How long does it take to recover from vestibular migraine?

Vestibular Migraine refers to an episode of vertigo in patients with a previous history of migraines. This so-called vertigo feeling causes people to feel unbalanced, disoriented, a sudden sense of dizziness, & nausea. They often feel that their surroundings are spinning or moving, & they are either floating away or swimming. Vestibular is the name of the system that lies inside the inner ear, & helps maintain the body’s balance with its position in space.

People usually associate migraines with headaches, however, vestibular migraines are different in that their episodes don’t involve headaches at all. Many patients that suffer from classic or basilar migraines, with auras, also suffer from vestibular migraines, although this isn’t true for all people.

Vestibular Migraines may last only a few seconds to minutes, however, they can sometimes persist for days. However, they rarely last longer than 72 hours. Mostly, vestibular migraine symptoms last for up to a few minutes to a few hours. During one of the vestibular migraine episodes, patients might feel off-balance, dizzy, & lightheaded. Patients might also notice that they feel worse when they move their heads.

Vestibular Migraines occur in only about 1 percent of the population, & is the most common cause of spontaneous vertigo episodes in people. Children have also been reported to experience vestibular migraine episodes. These episodes are known as Benign Paroxysmal Positional Vertigo of childhood. These children are also more likely to experience migraines later on in life.

Vestibular Migraine symptoms:

The most common & easily identifiable symptom of vestibular migraine is an episode of spontaneous vertigo that lasts anywhere from a few minutes to a few hours or days. In addition to this, patients of vestibular migraines might also experience the following symptoms:

A feeling of being imbalance or disoriented
Motion sickness is caused by moving the head in various directions
Dizziness that occurs by looking at various moving objects like cars or other vehicles passing by
A general feeling of being lightheaded
Feeling like you’re sitting on a rocking boat
Nausea & vomiting that occur as a result of the above-mentioned symptoms

What are the causes & triggers of Vestibular Migraines?

While doctors aren’t 100% certain as to what exactly causes vestibular migraines in people, many believe that an abnormal release of chemicals in the brain is to blame. A lot of other common factors that are known to trigger other kinds of migraines can trigger vestibular migraines as well in those that are prone to them.

These include:

Stress
A lack of sleep
Dehydration
Changes in the weather or barometric pressure
Menstruation related hormonal changes

In addition to these risk factors, there are some foods & drinks that can also trigger vestibular migraines. These include:

Chocolate
Red wine
Aged cheese
Monosodium glutamate(MSG)
Processed foods
Coffee
Sodas that contain caffeine

Women are generally more susceptible to vestibular migraines as compared to men. The medical community is also of the opinion that vestibular migraines run in families, however, studies have yet to prove this medically.

Vestibular Migraine diagnosis:

Vestibular Migraines often prove to be tricky to diagnose as there are no specific tests to test for them. More often than not, your doctor will rely on a general description of your symptoms, your medical history, & the consideration factors laid out by the International Classification of Headache Disorders. These guidelines state that a patient can be diagnosed with an episode of vestibular migraine if:

They have had at least five moderate to severe vertigo episodes that last anywhere between 5 minutes to 72 hours.
have previously experienced episodes of migraines with or without an aura
At least 50% of their vertigo episodes have occurred with at least one of the following:

1. a painful sensitivity to light, also known as photophobia, or to sound, also known as phonophobia
2. a visual aura
3. a headache that occurs with at least one of the following characteristics
centred on one side of the head
feels like the pain is pulsating
the intensity of the pain is moderate to severe
the headache gets worse with everyday physical activities

The migraines can’t be explained by the presence of any other disorder that causes similar symptoms.

These disorders include:

nerve irritation or fluid leaks in your inner ear
transient ischemic attacks(TIA), also called ministrokes
Meniere’s Disease, which is an inner ear disorder that is caused by an excessive amount of fluid inside the ear
Benign Paroxysmal Positional Vertigo(BPPV), which is a type of vertigo that causes brief, sudden bouts of dizziness, headache, nausea, imbalance, & vomiting spells.

