Why Vertigo with Migraines?

 By: J. Wes Tanner, MD
Vertigo can be frightening and unsettling. Vertigo may occur at the most inopportune time. If it occurs when you are walking, you can fall. If it occurs when you are driving, you can have a wreck. There are many causes of vertigo. The most common cause of vertigo is the migraine syndrome. The migraine syndrome can include migraine, headache, neck pain, fibromyalgia, palpitations, irritable bowel syndrome, TMJ syndrome, sinus pain, and vertigo.

Vertigo is the room spinning around, eyes going back and forth, nausea, and/or losing balance. Motion and migraines, as a general rule, are not good partners. Quite often, migraine sufferers will complain of motion sickness as a child and maybe even lifelong. Riding in the backseat of a moving vehicle, particularly if trying to read, often produces motion sickness or vertigo. Sometime the symptoms are mild and an individual may only have queasiness in his stomach. It's a pretty good clue that your children who have motion sickness will suffer from migraines and some of the other symptoms of the migraine syndrome. Some individuals only have motion sickness as a child. Some people will say that they have to ride in the front seat of the car, either drive, or sit in the rider's seat looking straight ahead. Doing the things appropriate for migraines helps this cause of vertigo. I usually do not recommend medicine specifically for vertigo to treat spontaneous vertigo of short duration. By the time the medicine can work, the vertigo is over and the patient is left with side effects from medication. Vertigo medicine may be helpful for cruise ships and situations where vertigo can be prolonged.

There are several mechanisms of disrupting the brain, nerves, or inner ear and cause vertigo. One of the theories for the cause of vertigo is inflammation of the cranial nerves. Inflammation of the cranial nerves is believed to cause vertigo as well as migraine pain. Inflammation in the cranial nerves may be caused by DNA viruses-Herpes simplex (fever blisters), Varicella-Herpes zoster (chickenpox and shingles), and other viruses that may not even be known at the present time. The inflammation in the eighth cranial nerve can be accurately detected and quantified by noninvasive testing equipment. The eighth cranial nerve connects the inner ear with the brain giving sensory input concerning hearing, body position, motion, and balance. Other names for the eighth cranial nerve are auditory nerve, acoustic nerve, and the vestibulocochlear nerve. Measuring inflammation in the other cranial nerves is not as easy or as accurate at the present time; however, the other cranial nerves are believed to be inflamed by the same virus. An easy but less accurate test you can do yourself is to stand on one foot for at least 15 seconds. If you cannot perform this task or there is a great difference in the length of time you are able to stand on one foot versus the other, then inflammation may be present in the eighth nerve. Antiviral medication would decrease virus activity and thus decrease inflammation. One way to tell if antiviral medication is effective is to measure the inflammation response to the medicine over time with accurate testing of the eighth cranial nerve. There is increasing interest in this area of study. In one unpublished work, approximately 70 % of individuals tested and placed on antiviral medication have achieved pain relief and improvement in function and balance. Future medical research will determine how effective antiviral medications are.
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