Vertigo as a migraine trigger – Neurology Aug 09

Hi All,

This study appeared in the journal Neurology last week and is a good piece of evidence showing that vertigo can cause migraine attacks. I would take this further and suggest that this provides some good evidence showing that those of us who already had an underlying migraine condition and were then hit with either VN or BPPV were launched into the migraine stratosphere by continuous and heavy vertigo for months on end. The latter could have easily ratcheted up the previously low-level migraine problem into full-blown MAV.

It also shows how important it is to get either the vertigo or migraine under control as it’s not hard to see how a downward spiral into hell can be kicked off by all of this. The vertigo–migraine story really is a circular argument. I think this shows quite clearly why people without migraine brains get over their VN and BPPV relatively quickly and unscathed. It’s all over in 6-8 weeks and in some cases some VRT might be needed to clean up some residual imbalance. But the recurring attacks that can go on for years is surely migraine-based.

Scott 8)

Vertigo as a migraine trigger
Neurology 2009 Aug 25;73(8):638-42

The vestibular group shown above and on the right were exposed to a caloric test which induced vertigo and then migraine. This definitely explains why I (and so many others) suffer so badly following the caloric. They told me I would be fine after a few hours yet it threw me into a meltdown for 2 weeks many years ago.

Would you say that those of us that had migraine prior to the vertigo or vestibular issues were more susceptible to having this condition effect us in such a debilitating manner. Or that this vertigo or vestibular issue was more likely to hit us than ones who do not have a migraine brain.

Thats an interesting study. When this all first started for me, I first had a true BPPV attack, and was unable to move my head around much for several weeks without the true spinning sensation. It was only a few months later that my MAV started up, with the daily dizziness. Prior to my first vertigo attack, I had never had any migraine symptoms whatsoever. Maybe the BPPV worked as sort of a light switch, turning on the dormant migraines. I often wonder if I had never had the true spinning vertigo, if I would have ever suffered from MAV.

And just for fun, let me share what my audiologist shared with me. It is his belief that Vestibular Migraine and Migraine Associated Vertigo are two different migraine disorders. One apparently CAUSES the vertigo, while the other is caused BY the vertigo.

Now - because my dizziness has enjoyed a constant presence in my being since the end of June - and because my ‘migraines’ are rather invisible aside from symptoms that I usually don’t recognize until that ‘oh yeah’ moment once the brain fog lets go and the special, humming/thrumming/electrified ball in the center of my brain evaporates, the distinction means absolutely nothing.

My bringing it up was merely to shine a light on this little factoid that floats about in my brain, looking for an outlet and by golly, if you didn’t go and do just that for me.

So really…you have only yourselves to blame for this entry.

My docs have always used the terms MAV and vestibular migraine interchangeably. What is the difference? Does your doc give different meds for the 2 conditions?

Since no one buy my GP (6 weeks after audio exam) thought it beneficial to try and do something to stop the freaking migraine cycle, I have no clue what audio dude would recommend for either ‘condition’.

It was enough, for them, to refer me to someone who is considered such a good Neuro/migraine specialist that it justified my waiting until…get this now…MARCH of next year.

GP disabused me of this notion, prescribed the Propranolol in the hopes that it would provide me with some relief,doubled my Diazapam to help with the muscle spasms I was having in lower back and to help relieve some of this dizziness.

I’ll definitely ask the new neuro on Sept 18. Is it possible i’m reaching the end of this diagnostic nightmare?

I sure hope you are going to get a dx soon. We all go through so much to get a dx. You said your appt is in march, but then you said sept. was it moved up? who is the “audio” doc you are talking about? best of luck

Sorry 'bout that.
Audiologist is the guy who did all of the hearing and vestibular testing because this all started with a severe attack of vertigo and nausea that was not compensating. I was unable to even rise from my bed in the morning after the attack. I went to my doc, who sent me to the ENT, who sent me to an audiologist for all kinds of vestibular testing as my symptoms were indicative of some sort of inner ear problem. I’d been experiencing dizziness to some degree for decades - and a recent sense of disconnectedness.

