Often headaches and dizziness coexist: this is the case with vestibular migraine, a form of migraine we explain together with Dr. Vincenzo Tullo, neurologist and headache clinic manager at Humanitas.

Dizziness is characterized by the sensation that the body is moving in relation to the environment or vice versa; in most patients with vestibular migraine, dizziness is felt regardless of the headache. As Dr. Tullo points out, other forms of headache can also be related to dizziness, such as “tension-type headache, especially when associated with cervical muscle contracture, and chronic headache, particularly in the presence of sleep disorders and drug abuse.

Headache and dizziness can also be associated with cerebral vascular diseases (such as desiccation of the vertebral artery, ischemia or hemorrhage in the posterior cranial fossa), endocranial hypertension, neoplasms, brain or systemic infections, cranial-cervical traumas, Arnold Chiari’s malformation or homeostasis disorders”.


How do I diagnose vestibular migraine?

The diagnosis of vestibular migraine makes use of certain criteria defined by the International Headache Society. There must be at least five seizures characterized by so-called vestibular symptoms, of moderate to severe intensity, lasting from five minutes to seventy-two hours.

Vestibular symptoms are: internal vertigo, when the patient feels a movement of the body with respect to the environment; external vertigo, when it seems that the environment is moving with respect to itself; positional vertigo, due to a change in the position of the head; vertigo triggered by visual stimuli or head movements. There may also be dizziness due to movements of the head, with the presence of nausea.

In at least half of these episodes then, there must be at least one of the characteristics of migraine: pulsating pain, unilateral pain, headache that worsens with movement (such as walking), photophobia, phonophobia or visual aura (presence in the visual field of sparkling lights and zigzag lines).

It will then be necessary to exclude other vestibular disorders and take into account the association with migraine, with or without aura, which the patient may have suffered in the past.


Pharmacological treatment and lifestyle

“After diagnosis, the practitioner will determine the most appropriate type of therapy. Medications such as betaistin, levosulpyride, dihydroergotamine, cinnarizine, dimenindrinate and cortisone may be indicated to treat vestibular migraine.

The role of lifestyle is fundamental: a correct dietary-nutritional approach and regular sleep can help reduce the frequency and intensity of crises. It is therefore good to follow a healthy diet that includes cereals, fruit, vegetables, legumes and fish and adequate hydration,” concluded Dr. Tullo.