Vestibular Migraine treatment:

Vestibular Migraine treatment often consists of the very drugs & medicines used for the treatment of vertigo. These medicines help relieve nausea, vomiting, dizziness, & motion sickness in patients, along with other vestibular migraine symptoms.

If you experience vestibular migraine episodes frequently, your doctor might prescribe the same medications that are recommended for patients of classic, basilar migraines. These drugs & medicines include:

Beta-blocker medications
Triptans such as sumatriptan (Imitrex)
Anti-seizure medications like iamotrigine(lamictal)
Calcium channel blockers
CGRP antagonists, such as erenumab (Aimovig)

You can also reduce the chances of getting a migraine by avoiding the foods & drinks that can trigger vestibular migraines. You should pay attention to what you’ve eaten by ideally maintaining a food diary & noting down symptoms as & when you eat any foods & drinks. As you notice your vestibular migraine symptoms flaring up after intaking certain foods & drinks, try to avoid those specific foods & drinks in the future to avoid any vestibular migraine episodes. In addition to these vestibular migraine treatment options, you can also try certain lifestyle changes in your everyday life. These changes include:

Ensure to get a full 8 hours of sleep & be properly rested throughout the day.
Indulge in regular exercises to keep yourself fit & healthy.
Drink plenty of water, at least 8 glasses of water.
Indulge in stress-reducing activities like meditation & gardening, to keep everyday life stress levels at bay.
If your vestibular migraine is caused by menstruation, you can try taking water pills(diuretics) & avoid eating too salty & spicy foods &/or soda, and caffeinated drinks.

In addition, you can also try certain vertigo treatment exercises like the Epley maneuver, the Brandt-Daroff exercises, & the Semont-liberatory maneuver to help with your dizziness, & other symptoms.

Brandt-Daroff exercises:

The Brandt-Daroff exercises are a set of movements used in Vertigo treatment for BPPV. They can either be performed at home or by expert Vertigo doctors & specialists. To perform the Brandt-Daroff exercises, follow the below-mentioned steps:

Sit down on the edge of a bed or a couch,
Lie down on your left side while turning your head to look upwards. Try to perform both of these movements within 1 to 2 seconds of each other. Also, try to keep your head up at a 45-degree angle for about 30 seconds.
Next, sit up for 30 seconds.
Repeat these steps on the right side.
Perform the steps 4 more times, a total of 5 repetitions in each set & side.
Next, sit up. You may feel a little dizzy or lightheaded, which is pretty normal & tends to go away on its own. Wait for it to pass before moving on with your day.

You should ideally perform one set of Brandt-Daroff exercises in the morning, one in the afternoon, & one in the evening. The success rate of Brandt-Daroff exercises is about 80%.

The Epley Maneuver:

The Epley exercises for Vertigo help dislodge these crystals from the semicircular canal to their original location in the ear. Epley Maneuver is especially helpful for patients whose BPPV symptoms are triggered by some specific head movements. To perform the Epley Maneuver at home by yourself, perform the following instructions carefully.

Note that, the steps given below are for when you have left-ear BPPV.

Sit up on the bed, with your legs flat out in front of you. Turn your head 45 degrees to the left.
Lie down next, keeping your head turned to the left. Wait for 30 seconds.
Turn your head 90 degrees to the right, until it’s facing 45 degrees to the right side.
Rollover to the right side before sitting up.

Doctors often put the success rate of the Epley Maneuver at close to 90%. Vestibular Rehabilitation Therapy can also help patients feel more balanced & at ease with their vestibular migraine symptoms in their everyday life. Vestibular Rehabilitation Therapy is a set of specially designed exercises for a patient that helps train their body to compensate for the loss in the natural vestibular system by employing their other organ systems in place.

It helps to gradually rewire the brain’s reliance on the vestibular system, & instead train it to rely more on signals received from the legs & the eye muscles.