Migraine–anxiety related dizziness (MARD)

[size=150]Migraine–anxiety related dizziness (MARD): a new disorder?[/size]

J Neurol Neurosurg Psychiatry. 2005 Jan;76(1):1-8
Furman JM, Balaban CD, Jacob RG, Marcus DA.

This editorial will focus on the pathophysiology and clinical issues relating to MARD, including the interfaces among balance disorders, migraine, and anxiety. We use current epidemiological data and studies of pathogenesis to develop comorbidity models. These models serve as hypotheses that may lead to possible treatment options for many patients with dizziness, including those with MARD.


It is not surprising that some patients with dizziness may suffer from a combination of a balance disorder, migraine, and an anxiety disorder, a symptom complex the authors propose to name migraine–anxiety related dizziness (MARD). Dizziness or vertigo occur in 54.5% of patients with migraine, compared with 30.2% of patients with tension-type headache.

Migraine related dizziness is a bona fide disorder.

The authors speculate that some episodes of vertigo in patients with MARD represent migraine aura without headache.

[size=130]Why are the three so tightly connected?[/size]

Fundamental to the pathophysiology of migraine is the trigeminovascular reflex.

Vestibular pathways can contribute to both central and peripheral migraine mechanisms. The reciprocal connections between the inferior, medial, and lateral vestibular nuclei and trigeminal nucleus caudalis suggest that vestibular and trigeminal information processing may be altered concurrently during migraine attacks, and that vestibular signals may directly influence trigeminovascular reflex pathways … changes in monoaminergic activity due to vestibular activation may both trigger migraine related symptoms and modulate activity in both pain related and anxiety related pathways.

In plain English: migraine, vestibular and anxiety neural pathways intersect in the brain. If one is stimulated, the others are impacted.

The previously held assumption that the presence of anxiety automatically implied a ‘‘psychogenic’’ cause for dizziness is no longer valid. It is for this reason alone that this condition is misdiagnosed so often!

The additive central effects of migraine, vestibular, and anxiety related circuits on perceptions of pain, vertigo, postural instability, passive coping, visual dependence, and space and motion discomfort are subject to considerable individual variations. [No two people are alike]


If anxiety is the predominant feature in the triad then a combination of an antidepressant and a benzodiazepene is the way to go. If migraine is predominant then any of the anti-migraine meds according to these guys.

The smart choice might be to use a med that tackles both migraine and anxiety all at once – the tricyclic antidepressants and Effexor fit this by killing two birds with one stone thus leaving the vestibular system alone and stopping all of the symptoms we love so much. On the other hand, it could be split in two so that one med tackles anxiety only and another the migraine if neither Effexor nor the tricyclics are a possibilty.

How did you overcome your severe anxiety? I’ve had severe anxiety issues for years now. I didn’t always have them but when I got into my teens they started to show. It’s pretty much killed my social life and even though I want to go out and do stuff and live my life. I am to worried about what might go wrong. I over think things and am afraid to try them.

Hi I totally understand where you are coming from, I am exactly the same… I have suffered for years with anxiety due to mav, I to would like to have a social life… It is so impossible having this problem also people not understanding mav… Everytime I get into the car to go anywhere I go into a panic as I can’t focus… I tried topamax last year and it give me the severe anxiety now I am so scared to take anything else… I wish there was something I could take that was herbal. X

the REAL question in my mind is could the anxiety, especially panic symptoms, themselves be aura phenomena?

— Begin quote from "dougiedd"

the REAL question in my mind is could the anxiety, especially panic symptoms, themselves be aura phenomena?

— End quote

Absolutely. Oliver Sacks has written widely on this - altered states of mood are a very common prodome and/or aura. These include intense feelings of doom, terror and panic. Speaking from personal experience I always feel panic just prior to a scintillating scotoma aura.

Glad i came across this article. I would probably put myself 75% anxiety, 25% migraine. Anxiety came way before the dizziness.
Dyyzzee, how did the magnesium experiment go? I am so desperate right now to avoid antideps that i will literally try anything. :frowning: I’ve taken antideps before (SSRIs and SNRIs)–i would rather be dizzy than get those side effects, sad as it sounds.

I think anyone who experiences, Migraine, dizziness, and anxiety should at least try taking magnesium. If you look over the list of symptoms that come with Magnesium Deficiency, it includes migraines, vertigo, tight muscles, muscle spasms, feeling a lump in your throat, anxiety, and many others. I just started magnesium in the last couple days so it’s far to early to tell. I’ll try to remember to report back here after a few weeks or months. I can tell you that my first dose made a noticeable and significant improvement on my tension and anxiety within about 30 minutes to an hour. The feeling of being relaxed was very comparable to taking Valium.

One thing you should do is do your research on which kind to buy and how much to take. So far, what I’ve found is that Magnesium Citrate is the most absorbable type of magnesium even though it is more expensive and somewhat difficult to find in local retailers (widely available online). When it comes to dosage amount, you should probably shoot for 600mg per day although your body may need less or more. If you get too much it results in diarrhea. Most of the information I’ve read says you should just back off until you don’t have diarrhea any more. Also, you might consider taking most of it before you go to bed. It has a tendency to relax you and make you sleep better.

Don’t buy a magnesium and calcium combination. There’s usually not near enough magnesium in these combinations to help you out with a magnesium deficiency and, if I understand correctly, the calcium actually has a way of cancelling out the magnesium.

Remember, I’m not a doctor. Neither am I a quack. I’m struggling with both MAV and anxiety and just sharing what I’ve been finding out from reading online and also from my own experience.