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The return of the migraine debate

There are many with this illness with no migraine ! VM can exist without migraine ! Hence the term silent migraine.

I’m not doubting one gets neurological fallout (I’ve had plenty!) but something caused the migraines in the first place …

I’m living proof insult to the vestibular system causes migraines. Sort out the insult (or it heals) and the migraines and neurological issues go away.

If that’s not causing your migraines something else is!

Something did cause my migraines and continues to. My guess is genetics. My thinking lately is that my migraine variant balance disorder is an autoimmune inflammatory condition affecting my brain chemistry and function. Everything else - ears, visual crap, brain fog, exhaustion, aphasia, imbalance, digestive issues, neuropathy, maybe even the migraine pain itself, is just collateral damage. Just like my PCOS, high BP, low thyroid and a long list of other co-morbidities, no physical assault was necessary, though my Type A high stress lifestyle combined with a bunch of stacked triggers took it from episodic to chronic. An underlying genetic predisposition ignited into a wildfire. It was always there. I’ve had it for at least 20 years, probably my whole life. Like Andy @Andy, I think there is a problem at the level of DNA affecting some very base functions in my metabolism, hormones and neurochemistry. I think that’s why I have so many of the commonly co-morbid conditions. And I think it’s related to issues with the X chromosome specifically, hence the dramatically skewed gender ratios within our demographic.

Migraine isn’t medical dogma - it’s the lived reality for the vast majority of us here, whether or not we can point to a discrete physical trigger or event. And Alan @bigalxyz, it is by no means all in our heads. It’s very real. Depression and anxiety are frequently associated with MVBD/VM, but that’s because we’re physically sick in bizarre debilitating ways for years on end. Some people get better. Some of us never will be free of VM, but we can all improve our quality of life with lifestyle changes, diet and meds.

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No one is debating that ear disorders cause migraine. Migraine from inner ear disorders is classified as secondary migraine( see screenshot below from Johns Hopkins). I just don’t think you can confuse that with Vestibular migraine.

the above screenshot is from the below youtube link from Jonh’s Hopkins and the video does a pretty good job of explaining VM

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Yes, now we are getting there!

I particularly like the “Almost any condition that creates sensory conflict”. Boom!

I’ve been saying that all along!

This could be inflammation, might even be blushing of skin (if that affected the middle or inner ear for example). Countless others! Any significant physiological fluctuation (unrelated to movement) that could create a chronic unpredictable change in or difference in response between the senses, especially the ears (which might be a result of some third party physiological process that has gone awry).

(One of those third party physiological processes could also be migraine and there you would have a vicious cycle.)

I think it’s fair to ask: what does that tell you about migraine?

I think that tells you a lot about what the mechanism of migraine might be - it is perhaps the result of breaching the allostatic load/stress level threshold of the brain, in coping with all this noise and conflicting information which a brain in a ‘healthy’ subject does not have to deal with. Mix that in with differences between each persons’ brains ability to navigate that and you have your spectrum of patients.

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I think that tells you a lot about what the mechanism of migraine might be - it is perhaps the result of breaching the allostatic load/stress level threshold of the brain, in coping with all this noise and conflicting information which a brain in a ‘healthy’ subject does not have to deal with. Mix that in with differences between each persons’ brains ability to navigate that and you have your spectrum of patients.

This.

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So why call migraine a medical dogma?

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Because it’s the stock label for a host of people’s issues of which there will be a significantly greater variance in underlying aetiology.

That said I think we are closer than ever to genuine consensus on what we are dealing with. At least on this forum.

VM is migraine variant.

Causation is central sensitization.

Causation should not be confused with stressors which take you over threshold.

Stressors aka triggers are any of the following. They are not causation. Causation is the innate or genetic propensity of brain to central sensitization.

