Diagnosis

To start off, people have been noticing this association with migraine and vertigo for centuries. Throughout the decades we struggled as physicians to not only notice it but label it and study its symptoms. This field is in its infancy compared to other conditions of the ear and brain and is constantly changing with evidence-based research.

Because this is a relative newer disease, correctly diagnosing a patient can be difficult to achieve. The challenge with vestibular migraine is two-fold:

1. The route patients take to the diagnosis can vary depending on the type of physician they see. Both neurologist and head and neck surgeons (ENTs- my specialty) see these patients. As a function of physician experience, training, and background, the diagnostic journey and treatment strategy to vestibular migraine can differ.

2. Second, the symptoms of vestibular migraine can be so diverse and unfortunately overlap with other conditions, making it difficult to pinpoint the true diagnosis that needs proper treatment.

It is important to note there is no special blood test that can be used for diagnosis. Diagnosis is often made with history and physical examination alone.

These findings often assist in ruling out different diseases such as BPPV or Menieres. To complicate the picture, there are many studies showing a clear overlap between these common dizziness causes and migraine- but that is a different topic.

There are complex vestibular diagnostic tests, such as VNG, that can measure your balance function. These tests can sometimes determine if one side of your vestibular system is weak, however, it is challenging to draw definitive conclusions. Studies often show these different testing modalities are not sensitive enough in detecting vestibular migraine and are often unreliable. However, it can be useful in ruling out other dizziness conditions.

In conclusion, diagnosis is heavily dependent on obtaining an accurate history of what patients’ experience in their day to day life. If a patient is able to recall attacks and its details, they are at a better advantage in determining if vestibular migraine is the culprit behind their misery. It is important to understand that not all physicians out there diagnose and treat this condition the same. From a patients’ perspective, this can become a point of frustration as you may be referred from one doctor to another with no help in between.

You may be prescribed a list of medications that can often be sedating and find no relief, with only increased side effects. Or, you may be just left feeling hopeless and stuck, wishing for a moment to return to normalcy. Take note of the details of your attacks and find a physician who treats vestibular migraine.