Vestibular Migraine As The Cause Of Dizziness

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By: Dr. John Conde DC, DACNB Special to the Boca and Delray newspapers

There are numerous types of migraines, classified according to the unique symptoms produced. A vestibular migraine is one such migraine which is characterized by dizziness in the presence or absence of a headache. The typical presentation of a vestibular migraine is dizziness as if the ground or the person is moving, a sensation of falling, or difficulty coordinating movement. Associated symptoms include neck pain, pressure in the head or the ear, ringing in the ears (tinnitus), partial or complete loss of vision, and visual disturbances. It may produce throbbing or pulsating one sided (unilateral) severe headache. However, there may be no head pain at all.  In fact some it is quite common for individuals to report light and sound sensitivity and dizziness without headache.

Current treatments for vestibular migraines are generally unsatisfactory for most patients due to a lack of understanding of basic neurophysiologic concepts concerning migraines.  Anti-emetics and anti-histamines which really only produce drowsiness and eliminate nausea. Exciting current research is focusing on a phenomenon termed cortical (brain) spreading depression (CSD) and on dysfunction in brainstem cells that are involved in the control of balance. Essentially, brain cells responsible for balance and coordination and spatial perception become very active prior to and during a migraine episode, producing symptoms such dizziness and nausea. It is theorized that this spontaneous activity of brain cells is due to an unhealthy state; a lack of oxygen, lack of appropriate food (fuel), and/or lack proper nerve activation.

How can this information help those who suffer from vestibular migraines? Our current understanding allows us to develop a treatment plan that is multi-factorial in nature addressing the oxygen deficiencies, inappropriate nutrition, and lack of nervous system stimulation. First off, it is of paramount importance to locate the specific region within the nervous system that is dysfunctional and for this we utilize a diagnostic tool termed videonystagmography (VNG). This state of the art equipment allows for in-depth examination of eye movement pathology which is a very accurate window into neurological dysfunction. In an effort to truly target the dysfunction in the balance centers of the brain, computerized posturography utilizing the computerized assessment of postural systems (CAPS) equipment is incorporated into the diagnostic battery. This tool provides an unprecedented amount of information regarding stability and balance and helps localize the problem areas.

Graded aerobic activity, oxygen supplementation, and prescribed breathing exercises aimed at increasing vital capacity are essential to allow for greater oxygenation.  Chiropractic adjustments of the thorax allows for increased rib excursion and greater oxygen intake. One should attempt to eliminate or reduce alcohol (red wine), caffeine, monosodium glutamate (MSG; found in some ethnic foods), nitrates (processed foods such as cold cuts and hot dogs), hunger episodes, and lack of sleep. Some nutritional supplements that may be of value are L-arginine, magnesium, and 5-hydroxytryptophan.  Specific brain-based rehabilitative treatments such as eye movement activities (oculomotoric rehabilitation), vestibular activities (inner ear), brain-balance auditory stimulation, visual stimulation, olfactory stimulation, and chiropractic adjustments are essential in stabilizing these clusters of unhealthy cell in our nervous system.  The CAPS technology is also used in brain-retraining.

Dr. John Conde is a Board Certified Chiropractic Neurologist, one of only one thousand in the country. He holds diplomate status through the American Chiropractic Neurology Board. He provides specialized care for difficult cases of back neck pain, numbness-tingling, vertigo-dizziness balance disorders, fibromyalgia, migraines, AD/HD, autism, and dyslexia. His office is located at the Atlantic Grove in Delray Beach, FL and can be reached at 561-330-6096, drconde@thecondecenter.com, and at www.thecondecenter.com