Migraine is one of the commonest causes of headaches. But did you know that migraine is also one of the commonest causes of dizziness?

The pandemic has changed not only the way we live and  work, it has also altered sickness patterns. The National Headache Foundation reported a 70 per cent rise in the number of migraine attacks during 2021. Migraine is commonly thought to be just a headache. But it actually can present in many ways like imbalance, dizziness, disorientation, neck pain, or the common throbbing headache.

Over 10 per cent of migraine sufferers have vertigo and dizziness as their primary symptoms. This form of migraine is called Vestibular migraine. It is usually associated with nausea and vomiting or difficulty in concentrating.

The dizzy episodes can last from seconds to hours to days. While migraine attacks often involve recurrent, throbbing headaches, vestibular migraine may or may not have any accompanying headache. Many vestibular migraine patients cannot tolerate loud sounds or bright lights. This is called sensory amplification, meaning that their sensory systems are over-sensitive. These patients often have motion sickness. Vestibular migraine is more common in patients in the 20-40 year age bracket, but children as young as five years and seniors up to 60 years may suffer from it as well.

Common migraine triggers

Most vestibular migraine patients will have specific triggers which bring on their attacks. The most common triggers include inadequate sleep, skipping meals, stress, and extended screen time (this was increased multi-fold during the pandemic!)

How do we diagnose Vestibular Migraine?

A thorough history is the most crucial part of the workup of these patients. This should be followed by a vestibular evaluation which involves assessment of the balance system by various tests like VNG (Videonystagmography), Subjective Visual Vertical (SVV), Dynamic Visual Acuity (DVA), etc. NeuroEquilibrium is the world's largest Vertigo and Balance Clinics chain, with over 150 centers in India. These clinics are equipped to diagnose and treat all causes of vertigo and dizziness.

How is it treated?

Vestibular migraine is largely influenced by diet and lifestyle. Some simple dietary tips to reduce the incidence and severity of dizzy episodes are:

• Eating on time: Skipping breakfast is the singularly most important trigger to increase your headaches and imbalance. Taking out those 15 minutes in the morning to have breakfast is the first and most important part of your treatment. Fasting can also aggravate symptoms.
• Reduce your caffeine intake: Slow down on your tea, coffee, and chocolates!
• MSG: Monosodium glutamate is used as a taste enhancer used especially in Chinese food. Avoid MSG intake.
• Alcohol: Certain types of alcohol, particularly red wine, have been seen to trigger migraine attacks.

Some lifestyle modifications which help in controlling the headaches and dizziness in migraine include:

• Reducing screen time: Long hours in front of your phone or laptop can cause a lot of strain and aggravate migraines. Try not to look at the screen when you are scrolling.
• Try to relax and cool down mentally. Many migraineurs are highly driven perfectionists. This strains the already overworked nervous system. “Letting go” will go a long way in helping you get better.
• Try to sleep on time. Adequate sleep has profound healing properties on the nervous system.

The writer is Dr Anita Bhandari, ENT specialist, Neurotologist and Founder at NeuroEquilibrium