Vestibular Migraine- A very common but rarely diagnosed cause of vertigo
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- čas přidán 27. 08. 2024
- Vestibular migraine is the most common central cause of vertigo, but it often goes undiagnosed. Real patient interview demonstrates how to diagnose this disorder.
Just a reminder that I won't give medical advice to individuals about their particular medical problem.
As a person suffering from chronic vestibular migraines, the diagnosis criteria of 'History of Migraines' is what prevented my diagnosis for 1 year. 1 YEAR of suffering, going to doctor after doctor who had no idea what was wrong with me. All my tests came out normal (VNG, hearing, blood, MRI, etc). Only in month 9 did I experience a visual aura, which is why I myself began wondering if it was vestibular migraines. While I lacked a history of traditional migraines, what I did have is a history of dizzy spells that would last anywhere from a day or two up to a week and a half. I began getting those when I turned 30, and I'd get 2-3/year. Looking back, this information should have led doctors to my diagnosis in a much more timely manner than a year. I even worked with a PT who 'specializes' in vestibular disorders for over 5 months. The diagnostic criteria of a history of traditional migraine is completely unimportant given a history of dizzy spells and no other vestibular loss. I know of many other people with VM who also do not have a history of traditional migraines.
Thanks for your comment. I couldn't cover everything about VM in my video, but it is true that you can be diagnosed as "probable migraine" even if you don't have migraine headaches.
www.jvrweb.org/Download/
Feature_22_4.pdf
Probable vestibular migraine
A. At least 5 episodes with vestibular symptoms of moderate or severe intensity, lasting 5 min to
72 hours
B. Only one of the criteria B and C for vestibular migraine is fulfilled (migraine history or migraine features during the episode)
C. Not better accounted for by another vestibular or ICHD diagnosis
@@PeterJohns Thanks for replying!
There are a couple other things I want to point out as potential problems to the diagnostic criteria. And I'm only saying all this because I hope to help inform doctors so that they can be better at diagnosing someone with VM (and vestibular patients in general).
The criteria of a timeline of 'vestibular symptoms lasting from 5 minutes to 72 hours' can be a big problem, and here's why.
If you are getting vestibular migraines rarely, meaning every few months or twice a year, an episode is quite clear. But most, if not all people I interact with who have VM are experiencing constant to near constant vestibular symptoms. The sensations of VM are so mystifying and confusing--especially at first--that if you are experiencing more than one migraine event--even once a week--it is almost impossible to tell when one is ending and the next is beginning. Like with most acute vestibular conditions, either the brain stem or vestibular system is being attacked, and the recovery of this acute phase takes time and leaves you with 'other' vestibular symptoms until the brain has the chance to adapt and habituate and build new neural connections to sensations of normal, rather than 'dizzy'. Chronic migraines are characterized by more than 15 'headache' days per month, and as you can see that could potentially create great confusion. Even if you were experiencing 14 'headache' days per month (and were thus considered episodic) you would still very likely be experiencing symptoms 24/7.
And finally, many other people who have VM only experience blurred vision and minimal noise or light sensitivity as their only other defining characteristic, and the sensation of vertigo is not necessarily room-spinning but rather a rocking/floating/swaying sensation.
Just a few things I wanted to say, hopefully I can be of help.
I had a vestibular attack and the doctors didn't to anything but give me some xanex and a 3000 dollar bill for two hours of stroke tests. I had to go online and figure out what was going on. Thank God for YT and other places.
@@PeterJohns when I was in my 20s I was misdiagnosed for 5 years. I had a 5 year migraine with severe vertigo!! It was horrible. The other was the excessive yawning.
@@diahegge5395 m too
I am a patient that was recently diagnosed with vestibular migraines. I’m trying to learn more about how I can stop the effects from lasting so long. Mine last for four days. I’m working with a doctor to test different meds that desire to shorten, the duration and intensity. My EMS background lead me to you video so I could educate myself. During your video, you talked about the fact that nystagmus is very uncommon during a vestibular. I have uncommon nystagmus with my vestibular migraines. During my first vestibular migraine, I was hospitalized, because I had a syncopal episode and was so dizzy I was unable to function. I also had nystagmus that the medical professionals told me was “weird, nothing they had ever seen.” I saw many specialists and I was told “I don’t know what it is.” Thank goodness for another vertigo enthusiast. She told me I have the vestibular migraines that caused PPPD and binocular vision disorder. I am in EMS and I understand the need for case studies. I wouldn’t mind sharing my tests and reports if it will help your clinical journey.
I have been diagnosed with VM recently. This started last November. I too have the foggy floaty head, mild headaches, nauseous , extreme fatigue and the boat rocking feeling. This is almost on a daily basis. Bbpv was also diagnosed. I have at least one bad episode every fortnight. The last physiotherapist I saw recommended vitamin b2 and magnesium. There is a little light at the end of the tunnel as there is slight improvement. I also do head exercises daily which involves focusing on an object on the wall moving my head from side to side and up and down but not moving my eyes. Hard work but persevering as I want my life back. Hope this helps.
Hi Maria! I have been struggling with these exact symptoms. For 7 months now. It resets every 3 months where it’s absolutely unbearable and then it dissipates slowly over a couple of weeks/months. I’ll have 2ish weeks where I’m okay. Then it happens again. It’s awful. Given medications that have only made it worse. Doc Suggested to do therapy because they diagnosed me with bppv. Not diagnosed with VM.
How are you doing now??
