When is a Migraine not a Headache?
general understanding of the typical constellation of symptoms that occur along with head pain, including visual changes, nausea, vomiting, light and sound sensitivity or dizziness. While The International Headache Society classifies migraines into several well recognized types, one version is fre- quently misdiagnosed or unrecognized by doctors and patients alike. That’s understandable considering the patients complain that they feel dizzy and may not have head pain. The migraine varia- tion I am referring to is called “vestibu- lar migraine” or “migraine associated with vertigo” (MAV). If you suffer from migraines, you are not alone, as nearly 30
M
million Americans get them. However, if you suffer from vestibular migraines, you may feel very alone because they are often misdi- agnosed as something else and it can be difficult to get appropriate treatment. Patients with vestibular migraines may or may not have head pain associated with their disequilibrium. They often complain of vertigo (a sense of spinning), or odd sensations of movement de- scribed as floating, rocking or swimming. In addition to their vertigo, they may also experience sensitivity to lights or sound and may have nausea or vomiting as well. A sense of fullness in the ear or ringing may accompany this situation, making the symptoms misleading and frequently results in an improper diagnosis of Meniere’s disease (episodic vertigo with tinnitus), especially with patients who never experience the headache along with their vertigo. Similar to other types of migraine, vestibular migraine can often be triggered by increased stress, sleep deprivation, fluorescent light-
igraines are so common that most people, even those who have never had one, have a
ing, certain foods, hormone fluctua- tion, caffeine or alcohol. With classic migraines, patients often experience symptoms that precede the headache known as an aura. They may see flashing lights, colorful blobs, zigzag patterns or hear ringing or buzzing in their ears. Some patients will occasion- ally experience aura symptoms, but the headache never follows. While the mechanisms of migraine
aren’t completely understood, a simple explanation of how an aura occurs is that a certain part of the brain becomes over excited, similar to a mini-seizure. If the involved part of the brain hap- pens to be associated with visual pro-
cessing, then the patient may experience the perception that they are seeing something that isn’t there, such as flashing lights. If that part of the brain affected is normally involved with processing hearing, then the person may have the illusion of hearing a ringing or buzzing noise in their ears. This is probably the best analogy for what hap- pens in patients who suffer from vestibular migraines. They experi- ence aura symptoms in the form of movement or vertigo because the part of the brain involved with the processing of where we are in space becomes over excited. As with other types of migraine, they then may or may not develop a headache. For those who develop the headache the diagnosis is fairly easy. Those who don’t are often shuffled between several specialists before someone finally recog- nizes the problem for what it is. Vestibular migraine is often a diagnosis of exclusion, meaning that it is typically only considered after other possibilities have been ruled out. Situations such as Meniere’s, benign positional vertigo, seizures, transient ischemic attacks (TIAs), tumors or inner ear
HAYFEVER? FOOD INTOLERANCES? SPRING OR FALL ALLERGIES?
34 Natural Nutmeg May 2012 }
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