It’s Enough to Make Anyone Dizzy!

Diagnosing Vestibular Migraine

Vestibular migraine is considered a migraine variant.¹ Migraine is a sensory processing disorder in which ‘virtual’ exaggeration of activity of trigeminally innervated structures (passing through a sensitised brainstem) is perceived as noxious, resulting in head pain.

Now let’s replace trigeminal with vestibular information² and ‘vestibular migraine’ results i.e. normal, sub clinical activity of the vestibular system is exaggerated and perceived as a disorder within the vestibular system. This is supported by research which failed to identify (‘peripheral’) vestibular pathology in patients with vestibular migraine.³

Challenging a ‘Vestibular’ Episode

Unlike cervical relevancy in migraine, which is confirmed by reproduction and resolution of typical head pain when examining O-C3 segments, reproduction of ‘vestibular’ symptoms occurs less frequently. Therefore reliance on cervical relevancy is dependent on the response when challenging a ‘vestibular’ episode with a guaranteed trigger.

Undoubtedly, rotation of C2 will be present. Correct this and then request the patient to perform their guaranteed trigger – you might be surprised. If there is no trigger then maintenance of C2 in neutral is required beyond the expected time frame for an episode, or if constant, symptoms become intermittent within the first 2-3 treatments.

References:

1. Stolte B, Holle D, Naegel S, Diener HC, Obermann M. Vestibular migraine. Cephalalgia. Mar 2015;35(3):262-270.
2. Lempert T. Vestibular migraine. Semin Neurol. Jul 2013;33(3):212-218.
3. Boldingh MI, Ljostad U, Mygland A, Monstad P. Vestibular sensitivity in vestibular migraine: VEMPs and motion sickness susceptibility. Cephalalgia. Aug 2011;31(11):1211-1219.