@MaeganMemories I’m in the same boat and also wondering if the exercises helped
How are you now Dave?
It is nice to hear clarity on this subject. As a chronic migraine patient who gets Hemiplegic migraines, migraines with auras, occipital neuralgia, vestibular migraines and ocular migraines, I think the nausea and movement sensitivity of the vestibular kind are the most horrific. Ill never forget crawling to the sink to vomit bile, because there was no way to ground my self to walk, was hands down the scariest. And they happen at the worst times, when you are home alone. I earned that day the value of tucking my phone in my shirt to crawl to sink. Oh. I wouldn't wish them on anybody.
What medicine do u take? How do I help myself? I am same as you
I was just diagnosed with this today! I was referred to a Neurologist. I've never been diagnosed w migraines, but I get borrowing in the back of my head! Thank you for this easy to understand
I am so grateful for this video. Thank you!!! I could just cry, being able to relate to your patient and having an explanation for the misery of Vestibular Migraine is such a relief!!!! Thanks!!!!!!
Thanks for the video on this. I’ve having vertigo and motion sickness episodes for about 22 years, and my doctor is finally taking me seriously about it. I’m currently undergoing tests to see if I have VM. Interestingly enough, my mother is an exact textbook case as you described and is also now just getting testing for VM done. When she was younger, she used to have debilitating migraines, which left me to take care of her as a kid, but that was long before a lot of this new info has come out. Anyway, great video, thanks!
Thank you for this information. I am on medication for this that has been life changing. I almost got used to feeling the way I was feeling 24/7 until the symptoms went away and a sense of clarity and calm came over me. The best way I can describe this condition for people who have never suffered from it is. Drink half a bottle of whisky, insert hearing aids even though you have no hearing loss so sounds are amplified and sting you, sit on a chair and have a friend spin you a bit, listen to the screeching brakes of a subway train in your head (tinnitus). Now imagine living like this 24/7. Not fun.
seephor , hey! Can i ask what medication you took for this? I’m not sure if my symptoms are migraine related, but for me it comes and goes. Im 2month in this time and I have this “im on a boat” dizziness or more like the feeling that I am floating. Never vertigo (spinning) also fast movements are hard to process for my eyes(eventho my eyes are fine) and when I walk my surrounding seems like if it’s moving too fast towards me / around me.
When I lay in bed i feel sensations like falling/dropping off of a building kind of dizziness.
I am not sensitive to noises or stuff like that and I have no headaches.
Did u experience any of these?
(All my tests MRI, blood test are negative)
Pls tell me whic pill helped you! I’d be so so happy if this nightmare would pass ... i am suffering from derealization and depersonalization too... its very devastating.
@@8QQ8 Those symptoms sound exactly like what I had. I also don't have a headache in the sense like throbbing pain but it's a dull pressure/fullness feeling like a stuffy head so that's typical of this type of migraine. I'm currently on 50mg daily Metoprolol Succinate (beta blocker) and it has significantly reduced the floating, strange movement feeling and some of the other symptoms but has not completely eliminated them. I have another appointment in a couple of days and I'm hoping to try some of the other migraine medication that is proven to work. Hope this helps and you get relief.
seephor , i’m afraid I can’t take beta blockers because my blood pressure is normally pretty low and beta blockers usually make it even lower... I hope I will get through this and it will be over soon. Good luck to you too!
seephor hey! I really hope you’re fine now!!? Did the medicine work? Please tell me
Zero challenge I’m currently taking medication on a as needed basis. I find it’s more effective and I don’t have to deal with the side effects. I have good days, ok days and bad days. It’s random but life stresses have a lot to do with what kind of day I have. The good things is even if I’m having a bad day, I know I will have a good day in the next couple days so that keeps my spirits up.
Thank you so much for this video. hits all points. ENT in the Philippines, saw a lady in the ER who had almost the same symptoms. First time to encounter a vestibular migraine patient - initially thought it was BPPV. Thank you again for all your educational videos, Dr Johns!
I’m a student nurse practitioner and I find your videos fascinating. Definitive and clear. These videos will help me be a more competent provider and will allow me to provide better care for my patients. Thank you so much.
A great complement that I appreciate very much!
Was diagnosed with VM a year ago, my symptoms have now been ongoing for two years. I suffer with dizziness daily, no medication has ever helped, I've tried 6 different options now and it's taking its toll on my anxiety and mental health.
I suffer from daily dizziness too, it's hard. I pray that we get some relief soon!
@MaeganMemories I'm on the waiting list at the moment.
@MaeganMemories what is vestibular treatment?
@@MinkasTNR you can find on CZcams look up vestibular physical therapy or vos. Also look up the dizzy cook!
Would you be willing to share which medications you tried?
Excellent Video! I am a PT and I always ask this question in my detailed exam. However, this is pretty concise and precise information I needed to be sure of possible Vestibular Migraine. Thank you.
Dizziness came with different stages for my spouse for 4-5 years, so I provided him the dizziness vertigo remedy. He began having results after 4 days, and now after a week, despite the fact that not 100% yet he`s had very long periods of complete alleviation. Hopefully, with continuing use, he`ll be dizzy free before too long. I save your time to do the research on Google. The guide’s is t.co/xFfs9TYvka
Interesting video to watch. I ended up here because I've had near chronic vertigo for years now without a diagnosis. MRI came back normal, vestibular testing came back normal, etc. Symptoms have typical been too constant for me to understand what my triggers are. Anyway thank you for creating content to help others with vertigo get a diagnosis, I really hope it can help other people not to suffer like I have had to.
elvsrbad2 , hey! Did u get any better? And did u feel like you are on a boat or floating dizziness or spinning? And if yes was it 24/7?