Stressors are as follows
Menstrual cycle
Sleep
Hormones
Stress
Dehydration
Hunger
Obesity
Metabolic syndrome
Lights
Sounds
Menopause
Childbirth
Surgery
Busy areas
Motion
Patterns in carpets or shirts

If an ear disorder causes migraine treat the cause. Lumping it with VM wastes the patient’s time. Doctors like Dr.Hain subject you to at least 10 different vestibular tests before proclaiming VM. If a thorough elimination was done, there is no room for dogma.

If more ear research is needed and want to challenge medical status quo, then be explicit. It is an admirable pursuit and talking in generic terms combining it with VM is diluting the pursuit. All you will get is more migraine management if you resort to doing that.

A bunch of my friends/fellow sufferers raised awareness of VM during the balance awareness week by biking and running and crowdfunding for research. A lot of work is involved in education of the condition vestibular migraine.

My 2 cents.

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Ah but unfortunately we don’t all have access to Dr Hain or his 10 different vestibular tests I’m afraid. I’m sure that thorough an investigation makes some people totally confident in diagnosis. For many others - like me - all I’ve ever had is an educated ‘guess-imate’ at what I probably have. Doesn’t bother me personally because, after further reading and reflection on my previous history, ‘migraine’ made sense to me and Migrainous vertigo, ie stemming of the migraine was meaningful. Even though mine are ‘silent’. Causation was predisposition and stressor fluctuating hormones. There’s a lot of females who would say the same but others are different.

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Amen to that! And a lot of money.

This is just bundling a lot of things together. The root cause might not be the brain at all and as I have pointed out involve the ear (though the ear might not be the root cause either).

Triggers are only triggers when the entire system is weaker and cannot tolerate the complexity. This is not necessarily only a brain issue and may well involve weaker peripheral senses, or be due to a physiological impediment which is weakening the stability of the peripheral sense or the brain, or both.

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It’s central sensitization - that’s brain.

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The vestibular system is a combination of all elements. The senses limit what the brain can achieve. The brain is only as good as its senses when it comes to performance because that’s all the data it has.

I had issues with motion, busy areas, patterns, lights, sounds. My brain wasn’t ill, my ear was and that was bringing the entire vestibular system down and my intolerance up. For me that did end up with my brain becoming dysfunctional too, I would agree. But no issue in my brain caused this all to happen in the first place, there was no issue there - I was 100% fit and healthy. My significant neurological issues were an escalation.

Check this out, great video explaining Migraine neurobiology . It is the brain and brain alone freaking out !

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Great video, but incomplete. Does not discuss the processes around learning which I think are key to understanding MAV.

It also doesn’t cover the issue of “Secondary Migraine” which I suspect is also key to understanding a lot of cases of MAV.

It admits that there is a relationship between hormones and migraine, but the relationship is not well understood (only that there is a relationship). Might there be multiple impacts to hormone fluctuations, some of which are external to the brain but eventually have an influence on the brain if indirectly?

I don’t think it’s possible to discuss organs separately and have a sensible discussion about the vestibular system.

Each to their own!

learning what ?

Did you see the video from John’s Hopkins. The video argues secondary migraine is NOT VM.

To balance!

But it’s still migraine and not covered in this last video.

unless you have ear injury there is nothing to learn…all human compensation is complete in 90 days. Helen and Em are learning for a decade or longer ?

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My ear trouble continues after 4.5 years, I compensated within, say, 3.5 years but only thanks to a relative stabilisation of the condition. It still fluctuates though, I can tell, but somehow my brain copes. I get moments where I reach the limit of tolerance though (mixed lighting).

Yeah, I’ve shared that research that shows stable lesions can be compensated for within weeks, 90 days is not far off so makes sense.

Actually I think it is constantly tuning (the brain is a huge correlation machine!) and why getting older doesn’t affect most healthy people (until very old age). The system is changing slowly, but your brain adapts.

Unless your brain chemistry was the issue from the outset - which mine certainly was. I have no problem thinking these things can go in both directions. Not a great prognosis for those of us that start in the brain - mainly because the science isn’t there.

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