By Karen Stephenson, Research Assistant, DENT Neurologic Institute
A migraine is a moderate to severe headache that can also cause nausea, vomiting, and light sensitivity. Of the 25-28 million people in the United States affected by migraines, about 40 percent also experience dizziness, imbalance, room spinning (vertigo), and motion sensitivity.
Lixin Zhang, MD, PhD, Director of the Dizziness and Balance Center at DENT Neurologic Institute, says, “Patients can experience dizziness with or without an active migraine or any recent headache. Dizziness can even occur years after a patient’s last migraine, with symptoms that last from just a few minutes to several days.
Dr. Zhang says that many patients who have migraines and dizziness are actually suffering from migraine-associated vertigo (MAV), also known as vestibular migraine or vertiginous migraine. MAV is more common in females than in males. One such patient is Mary, a patient who was suffering from both headaches and dizziness. One month after her first appointment with Dr. Zhang, Mary had a vertigo attack with nausea, and felt like the room was spinning. Thereafter, she had three more attacks that lasted one hour each, during which she was constantly dizzy, and felt like she was either on a boat, or drunk. Now every time that Mary has vertigo, she also has a headache. Although she remembers having headaches while in high school, they were not accompanied by dizziness.
“Since MAV symptoms are similar to other disorders, it is difficult to diagnose,” says Dr. Zhang. He says, “An accurate diagnosis requires testing and imaging to rule out other vestibular disorders. Such tests examine eye movement, head movement, spinning, and the ears’ response to different water temperatures. Diagnostic imaging, including MRI is required to rule out a tumor or other brain abnormalities.” Mary’s MRI did not reveal anything significant. Despite being unable to fully complete her vestibular testing, Dr. Zhang was still able to determine that she had MAV.
“What patients diagnosed with MAV really need is a way to prevent the onset of their dizziness symptoms by making lifestyle changes,” explains Dr. Zhang. To start, he tells patients to avoid common food triggers such as MSG, caffeine, and cheese. He also tells them to keep a journal of the foods they eat and to record any incidents they experience of dizziness and migraine, in order to determine other possible triggers. He says, “Managing stress and getting sufficient sleep also helps prevent MAV episodes.”
In caring for and conducting research on his own patients, Dr. Zhang has found that individuals with a history of motion sickness and hormonal changes related to perimenopause and menopause are at an increased risk for developing MAV. He has also found that, on average, MAV patients tend to develop vertigo about 13 years after their first migraine. Other MAV risk factors include having an individual or family history of migraines, anxiety, depression, bipolar disorder, drug, and/or alcohol abuse.
More significantly, Dr. Zhang and his research team have discovered that lamotrigine, a drug that calms the brain’s neuronal hyperactivity, helps prevent the onset of MAV symptoms. Dr. Zhang cautions that although lamotrigine is approved for other disorders, it is not yet FDA-approved for MAV. As a result, patients who are treated with lamotrigine for headaches and dizziness are required to receive it under a doctor’s supervision, so that they can be monitored for potential side effects. Meanwhile, Dr. Zhang is very encouraged to see so much improvement in his patients who are currently receiving this effective treatment.
If you are experiencing migraines with dizziness, and would like to be evaluated in order to receive this medication, please contact Dr. Zhang at 716-250-2000 to make an appointment. Visit https://www.dentinstitute.com/lixin-zhang to learn more.
Lixin Zhang, MD, PhD is a neurologist and Director of the Dizziness, Balance and Tinnitus Center at DENT Neurologic Institute where he treats migraines, dizziness and balance disorders, vertigo, tinnitus, sleep disorders, epilepsy, post-concussion/head injury, and other neurologic disorders.