I’m trying to find out what I’ve got , because I feel this 24/7 since december
@@8QQ8 how are you now???
@@oliviawesterbeck1253 same…its probably mal dedebarquement syndrome…
Most excellent! I plan to use this video for my physical therapy vestibular rehab special interest group. I have seen many patients that fit these criteria and I think the video really boils the differential dx down to a few easy to remember neat and tidy essentials. Please keep these video gems coming!
Tony Friese, PT
Wausau, WI
Thank you for this, it has described my symptoms exactly, I have a history of aura without headaches but have been having these dizzy spells for a number of years and have definitely had way more than 5 episodes. I have to go to bed until it passes and can't stand any noise, the dizziness is very intense when I stand and move around, so I just have to lay down until it passes, usually 24 hours. I also have BPPV but I knew these episodes were completely different as I only have BPPV when laying down and turning over in bed. I guess I'm just unlucky to suffer with both but have done for over 30 years.
Actually, there is an association between BPPV and vestibular migraine. So unlucky perhaps, but it's a known association.
@@PeterJohns Thank you for your reply, that's reassuring to know.
Hi Peter. These videos are extremely helpful. Thank you so much!
THANK YOU for this! I had 2 ENTs and a vestibular rehab doc all try to tell me that my dizziness was vestibular migraine. They determined this solely on 1. I was dizzy and 2. Had a history of migraines. I went round and round with them until I was so frustrated I switched doctors entirely! This video just confirmed what I've known all along. It's my ear, not my head. Third ENT is putting tubes in my ears in 2 weeks.
Well if the tubes do nothing maybe you will listen to neurologist Michael Teixido on how migraine affects your inner ear and stop resisting treatment for migraine as migraine history correlates with vertigo conditions eg 7 times more likely to get BPPV
Diagnosed yesterday. Your video was super helpful. Thanks.
Great video Peter - definitely have to agree with how under diagnosed this condition is and how much it can respond to treatment once diagnosed. It's benign but definitely a cause of significant trouble for people who suffer from it. Hopefully this video helps out with making a few more diagnoses and getting people the treatment they need!
Right you are Danny about the suffering that people have from VM. Emergency physicians often focus on the "deadly" causes of any complaint, and not enough on the common causes where you can really make a difference in someone's physical distress, like BPPV and VM.
I found this video the other day. I've had what I've described as ocular migraines stemming from light sensitivity since 1993. I began having short vertigo spells in 2009. In 2010 I had a major spell that left me spinning hard for 15 minutes straight. From there I would have them come and go in short spells. First week of January 2012 I had a spell that lasted a month straight. From there I would have spells with some frequency but ultimately tapering off. I have struggled to get a proper diagnosis and struggled even more so for my doctors to take me serious. Since 2012 spells come and go but what I am left with on a day to day basis is loopiness and a constant dull pressure in my head which makes thinking clearly difficult. I realized that windy or humid conditions flare up the instability in my head which is incredibly frustrating. I have experienced a bit of relief through acupuncture but not much else. Seeing your patient in this video is the first time I have felt as if im not alone. I am stuck in a state of caution and I would like to break this cycle. I will read more from you and look at newer videos from you but unfortunately the rest of the medical world is not moving at the same speed when it comes to newer ways of exploring vertigo.
So you're saying that hunger can be a trigger? I've felt like I'm on a boat for the past year. All the dr's ask me if I've ever had headaches. Yes, I have and do, not often. I've also had auras and flashes of lights. I'm getting so fed up with being dizzy everyday. It makes me want to die honestly.
Yes, all things that trigger migraine headaches can trigger dizziness in patients with vestibular migraine. Hope you feel better soon!
Thanks for taking the time to make this video Peter, very informative.
Glad you enjoyed it!
Peter Johns would treatments for Menieres vertigo such as cutting the vestibular chord or gentamicin injections also help the vertigo if it’s caused by Vestibular Migrane?
THANK YOU 🤗 I can’t even begin to tell you how many times I have been misdiagnosed. You just described me in a nutshell! Can you share… what are some of the causes of these migraines? Stress? Barometric pressure? Lights?Plain old luck?
The same triggers for migraine headaches can trigger vestibular migraine. This is a pretty good list. americanmigrainefoundation.org/resource-library/top-10-migraine-triggers/
Thank you Doctor Peter Johns !
Excellent video. Thanks from another emergency doc!
Very nice videos Dr. Peter, keep on, they are very informative and they simplify these complicated diagnosis to the point. I spread your channel to all me ENT friend and they liked it.
Thanks! I have some new videos ideas, hope to publish them soon.
thank you sir and thanks to your patient , i will remember you when i diagnose a case of vestibular migraine.
best explanation outthere very well put together
THNAKS
I don't understand how something so common is rarely diagnosed. Seen two different doctors and they did not mention this.
Yes, it is very common. Trying to get the word out.
I had a migraine that came on with aura one week ago. I’ve been feeling unsteady ever since, my vision is off. This is describing my last week to a T
Thank you so much for the video. Please tell me how you feel about sumatriptan during an attack of vestibular migraine, including injectable forms.
I apologize for my bad english and thankful in advance for the answer. P.S. I'm from Russia, Irkutsk
There is no good evidence for any particular treatment of vestibular migraine so most experts suggest using the same treatment as for an acute migraine headache. Sumatriptan could work. If you and the patient are comfortable trying it, it would be worth seeing how it works on an acute vestibular migraine attack.
