This is a really great question and worth revisiting again since I have been learning a few new things lately, namely through dialogue with Prof Steve Rauch and reading the science literature.
Migraine or MAV in this case (a migraine variant) can mimic just about all of the other vestibular problems out there such as Menieres, BPPV, labyrinthitis and even early stages of multiple sclerosis (MS). This diagram is worth a look as it shows the differential diagnoses. In all three vertigo types presented here, MAV is considered.
Recently Rauch pointed out that in most all other vestibulopathies apart from MAV (disease/ abnormality of the vestibular system), both central and peripheral, test abnormalities tend to “cluster”, showing all peripheral dysfunction or all central. Migraine does not cluster, but shows “scattered” abnormalities that have some elements of peripheral dysfunction and some elements of central dysfunction. Cases of scattered abnormalities are almost diagnostic of migraine – or at least highly suggestive. There also seems to be greatly increased test-retest variation rather than consistent findings.
- Peripheral: the most common cause is probably BPPV but other causes include Ménière’s disease, superior canal dehiscence syndrome, labyrinthitis and vestibular neuritis for example.
- Central: If vertigo arises from the balance centres of the brain, it is usually milder, and has accompanying neurological deficits, such as slurred speech, double vision or pathological nystagmus. Multiple sclerosis is an example of a condition that involves the central nervous system (CNS) and may lead to vertigo.
So one of the things that will often be asked is whether or not you experience photo or phonophobia – both central issues. That combined with test results showing peripheral problems points to migraine. Of course Meniere’s is associated with hydrops and progressive hearing loss in the low ranges, however, migraine can also produce hearing loss. It’s not always clear cut and some may have both MAV and Meniere’s … or perhaps they may even be two branches off the same tree:
Prof Timothy Hain: There is some thought that Meniere’s and Migraine are two faces of the same indistinguishable condition. This may be indeed the case in a substantial number of people. About 50% of people with Meniere’s also meet the criteria for Migraine, and for this reason, it is often a good idea to try the large repertoire of migraine treatments in persons with Meniere’s disease.
So the take home message is that if it’s not clear, the first point of call is to treat it as though it is migraine and see if you can kill the symptoms that way first. Migraine lifestyle (see The Survival Guide) and a migraine medication.
Hope the above makes sense and feel free to ask questions here.
Best … Scott 8)