Overview of Chronic Vestibular Migraine

The main symptoms of CVM are:

• severe headaches that feel like throbbing pain on one side of the head
• vertigo, or problems with balance and coordination
• sensitivity to light and sound
• Alice in Wonderland syndrome, where you see things larger or smaller than they actually are
• brain fog
• fatigue
• diarrhea
• sweating
• yawning
• dry mouth

Doctors don’t yet know the exact cause of CVM. Some believe it’s a combination of genetic factors, environmental triggers, and certain lifestyle habits that may contribute to its development.

These include:

• stress
• dehydration
• lack of sleep
• menstruation
• caffeine

CVM can affect anyone, but it’s more likely to affect middle-aged people born female.

CVM can have several complications that may affect your daily life. These include:

• persistent symptoms leading to constant discomfort
• increased sensitivity to light and sound, and an impaired balance, which can impact your daily life
• increased risk of other conditions, such as Meniere disease or benign positional vertigo

CVM can affect anyone, but certain factors increase the likelihood of developing this condition. Risk factors include:

• Age and gender: CVM is more common in people born female under 40 years old.
• Pre-existing mental health conditions: You may be at a higher risk if you have a history of anxiety or depression.
• Previous head trauma: People with prior head injuries might be more susceptible to developing CVM.
• Family history of migraine: If migraine runs in your family, you might have a higher risk of experiencing CVM.

While these factors can increase the risk, anyone can develop CVM. A higher risk does not necessarily mean you will have CVM.

You may want to consider speaking with a doctor if you notice:

• Persistent symptoms: If you have ongoing or worsening symptoms of dizziness, vertigo, or balance issues that disrupt your daily activities.
• New or intensified headaches: If you’re experiencing severe headaches that are different from previous ones or if your existing headaches become more frequent or intense.
• Associated migraine symptoms: If you notice sensitivity to light or sound, visual disturbances, or other typical migraine symptoms along with your dizziness or vertigo.
• Change in symptoms: If you observe any changes in the pattern, duration, or intensity of your symptoms.

Diagnosing CVM can be challenging because of its varied symptoms and the lack of diagnostic tests.

Doctors typically ask about medical history, medications, and migraine episodes. A positive diagnosis requires at least five episodes lasting 5 minutes to 72 hours, including pain location, sensation, and physical activity.

You may also need a physical exam so that your doctor can rule out other conditions that could cause similar symptoms.

The primary goal of treatment is to reduce the frequency and severity of your migraine episodes. Here are some of common treatments:

• Medication: Both over-the-counter and prescription medications can help treat CVM. Acute symptoms can be managed with triptans. You may need antiemetic drugs to counter vomiting and nausea. Preventive medications, such as propranolol, venlafaxine, and topiramate, can help reduce the frequency and intensity of episodes.
• Lifestyle modifications: Changes in diet and lifestyle may impact CVM. Regular exercise, adequate sleep, and a balanced diet can help manage your symptoms. Avoiding known triggers like certain foods or stress can also be beneficial.
• Vestibular rehabilitation: Vestibular rehabilitation is a form of physical therapy that aims to improve your balance and reduce problems related to dizziness.
• Calcitonin gene-related peptide (CGRP) medications: CGRP medications are a newer class of drug that target CGRP, a protein involved in migraine episodes. They show promise in treating CVM. A small 2022 study showed that 21 of 25 participants saw improvement in their symptoms.

There’s no guarantee to prevent CVM. However, you may want to consider these with your doctor:

• lifestyle adjustments, such as maintaining regular sleep and staying hydrated
• avoiding triggers, such as certain foods or stressors
• taking preventive migraine medications
• vestibular therapy (see above)

Here are some frequently asked questions about chronic vestibular migraine.

Can vestibular migraine episodes be chronic?

Yes, vestibular migraine episodes can become chronic. This means that the symptoms, particularly vertigo and dizziness, can persist over a long period.

What are the stages of chronic vestibular migraine?

Chronic vestibular migraine typically goes through four stages: premonitory, aura, headache, and postdrome.

The premonitory phase alerts you to an upcoming episode. The aura phase may involve visual or sensory changes. It’s followed by the headache. The postdrome phase involves a feeling of exhaustion following the headache.

What is the most common trigger of chronic vestibular migraine?

Stress is often the most common trigger for chronic vestibular migraine. Other frequent triggers include altered sleep patterns, caffeine, and menstrual cycle.

Is there a link between chronic vestibular migraine and anxiety?

Yes, research indicates a significant link between chronic vestibular migraine and increased levels of anxiety.

Is there a vestibular migraine diet?

While there may be dietary triggers to chronic vestibular migraine, the evidence is frequently disagreed upon.

The Mediterranean diet is one that may have some benefits for people with migraine, but more research is needed.

There’s no cure for chronic vestibular migraine, but many treatments are available, from prevention to medication and rehabilitation.