@@PeterJohns
Thank you very much for the answer. I try in my practice. In half the cases, the answer is good. I will wait for licensing erenumabi in my country
I was diagnosed with VM about two years ago and I'm having symptoms again. Yet I do not have a history of migraine. No auras. However, I've had spontaneous vertigo unrelated to head position, as well as BPPV. Most of them are brief. After these events, I get a headache, and I have continued occasional instability for weeks afterward. The vertigo movement is upward - vertically.
Wow!! Same. Me: silent migraines, and vertigo just sitting looking at phone, last 3-5 sec. And light dizzy for days. Some headaches are silent. Lots of yawning mood changes. I hope u feel better
I have bppv too
Do you have intermittent tinnitus and any middle ear issues like spontaneous pressure or ear tempora muscle switch in low decimal sounds?
I'm at a crossroads. The first ENT diagnosed me with VM and the 2nd tentatively with Autoimmune inner ear disease based on very slight hearing improvement on prednisone. (But wasnt convincing enough)
The symptoms were:
occasional episodes of intense vertigo with loud tinnitus and muffled hearing lasting under 10 mins usually. (Usually brought on by alcohol/stress/caffeine I find)
permanent high frequency hearing loss from 2K+ hz (I have a family history of Vestibular migraine symptoms and high frequency hear loss from a young age)
Other episodes were classic migraine aura and headache and sometimes aura but no headache and other times intense headache but no aura.
Most days are slight dizziness/unsteady on feet and slight hissing in ears.
So I'm planning on consulting a neurologist to try some migraine prevention medication in hope I can arrive at a solution
My experience with patients is that far from under reporting of migraine they tend to see any distressing headache as “ migraine”, thereby seeking an upgrade to “ serious problem”
I think it happens both ways. Yes, some patients will self diagnose themselves with migraine when they aren't having the diagnostic features of migraine. But others will have lifelong migraine headaches and think that it's a normal human experience that everyone must get.
For instance, I suffer from the photic sneeze reflex. When I am exposed to bright sunlight, I sneeze. I think of it as normal, as most people in my family suffer from it. It's autosomal dominant. When I describe it to those who don't have it, they are surprised that it is a thing. I saw a woman in her 30's accompanied by her mother who denied having migraine headaches, but after a while she stated she does get bad headaches before her periods, but she thought everyone got that. Her mother had the same story! Never knew they had migraines.
Also patients are often misdiagnosed by their doctor as suffering from "sinus headaches" as they get them rarely, and it's in the front of their head.
Again, personally, I suffered from rare (once a decade or so) but severe headaches, and it was only when I had several visual aura in my 50's like this
czcams.com/video/qVFIcF9lyk8/video.html&ab_channel=MayoClinic that I made the realization that I have the occasional migraine headache. So far, no dizziness though!
@@PeterJohns Yes, yes me too ! Whenever a patient tells me they have dizziness , I get an immediate feeling that I should have done Engineering
Thank you so much for your amazing work and sharing it with us.
I am so desperate for help. I'm 36 and had 2 auras in 2020 then permanent migraine symptoms 24/7 ever since. It never goes away. Extreme light sensitivity, darkness in dim light, light bursts, etc. It never went away. The odd thing is never very bad headaches but was diagnosed as silent migraines. Now out of nowhere 3 months ago I got Extreme vertigo & brain fog that has not gone away. Its 24/7 in addition to the 24/7 silent migraine symptoms for 2 years. . . I've gone to DRs, ophthalmologist, retina specialist, ENT, and neurologist. I've had CT scan, EEG, spinal tap, etc with no tests to conclude what is going on. I'm so frustrated & defeated. None of these symptoms go away.
Thank you for posting this video. It is informative, well done and should really help with my diagnosis.
Thank you so much for this. I had a Craniotomy on my Occipital lobe at age 23. I have had migraine with scotoma since then. It stopped at age 40 and has turned into these horrifying dizzy spells. My PCP and Neuro pointed right to ear crystals but I don't believe that is the case.
I have never had a migraine headache that I am aware of. I have been having ocular migraines, which cause a shimmering mass that last for about 25 minuets for about 30 years, about once or twice a year. The vestibular migraines started about 4 years ago. They last from about a day to several days. They cause vertigo and nausea. I have never being officially diagnosed with vestibular migraines. The last doctor sent me to a physical therapist, who rearranged the crystals in my ears. I will ask my doctor for a prescription for metroclopramide. Thanks for the video.
Don't ask for a prescription. Ask for a referral to a neurologist who can work with you to treat as there are many different preventatives
I have had migraines since I was 13 years old I am 54 my
Migraines were with aura and awful headache and vomiting now my migraines have changed from migraines from headache and aura to now dizziness nausea. I am a 54 year old man. My vestibular migraine has lasted 2 weeks now.
Me too man. Any treatment for it?
I see a lot of comments on good video but no mention as to the successful treatment of vm as many of us have been on all kinds of meds with no relief
Very informative!!
