Dr. Shin Beh discusses vestibular migraine, a prevalent condition affecting around 3% of adults, particularly women, and emphasizes the importance of recognizing its symptoms and diagnostic criteria due to common misdiagnoses with other disorders. He highlights various treatment approaches, including medications, lifestyle modifications, and the management of comorbid conditions like anxiety and depression to improve patient quality of life.
Dr. Shin Beh, a neurologist specializing in vestibular and migraine disorders, discusses vestibular migraine, a condition that affects approximately 3% of the adult population, making it the second most common cause of vertigo among adults. He highlights the strong female predominance of this disorder, with symptoms often emerging in women in their late 30s to early 40s, typically involving a history of migraine headaches and motion sickness. Although there are various terms used to describe vestibular migraine, the current preferred term helps streamline diagnosis.
Diagnostic criteria for vestibular migraine rely on clinical assessments rather than specific tests, necessitating a comprehensive evaluation of a patient’s history and symptoms. Patients generally experience moderate to severe episodes of dizziness lasting between 5 minutes to 72 hours, with a significant portion of these episodes accompanied by migraine symptoms, including throbbing headaches, photophobia, and phonophobia. The relationship between migraine symptoms and vertigo has been recognized for centuries, but formal diagnostic criteria were only established in 2012.
Dr. Beh presents a case study of a 43-year-old woman suffering from vestibular migraine, emphasizing the complexity of diagnosing this condition due to overlapping symptoms and misdiagnoses she received from various specialists. This highlights the importance of recognizing vestibular migraine as a potential diagnosis when patients present with dizziness, alongside their history of migraines. The dynamic nature of vestibular migraines is explored, noting that symptoms can occur during the prodrome, aura, and headache phases of a migraine attack, and that the frequency of headache symptoms typically diminishes with age.
The presentation also covers the extensive variety of symptoms associated with vestibular migraine, including types of dizziness, balance issues, visual disturbances, and even cognitive dysfunction. The overlap between vestibular migraine and other conditions, such as Meniere’s disease, is significant, with a shared association with migraine history. Dr. Beh encourages healthcare providers to investigate these symptoms more thoroughly to avoid misdiagnosis and inadequate treatment.
In terms of treatment, Dr. Beh discusses both acute and preventive strategies, including various medications and lifestyle modifications such as sleep hygiene, stress management, and trigger avoidance. He stresses the importance of recognizing and managing comorbid conditions like anxiety and depression, which frequently accompany vestibular migraines. Cognitive-behavioral therapy, along with pharmacological interventions such as triptans and newer CGRP inhibitors, is suggested for effective management in these patients, ultimately aiming to alleviate symptoms and improve their quality of life.