kind of dizziness is caused by migraine, it is called “migrainous vertigo”. In fact, migraines have been associated with vertigo for a long time in medical research. For example, it has long been found that some children have frequent episodes of vertigo that are severe but short-lived, and almost all of these children grow up to have migraines. As another example, clinical observations have found that some migraineurs gradually reduce their previously severe and frequent migraine attacks by middle age or menopause, but have frequent episodes of dizziness or vertigo, accompanied by nausea, vomiting, fear of light and sound similar to the original headache attacks. More interestingly, about %5 of the general population without migraine will have motion sickness or seasickness, while in the migraine population, the percentage is as high as %45. Researchers have also found interesting phenomena in studies of migraine populations and dizzy and vertigo populations: about one-third of migraineurs have had vertigo at least once in their lives, a much higher percentage than the general population without migraine. About one-third of frequent vertigo sufferers were diagnosed as meeting the diagnostic criteria for migraine, a proportion also much higher than in the general population. Migrainous vertigo Medical studies have also found that nearly 10% of migraineurs have migrainous vertigo. The clinical presentation of migrainous vertigo is not the same in every patient, and varies from episode to episode in the same patient. Vertigo can come before the headache, with the headache, or after the headache is over, or even if the headache attack is unrelated to the vertigo attack. The duration of each vertigo attack also varies, from a few minutes in mild cases to several hours or even days in severe cases. Some patients have only headaches when they are young and start to develop vertigo when they are older, while others, on the contrary, have vertigo when they are young and start to develop headaches when they are older. Easily misdiagnosed Most patients are easily misdiagnosed/mistreated. Migrainous vertigo is most likely to be misdiagnosed as Meniere’s disease. In fact, there is a significant difference between the two. Meniere’s disease is often associated with deafness, tinnitus and ear congestion during vertigo attacks, and hearing loss if the attacks are recurrent over a long period of time, whereas migrainous vertigo does not have these symptoms. In addition, some middle-aged and elderly patients with migraine vertigo are often misdiagnosed as “cerebral blood supply deficiency”, “multiple cavernous infarction” and “cervical spondylosis”. The main reason for this is that many doctors lack knowledge about migraine vertigo, do not understand the disease, do not ask the medical history carefully, and over-rely on the so-called tests. If CT reports “multiple cavernous infarcts in the brain”, they diagnose “multiple cavernous infarcts”; if CT reports “cervical spine osteophytes”, they diagnose “cervical spondylosis”. If CT reports “cervical spine osteophytes”, the diagnosis is “cervical spondylosis”. What exactly is “insufficient blood supply to the brain”? In fact, clinical experience from a large number of clinical studies shows that “cervical spine osteophytes” is a physiological aging process, just as common as gray hair and wrinkles in the elderly, and true cervical spondylosis rarely manifests as episodes of vertigo. “The same is true of “multiple cavernous infarcts in the brain,” which are inherently more common in the elderly than in the general population. “Multiple lacunar infarcts” are also an age-related phenomenon and are significantly more frequent in the presence of poor lifestyle (e.g., smoking, alcohol abuse) and vascular risk factors (e.g., hypertension, diabetes, heart disease, hyperlipidemia, etc.), but they manifest The main manifestations are cognitive impairment or dementia, stroke, emotional disturbances (depression or apathy), abnormal walking gait and urinary disturbances, and rarely episodes of vertigo. The diagnosis of “cerebral insufficiency” is a concept that has been eliminated internationally for many years. It is no longer recommended in China. Typical “cerebral insufficiency” is a kind of cerebral ischemic attack, which is almost always accompanied by other manifestations such as limb weakness, hemianesthesia, ambiguous speech, double vision or fall, etc. Besides vertigo, patients basically have vascular risk factors such as hypertension, diabetes, heart disease, hyperlipidemia, etc. Rarely, there are many years and many episodes of vertigo without other abnormal manifestations. It is rare to have multiple attacks of vertigo for many years without any other abnormal manifestations. The form of migrainous vertigo varies from person to person. It takes time for the physician to take a careful history and sometimes to perform the necessary tests to rule out other diseases. Of course, the correct diagnosis of any disease requires the cooperation of the physician and the patient, who needs to know something about the disease and the patient needs to provide a detailed and accurate history. Some patients are unable to give a clear picture of their vertigo attacks at the time of consultation and always hope that the doctor will help the diagnosis by various tests. The diagnosis of migraine vertigo depends almost entirely on the doctor’s analysis of the history and symptoms of the attack. Generally speaking, most patients with migraine vertigo have a clear history of migraine, and vertigo attacks are often accompanied by nausea, vomiting, fear of light, fear of sound, and other symptoms that easily resolve on their own after rest, without deafness, tinnitus, or other discomfort. Medication for migraine? Studies have proven that medications that can prevent migraine attacks can also prevent migraine vertigo attacks. The most commonly used medication is flunarisolide, and other medications that are available include tretinoin (antihypertensive drug), propecia and tol (anti-seizure drug), and amitriptyline (antidepressant). It should be reminded that all preventive medications work gradually, and it usually takes 4 to 8 weeks of adherence to treatment before the frequency of dizziness and headache attacks gradually decreases and the severity of the attacks diminishes. During the treatment period, patients should insist on keeping a headache and dizziness diary in order to objectively respond to the effect of treatment. Patients can keep some medications for headache, dizziness and vomiting, such as acetaminophen, diphenhydramine, halohydramine, morbutrin, etc., and take them as early as possible when the headache or vertigo first occurs, which can effectively relieve the discomfort during the attack. If vertigo attacks are particularly severe, with frequent vomiting and inability to eat, you should go to the hospital as soon as possible.