My mother with multiple comorbidities like DM, HTN, IHD, and Psoriasis taking dual antiplatelet, lipid-lowering, metformin, methotrexate, acitretin, clonazepam, aceclofenac, had such episodes for last year with the recent 3rd one a few days ago, having vertigo for days that exaggerated when she changed her position and her symptoms triggered with multiple episodes of vomiting, I couldn't assess then & there so preferred to stabilise her symptoms first with IM dimenhydrinate which somehow resolved her symptoms and during the episode her BP was 170/110, but the next day she was only Complaining of headache, now in view of the DDs I haven't come up yet with the diagnosis but previously after consultation with neurologist he diagnosed it to be BPPV and started beta blockers & flunarizine for last 3 months. I performed HINtS, the Dix-hall pike test but couldn't conclude It for maybe the nystagmus wasn't that pronounced the way it's there in your videos, so I am still confused about her diagnosis, although I do have a plan to go for her brain imaging.
Great video
This hit me almost 2 years ago out of nowhere. First it was crystals, then Vestibular neuritis, then it was a Vestibule Migraine, then it was POTS. Everyone has there own theory. Frankly I don't care I just need it gone. As a side note more short term memory is now toast.
Same happening with me, do you have any improvement now?
I've been having these types of migraines but I've also noticed the aura's are very different from the other migraines I may get. They are darker, more lose of the visual field and black spots would appear. Anyone else experiencing this?
excellent video!
Have you also thought maybe ACS F leak is also to blame because those who can also get misconstrued especially if a patient has had spinal surgery is something to look into as well
I have seen CSF leaks. I don't consider their presentation all that similar.
My symptoms are severe vertigo attacks accompanied by nausea, vomiting, defecating, and sweating profusely. Usually comes on suddenly and lasts for a few hours.
I was recently diagnosed, after 2+ years of dreadful symptoms, with
vestibular migraine by an ent doc...he was thorough and I am certain his
diagnosis is correct....a VNG, cVemp, fistula testing, auditory tests,
an MRI of the head and a CT scan all proved to be normal...(I am a
breast cancer survivor and scans showed no metastasis) ...he Dx VM based
on my symptoms....he referred me to a neurologist who says he's not
convinced I have VM, based on the diagnostic criteria...I was a bit
puzzled..I asked him what the criteria was...he told me the diagnostic
criteria says VM migraine is episodic (mine is not, it's chronic).....
He suggested I take a CGRP MAB (1 injection for 30 says made by Ajovy)
stating it if it worked it would confirm VM and if it did not would
eliminate VM....... I agreed to the injection at the time b/c I hadn't
gotten to the part, in the book Heal Your Headache, about preventative
meds not being added to the treatment plan until an elimination diet
looking for food triggers, if any, had been done for 2 to 4 months..... I
had begun the elimination diet and had huge improvement. After 14 days
on the diet, I had 7 days almost symptom free (I don't have head pain,
just the accompanying symptoms of vertigo, tinnitus, balance issues,
phonophobia and photophobia, vision not crisp. ....After I got home I researched the drug
and found that there are some concerns for a woman my age (72)
inhibiting CGRP, which is a vasodilator. I also found that no long term
side effect studies have been done. I am thinking the neuro doc is more
interested in prescribing me an expensive drug that he knows can't
confirm VM which will give him cause to order other expensive tests. I
don't like questioning his motive, but I must. It's my body, my life
and I've had previous experience with misdiagnoses (breast cancer for
one) hence, I always verify everything doctors tell me. Dr. Buccholtz,
the neurologist who wrote the book HYH says the best docs order the
fewest tests and prescribe the fewest meds. Experience has taught me
that this is true. I have decided I will do not any more CGRP MAB
inections or any preventative meds for that matter, until I have done
the elimination diet for 4 months in the event I can reach a
satisfactory level of control of VM without meds..adding meds would be a
final option in the treatment plan. If you have any helpful thoughts
please share them, I am thinking I should return to my ent and discuss
this with him. I plan to cancel my 30 day follow up with the neuro b/c
should I need preventative meds, I'd not have much confidence in his
expertise re: VM...btw: I had nine years of migraine, in my 30's, which ceased, followed by 20 years of BPPV, chronic fatigue and a diagnosis of IBS...as well I have diverticulosis and have diverticulitis attacks, but when there is no fever present, and only abdominal pain I do wonder if I'm having an abdominal migraine......I've listened to Dr. Teixido and per what he said in a podcast, my Hx is a classic pattern for VM..he says it can take years to get a VM Dx b/c other things are wrongly Dx'd.
The look on her face is exactly how I look when having an attack
Thanks a lot
I have had 3 hospital admission between 8 years with vestibular symptoms. No-one ever came with the idea,that maybe I am safering with this type of migraine. Every time is worse and last longer, between 1-2 weeks not been able to walk and around 8 weeks of recovery period
thanks alot
I’ve had headaches every day for over 15 months and they can’t figure it out! I’ve only had vertigo 2 times which was insanely crazy to have, felt like a dizzy seizure I could not get rid of.
Peter , very good job - always informative
Thanks Yossef!
Dr. Johns, it probably has already been brought to your attention that you were "leading" the patient's answers. Instead of asking specifically about photophobia or phonophobia, a more generalized sensory-based question would be more objective: "When you experienced the dizziness, did you notice any sensations involved, with smell, taste, vision, hearing, touch, speech, clarity of thinking, or ability to move around?" This should be sufficient to trigger any recollections without leading in one direction or the other. 😊
No, Don, you are the first to suggest it. The fact is that I had already established the diagnosis by history before I started recording. I re-asked the questions in a manner that would bring rapid answers to allow a more manageable amount of video to be brought into this already fairly long video. I agree that open ended questions is the best approach in certain circumstances. Working in an emergency department does not always facilitate this method however. Where do you work?
