Vestibular migraines

Question 1

What is a vestibular migraine

Answer 1

Vertigo associated with a migraine

Question 2

Vestibular migraine presentation

Answer 2

Female >40yrs presenting with migraine but also having vertigo and balance problems. May have associated nausea and vomiting and extreme motion sensitivity.
Lasts more than a few minutes.
PMH of migraines - may also have headache

Question 3

Vestibular migraines diagnostic criteria

Answer 3

1. Have had migraines in the past
2. Had at least 5 episodes of vertigo that make you feel like you’re spinning or moving
3. Feeling lasts between 5 minutes to 72 hours
4. Moderate to severe symptoms that stop you from completing everyday tasks
5. At least half of episodes happen with one of following migraine symptoms: sensitivity to light or sound, flashing lights or aura, pulsing headaches or worse with activity

Question 4

Vestibular migraines differentials

Answer 4

Meniere’s disease, Labyrinthitis, Brainstem stroke

Question 5

Vestibular migraines management

Answer 5

Triptans e.g. sumatriptan for when they feel an attack coming on
CCB/BB
Vestibular suppressants e.g. lorazepam, promethazine
Antihistamines