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INTRODUCTION

The following information will tell you about a condition called Migraine-Associated Vertigo, or MAV.

ISN'T MIGRAINE JUST A HEADACHE?

Migraine comes in two forms: simple migraine and classical migraine. Simple migraine is the form that most people recognize as migraine. People with this condition get very painful headaches, often with nausea and/or vomiting. They often avoid noise and light during their headache, as they tend to make the pain worse.

Classical migraine is different. In a classical migraine attack, the sufferer experiences altered sensation of some kind, and sometime altered muscle control. This aspect of the migraine attack is called the aura. The most common aura that sufferers experience is distorted vision: they may see coloured lights, black spots or patterns in their vision. Some people even go completely blind during their attacks.

The reason that you are reading this, however, is because your aura consists of an altered sensation of balance, called vertigo.

In the commonest form of classical migraine, sufferers get their aura first, and then go on to develop the typical migraine headache.

But there is a twist to the tale here: sufferers of classical migraine do not have to have a headache as part of their attack. They may get the aura without the headache, or the headache may occur at a completely different time.

WHAT ARE THE SYMPTOMS OF MAV?

The main problem that patients with MAV complain of is dizzy spells. These can occur at any time and last anywhere from a few minutes to a few weeks. During these episodes patients often feel as if the world is spinning around them, although some patients will experience different sensations of movement. This dizziness usually results in nausea, and in some cases this leads to vomiting.

During the attacks the dizziness is often made worse by movement of the head, so patients usually want to lie still. In between attacks the balance is usually entirely normal.

WHAT CAUSES MAV?

The causes of migraine are not clear at this time. There is a lot of research going on in this field today, and interesting new theories are frequently being proposed.

We believe that migraine is a disorder of the brain, but how it causes headache and aura is not known.

It is known that migraine is very common; around 1 in 11 people are affected by this condition. We also know that it tends to be inherited; sufferers will often report other members of their family being affected.

There are a number of triggers which will make all migraine sufferers more likely to get an attack. These include:

·        Disordered sleep patterns

·        Chaotic eating patterns

·        Emotional stress

A small minority of migraine sufferers will also have very specific triggers for their migraines, usually things they eat or drink. The commonest of these triggers are:

·        Caffeine

·        Chocolate

·        Red wine

·        Cheese

·        Preserved foods, such as bacon and pickled fish

·        Aspartame (also known as Nutrasweet)

Women with migraine often find that they are more prone to attacks before or during their periods.

The pattern of a migraine sufferer’s attacks can change during their life too. People who used to get a visual aura in their teenage years may finf their migraines go away for years only to return in the form of attacks with a vertigo aura and no headache. It could just as easily be the other way round.

It is an interesting oddity that children who are very car-sick are more likely to go on and be a migraine sufferer, but why this should be is a mystery.

ARE ANY SPECIAL TESTS NECESSARY?

The diagnosis of MAV is generally made from the pattern of symptoms, but it is usually also a matter of excluding alternative causes for the vertigo. Any tests you have will be aimed at excluding these other causes, as there is no test that will confirm a diagnosis of MAV.

WHAT TREATMENT IS AVAILABLE FOR MAV?

There are 2 types of treatment for MAV: those aimed at preventing the attacks from happening, and those that stop the dizziness during an attack.

Drugs used to stop an attack once it has started include:

·        prochlorperazine (Stemetil® or Buccastem®)

·        cinnarizine (Stugeron®)

·        metoclopramide (Maxolon®).

·        tryptans

Which one you are prescribed will depend on how well you tolerate a particular drug, or simply on your doctor’s preference. The first three of these drugs are all very good at reducing the nausea associated with an attack, but they should not be used long-term, and are not effective at stopping the attacks developing.

Tryptans are often used to treat simple migraine, as they are very effective at stopping the headache phase of a migraine. They can work for the aura, but tend to be less effective.

TREATMENT TO PREVENT ATTACKS OCCURRING

There are several treatments that are aimed at controlling the attacks. These include:

·        Beta-blockers, such as propranolol

·        Amitryptiline

·        Sodium valproate

·        Gabapentin

The management of MAV is complex, however, and your specialist will discuss your particular management plan with you in more detail.