Also, I have found that migraine headache history is often denied by patients until you ask very specific questions.
Example: Do you get migraine headaches? "No"
Do you ever get headaches where you get nauseated. "No"
Or lights bothering you with a headache? "No"
Have you ever had a headache where you had to go lie down in a dark room, and if you got some sleep, the headache would be better? "Hardly ever."
But you'd had some. Did you ever have lights bother you when you had those kind of headaches. "yes, but again, I rarely get those headaches."
When did you first have those kind of headaches? "It's been about 8 years"
And in those 8 years, how many headaches have you had where lights bother you, and you have to lie down in a dark room? "Oh, about 10 or so"
And thus the diagnosis of migraine headaches starts to come out of the initial denial.
@@PeterJohns Excellent illustration of exploring from the general to the specific! In the video, you did explain you were adjusting for the purpose of creating a clear video; my apologies!
Retired PA from the Atlanta area; now a musician, not very famous; I'm a composer of little note.
Thank you for these videos! I have also just been diagnosed with VM with a 15 year history of BPPV and im only 38! It started so young and im so over it! It affects my daily life. I walk around feeling like my head floats in the air with constant auras and vertigo spells. I'm constantly doing maneuvers but it never clears my ears. What are you all doing to treat the VM? The topiromate I've been on is not going well so far. 😒 Thanks for your help.
Did you figure out a solution that helped?
Ask you ENT about trying a Calcium Channel Blocker or Beta Blocker. There is literature about both and a calcium channel blocker works pretty well for me.
Everything you have said is happening to me. My doctor is treating my vertigo with meclizine. This works; however, I must also lay down for awhile. I'm not sure what to do.
I hope someone reads this after 3yrs.
@@timsoos3096 I hope you feel better soon.
I was told I had PPPD, not vestibular migraine even though I fit all 5 areas you use to dx v.m.
I’ve had dizziness ( I’m floating or bouncing. The room isn’t spinning) since February. All day everyday without end just this week I’ve had hours in between the floating dizziness) along with extreme fatigue. This is the first time and has lasted this long without end. Over 20 years recall two major headaches ( migraine,I don’t know) I don’t feel I met the criteria for VM. But based on talking to me doctor said I do. He did check ears and for BPPV.
Me too. I feel like I'm on a rocking boat. It gets worse when I am looking at a computer screen. Bright light or loud noise also make it worse. I've got headache on and off but it's not severe, just a constant pressure. I've been diagnosed with BBPV and inner ear infection and given meds but they didn't work.
@@nilak.s617 I was finally diagnosed in August with VM and Mal de Debarquement Syndrome (MdDS) supplements are Magnesium glycinate; Ubiquinol (Co Q 10) b 2 and vitamin D. Ample hydration is a must. Also other things including meds. I was at about 75% return to normal in October, now I’m at 50%. I am not sure why but I believe some of the “triggers” could be controlled by me. ( better nutrition for example) I am working on it. I hope you find answers. 🙂
@@jimkline6285 I’m new to this but I can try to compare notes. Please send email. 🙂
@@jimkline6285 sorry about the email, I’m slow to respond too. Dr. Shin Beh. Search the name he has stuff on CZcams 🙂 he is a neurologist
@@juliekling8598 have you gotten better?
Have you heard of Aimovig causing a new symptom of vertigo? Or if it does?
Sorry, I don't have any information on that.
@@PeterJohns I've heard of it happening to some people. Thank you :)
Yes most common cause of vertigo, also in my practice also
Why is it not 3pD??! The first attack lasted 10 days so it could had been vestibular neuritis. Lots of your questions were a leading questions which were biias towards migraine.!!!!!
I hope I am not wrong.
I had already taken a history, and then she agreed to go on camera. So the questions were leading to the answers she had already given. Otherwise, it would have been a long interview. Do you see much PPPD?
Hello so my dizziness was an onset of mono that gave me extreme vertigo for 6 months. I now always have an inbalance going on 6 years now. However, I’m currently doing vestibular therapy because sometimes I have episodes. So I’m wondering why I have a vestibular weakness in both years but I get episodes? I thought vestibular episodes aren’t normal with vestibular neuritis. So can my vertigo be vestibular neuritis and vestibular migraine? I don’t have light sensitivity but sounds do bother me very little. I think the sounds just make annoyed. I never get a visual Ora.
Hi. I have episodes of vertigo during which I hear a swishing sound when my eyeballs move left or right. Have you come across this?
I have heard of patients hearing their eyes moving with Superior Canal Dehiscence Syndrome. But I have never seen a case. Watch this video at this time stamp. czcams.com/video/i7zkb30-d50/video.html
I started got migraine at 20 y.o..yet got 1st vertigo at 25y.o..and now i'm 35 y.o with both..always hit me monthly coz menstrual migraine...
The dr wants me to do a m r I with contrast. Is there other testing?
The diagnoses of vestibular migraine is made by taking a history. Sometimes imaging such as MRI is ordered to ensure there isn't another cause.
For 2 years I have had intermittent vertigo, with nystagmus, following vestibular neuritis. Vertigo lasts between 9 and 96 hours, always with left beating nystagmus that decreases when I look right, increases when I look left. I have been consistently diagnosed with vestibular migraine. Is nystagmus that follows Alexander’s Law typical in vestibular migraine? MRI, MRA, VEMP, VNG, audiogram, and rotary chair all WNL. One VNG did suggest upbeat nystagmus >6 degrees/sec while supine, but another did not.
