Migraines include a balance element

Dear Dr. Roach: Can you shed light on how vestibular migraines are diagnosed and the best treatment? — J.H.

The vestibule of the ear is where the organ of balance is located, so vestibular symptoms relate to balance issues in general, but most commonly, it means vertigo. The term “vestibular migraine” means vestibular symptoms attributed to migraine.

Vestibular migraine thus includes migraine headache — most people with vestibular migraine will have headache with at least some of the episodes. These could include vertigo, unsteadiness or movement symptoms with a change in head position that persists long after the head has moved. Abnormal sensitivity to sound and vision are also prominent.

There is a similarly named condition, basilar migraine, that also has vestibular symptoms. However, basilar migraine has additional symptoms seen during the early, or aura, phase coming from the brainstem, deep in the brain, such as clumsy movements or confusion.

Making the diagnosis of vestibular migraine is challenging, since there are many clinical entities with similar symptoms. There is no conclusive laboratory or radiology tests to confirm the diagnosis. In practice, the diagnosis of probable vestibular migraine is made in people with recurrent migraine symptoms associated with vertigo.

Treatment for vestibular migraine is broken down into treatment for acute attacks and treatment to prevent attacks. Many neurologists use diazepam (Valium) and similar drugs for acute attacks. Preventive medicines come in many different families, and the choice of the best agent depends often on other conditions the person has.

If medications are needed, prescription choices include blood pressure medicines, antidepressants and seizure medicines.