A migraine without a headache can be the cause of dizziness?


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

Migraine-associated vertigo (MAV) is a type of migraine which is characterized by dizziness in the presence or absence of a headache. MAV typically presents with one or a combination of these symptoms; dizziness as if the ground or the person is moving (vertigo), a sensation of falling, feeling, “off-kilter” or difficulty coordinating movements. Auras are accompanying symptoms of a migraine secondary to irritability of the neurons prior to a migraine most often due to hypoxia (reduced oxygen) and usually precede an episode.  These symptoms can include neck pain, pressure in the head or the ear, ringing in the ears (tinnitus), partial or complete loss of vision, sensitivity to light, sensitivity to sound, sensitivity to smell, 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, it is quite common for individuals to report light and sound sensitivity and dizziness without headache.

The present treatment paradigm for MAV is generally unsatisfactory and focuses purely on the outward symptoms not the genesis of the condition. Medications such as triptans focus on the vascular component of the migraine but are not always effective and carry side effects. Anti-emetics and anti-histamines such as meclizine are usually prescribed for the dizziness, however they are usually most effective for the nausea and end up producing drowsiness. Exciting current research is focusing on a phenomenon termed cortical (brain) spreading depression (CSD) and on dysfunction in brainstem cells primarily in an area termed the trigeminal cervical complex (TCC) 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 MAV? 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 video-oculography (VOG). 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.

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 the nervous system. The CAPS technology is also used in brain-retraining. In addition, a procedure termed external trigeminal nerve stimulation (eTNS) has been garnering traction in the neuroscience world.  This modality was FDA approved just a couple of years ago and involves activation of specific branches of cranial nerve number five. This nerve is responsible for providing sensation coming from the face but also originates in a part of the brain stem where head and face pain are processed and where some of the balance centers are located. Thus, activation of this nerve may have the outcome of improving dizziness and headache especially when in conjunction with the other therapies described.

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 and can be reached at 561-330-6096, drconde@thecondecenter.com, www.thecondecenter.com