From my understanding, nystagmus in vestibular migraine can demonstrate pretty much any kind of nystagmus. Possibly with the exception of the nystagmus of posterior canal BPPV during the Dix-Hallpike test, unless of course the two conditions exist together, which they are known to do at times.
Are you seeing more people getting vestibular migraine? Suffering from long covid for 6 months now with vertigo and migraine as main symptoms. Got diagnosed week ago with vestibular migraine.
I had vestibular neuritis for 3 months 4 years ago but got better with prednisone. Is that considered for vestibular migraine as well? Thank you for this video
I cant say I have. And prednisone is not indicated for vestibular migraine. Keep in mind, I see all types of emergency department patients in my practice. Not just dizzy/vertigo
Interesting Fills a deficiency in my education. Am I right in thinking vestibular migraine is mostly without nystagmus but has true vertigo as opposed to dizziness?
Yes, that is generally true. If you remove fixation somehow, you will possibly see more nystagmus at rest. And positional testing such as in the Dix-Hallpike test can also bring out nystagmus in vestibular migraine. But importantly, the nystagmus seen will not be in the pattern of the canal tested.
In english, dizziness is just a word that sometimes means the patient is experiencing vertigo, and sometimes other things. Some languages don't have a word for dizziness apparently.
Dr. John’s,
I have a question for you, I’ve been told my episodic dizziness/vertigo is related to migraine, but when I try to recreate it at a therapists office it’s difficult to trigger with their various maneuver and I don’t produce a Nystagmus. Have you heard of this being common and is there a known reason? Thank you for your time.
I would say that vestibular migraine patients do not have diagnostic findings on any maneuver. The diagnosis is made by the history of repeated episodes of vertigo that fit the diagnostic criteria as I described. And as long as other causes of dizziness have been considered and thought not be the cause.
@@PeterJohns Thank you so much doctor, one last question when/if you have time. Is it common for a vestibular migraine sufferer not display Nystagmus? I’ve come across a few sufferers like myself who don’t show signs of it even when a therapist tries to provoke it. Do you think it would possibly only be caught during an episode or is it possible to just not have that symptom? Thank you again, love your chanel.
@@Fl3213 Patients suffering from vestibular migraine can definitely be dizzy and not have nystagmus. If visual fixation is removed with infra-red goggles or other devices, or if positional testing is performed, it's possible to bring out nystagmus in many patients, but I would not say all.
Mine have last for over a MONTH….. does this sound like something else? Meaning not Vestibular Migraine. They hit out of the blue , I can feel it start in a matter of 10-30 seconds. Then it ramps up over next hours. It wrecks cognition completely. Makes me feel like a retard. Light and sounds, or really any sensory stimulation is offensive as hell. I can’t explain the level of suffering involved here. I broke my spine 8 years ago. Supposedly a stable compression fractures but wondering if this could possibly have something to do with this?
How do we differentiate it from
PPPD
There are diagnostic criteria for PPPD. I don't know that much about PPPD as I don't believe it ends up in the ED that often.
Nice👍
Are Vestibular Migraines similar to Occipital Neurolgia?
in what respect are you suggesting a similarity?
Very helpful video. Is it possible to have nystagmus with the vestibular migraine? I have a history of migraine with aura since my teens, now 59. I have had fewer migraines as I aged, but as you stated, more dizzy spells. My eyes had been extremely dry lately and felt bulgy and jumpy, but eye exam negative. Gradual occasional upward moving eyes at night which seem relieved if I physically put my hand over closed eyes. Yesterday extreme dizziness on getting up from bed and severe nystagmus upwards and sideways. Stops eventually if I don't move. Difficulty walking straight, fall sideways to the right. Eyes move to left or upwards. Saw MD yesterday, diagnosed inner ear virus and gave me prescription for serc 16mg three times a day. Helping somewhat but still dizzy when getting up or moving head, bending. Very scary. I feel the right side of my face feels tender as when I have a migraine. I have a prescription for Axert fir migraine relief but not sure if I should try one. Have also had nausea with this as I do with migraines. Serc is for 10 days, I have had four doses so far.
Yes, patients do get nystagmus during a migraine attack sometimes. I can't comment on your symptoms. Hope you feel better soon.
@@PeterJohns Thank you for replying. I understand that you cannot speak to my symptoms. I was wondering about the nystagmus and migraines because in all the videos I have been watching I haven't heard the two mentioned together.
Hello Peter, great video on Vestibular Migraine/Migraine Associated Vertigo. However, I was curious to know why you seemed somewhat dismissive of medication in your Treatment section? I suffered MAV for 6 months, 24/7, and the while the diet and exercise helped, it didn’t “break the cycle” so to speak. It took a gradual increased dose (up to 50mg) of Amitriptyline to bring me back to normal.
Hi John, The video was made from the viewpoint of an emergency physicians (which I am) and so not representative of medical practitioners that might see these patients in follow up. Emergency physicians rarely initiate migraine prophylaxis for migraine headache, but should refer patients with frequent headaches to clinicians who might do so. The majority of emergency physicians have never made the diagnosis of vestibular migraine, let alone think about starting prophylactic treatment for it. They certainly should ask the patient to see someone for ongoing treatment, but initiating daily treatment for vestibular migraine I believe is beyond the scope of emergency medicine practice. Thanks for the comment and question.
Did you get Absolutely fine??!
Hi Dr. Johns. My DX is migraine and Vestibular Neuritis. Vertigo and dizziness is minimal, my main symptom is visual overload. Starting nortriptyline.