The audiologist is the guy who diagnosed me with Non-compensated Unilateral Vestibular Loss with a suspicion of either vestibular migraine or Migraine Associated Vertigo. He was clear is that one would cause the vertigo and the other was caused by the vertigo. No mention of meds as migraines aren’t his specialty. But he did recommend an ‘excellent’ neuro, who couldn’t see me until March.

When I went to see my GP a couple of weeks ago, she worked so hard to not come flying out of her skin, she was so irritated! She had me cancel my first appointment and go to her guy, who could see me on the 18th of this month.

Like I said. I don’t care what manner of migraine this is - who or what it causes (aside from further vestibular damage) so long as they say, “Well…how simple is this?! Here’s the magic pill (which may well be the Propranolol if it keeps working like it is). Have a nice day!”

Somehow, however, I doubt it’ll be that easy…because it never IS just that easy.

Wah, wah, wah. Party with whine, cheese and apple pie, at my place. See you there. :smiley:

I had my first severe attack of vertigo morning after drinking at the age of 17. The odd attack in my 20s, ENT tests showed 54 per cent paralesis in one ear, they said it was menieres that had burnt itself out. The attacks got more frequent. I kept a diary. Sometimes the severe vertigo would be the day before a migraine, sometimes the day after. I had severe motion sickness as a child. On the other board, expert says that the migraines damage the ear.

Which comes first? Who knows. In the end you can just keep trying the pills. I have been taking betahistine (serc) for the last 10 years for the ear and still looking for a preventative for the migraine.


Hi Marie-Johanne,

I just wanted to sympathise with you over the ridiculous notion that you wait until March to see a specialist. I also know many others have had problems getting in to see specialists. It really dumbfounds me how doctors can think that you can live with this condition at all, let alone undiagnosed or untreated for as long as six months!!

I am going to have to give credit to my own wonderful GP and my neurologist, Dr Halmagyi (who considered the top guy for MAV in Australia). When MAV struck again this year my GP was determined to figure out what was actually wrong with me. After a few fruitless weeks of testing (rare tropical diseases etc) I ended up on the phone to Halmagyi himself (in the foggy confusion I can’t remember who rang who or the GP’s involvement). Halmagyi told me to come in THAT DAY, without an appointment and to squeeze in between other patients.

Whatever other complaints I have about the Australian medical set up, on this particular occasion I was really impressed.

Good luck Marie-Johanne!


I have no idea what my condition really is. My neuro-otologist called it “a type of migraine” which causes me to have episodes of vertigo but I know it isn’t BPPV but I assumed that vestibular migraines are the same as migrainous vertigo. I was only diagnosed a month ago so I am not up on the terminology and the study on this thread has completely confused me. This is what the consultant told me.

He explained that the brain is like a jug which fills up with daily stimulii and gradually empties as the brain processes. However, my brain does not empty sufficiently quickly before the next load of activity and stimuli and so it overflows, causing a migraine attack which I can have even if there is no pain. This causes the attacks to escalate each day and get worse with each attack and then the jug completely spills over and empties so I have a couple of days of no problems. In my case the migraines trigger spasms in the blood vessels in my brain and depending on which part of the brain is affected , I have vision, sight, or balance/vertigo problems etc. The brain then tells the rest of my body to panic and I have breathlessness and palpitations and aching limbs (poor circulation).

I am not entirely sure why he didn’t call it MAV if that is what it is unless of course it is not MAV and I have now self diagnosed !!!

The bottom-line for me is that i had approx TWO Strong Vertigo Attacks per year…from 1989 to 1991 but i always got well within 48 hours. Then the Super Big Vertigo Episode hit in 1992 and i guess you could call it my Big Crash because that is when the Rocking Motion and very intense Tension in my head began…and the Vertigo attacks continued on occasion. The Rocking began after puking my guts up (sorry about being so graphic). So the big question is was the occasional vertigo attacks that led to the big attack in 1992 a MAV - Silent Migraine Condition?