Hope you feel better soon.
HoaHell , hey! Did the meds help? Do u feel any better?
Who decides that the patient must have other migraine symptoms for diagnosis? Surely if they have a history of migraine, especially a significant history, along with undiagnosed or vaguely diagnosed vertigo, an underlying migraine disorder should be recognised. It is counter productive for the patient if a medical board decides to say other migraine symptoms need to be detected. Migraine disorders are highly individual and nuanced and often symptoms become such a normal part of daily life that a patient may not even mention them. Aura does not need to be present to experience vestibular migraine any more than headache needs to accompany aura and so on. This criteria is a distraction.
I appreciate your concern. But the reason I made this video is that I'm an emergency physician, and ED docs generally have never heard or diagnosed vestibular migraine. I was trying to make them aware that they do see it and that it can be diagnosed.
There has been an update in the diagnostic criteria. Read this www.ncbi.nlm.nih.gov/pmc/articles/PMC9249276/#:~:text=Symptoms%20that%20qualify%20for%20a,5%20minutes%20and%2072%20hours.
and in particular the definition of "probable vestibular migraine".
@@PeterJohns I checked out that DSM update and it's not based on reality - even the literature agrees - eg "vestibular migraine varies widely from seconds to weeks" - my Mum is a case in point with no other diagnosis for her vertigo that lasts longer than 72hrs and she first experienced in her 40s along with other migraine symptoms. She had all the tests for MS just to be sure but it was inconclusive and she still gets vertigo and some aura symptoms at 80.. So my point - while i do understand the need to make an accurate diagnosis of a life-threatening condition, with most other conditions they should be approached with a more open mind. Not keeping an open mind - depending on a DSM, actually causes people more stress because they wind up with no clear diagnosis and therefore no treatment plan at all or self-management strategy.
@@JGalegria Not sure how the Diagnostic and Statistical Manual of Mental Disorder got into this. In any case, currently if anyone shows up in the emergency department with vestibular migraine the chances they will be properly diagnosed is very close to zero. I'm trying to change that. I wish I would say that we could make it 100% but that isn't realistic at this point. Little steps.
It can be extremely complex and a frustrating path to a diagnosis.
You can have nystagmus with VM. I have 'selfie videos' (horizontal nystagmus). Actually my symptoms resembles BPPV just extended to sometimes last over 2 minutes sometimes with some residual dizziness (I am certain of the duration due to the videos). I have actually myself been suspecting HC-BPPV.
I haf vertigo spells as a child (10- 60 seconds) - they disappeared after roughly half a year - then after 35 years the spells came back now more of 60 seconds duration or more. This was after increasing frequency of what i thought was intense headaches - sometimes lasting 3 days. The vertigo episodes of total 12-14 over half a year was followed by a 3 years remission and then now i have had it now for half a year (~ 12 episodes).
I have no hearing loss - no tinnitus with the episodes - no blurred or double vision and no headaches during the spells. No tingling or numbness - no syncope or pre-syncope (i can get my car safely to the side of the road - but it is not a experience).
Strangely my 'headaches' almost disappears in periodes with vertigo spells.
First ENT couldn't figure it out other than a strange behaving BPPV. Sent me to MRI - nothing.
Neurologist - nothing but perhaps BPPV thus sending me to another ENT.
This ENT - indicated possible vestibular paroxysmia - hinting hypertension regulating might solve the problem.
Then 3 years remission.
New ENT with TRV chair twice to resolve for BPPV - negative. Conclusion possible VM sending me to a neurologist.
Neurologist sent me to new MRI to exclude Bow hunters syndrome and Vestibular Paroxysmia - result no MVC of the 8th nerve = no vestibular paroxysmia. Though MR images wasn't super for resolving for bow hunters it was deemed highly unlikely (I can rotate head laterally and vertically without symptoms but a clockwise 20 degree looking down kept position often triggers a spell) and vertigo is the only symptom.
Conclusion from neorologist Vestibular Migraine and anxiety.
My mother had migraines with visual auras for a couple of years and the fact that i had the spells as a child is a known pre-cursor for adult migraines....
So yes Vestibular Migraine is the probable cause - but can you ever be certain ?
There are patients with vertigo that are difficult to diagnose, no question. My focus with this video is to introduce the diagnosis of vestibular migraine to clinicians who are unfamiliar with this common condition.
Benign? WTF! How about the destruction to their lives? Years and years into it, I finally even hear the word uttered by a doc but with no treatment and only a referral for someone another 8 months out……. Your life is already hanging by the threads by that point, then u have to wait another 6-12 months to see a specialist AND then you have to get Thru the years of combo of treatments knowing that some will not work.
Years later u MIGHT have found something that helps SOME…. By this time, many years later and MEDICAL GASLIGHTING done to you, your life if already shredded to tiny pieces of not “unliving” yourself already. It’s a LIFE DESTROYER made WORST by the medical industry.
I can’t even begin to describe the process in short order than the above. Oh yea, Insanity is likely to set in , IF you are lucky…….
I don’t have the migraines but I have the severe dizzy spells
My ear nose throat specialist says I have Ménière’s disease symptoms but pass all tests. So as of right now this is what he’s thinking it is. My left ear gets full and I can almost tell when a dizzy spell is about to happen. It will last about 6hrs. It’s only in the left ear. Dr put me on nortriptyline/pamelor
So hopefully it works
If you dont have permanent hearing loss then it is probably not menieres
Nice👍