Vestibular migraine: What symptoms do you experience?

Have you read ‘Heal your headache 1-2-3’? My vestibular group on FB is specifically for SCDS, but a lot of them have MAV (migraine associated vertigo aka vestibular migraine). It breaks down the triggers of migraine and medicines/foods, etc. I took it with a grain of salt and agree with 50% of it. PT, dry needling or acupuncture can also help with migraine. Those who have done the diet consistently have great success with their migraines. Knowing triggers and avoiding them also help. Vestibular rehab therapy helps with the vertigo/vestibular symptoms.

What I might suggest looking at is if your vertigo could be caused by a misalignment of your upper cervical vertebrae with your neck and jaw. If you are having muscle spasms moving the vertebrae around, you can have vertigo, and severe headaches up the back and sides of your head. Some of those conditions might also compromise blood flow which then could cause dizziness. If you haven't considered this before, I would recommend possibly seeing a spine specialist and getting imaging to diagnose any alignment or instability spine problems. A physical therapist should not treat your neck without imaging and a doctor's approval because instability in the upper C spine can be serious. I have experienced sudden vertigo and at the time, I didn't know my upper cervical vertebrae were out of alignment. All I had to do was look upward, and I lost my balance immediately. At the time, I did have a cervical spine problem and had not had surgery, and it was generating lots of muscle spasms that did change the normal alignment and curve of my C spine and everything was tighter on one side causing vertebrae to twist or tilt. My physical therapist very gently realigned my spine and released the muscle spasms which corrected the vertigo. The other symptoms you mention with severe headaches, arm weakness, fatigue and tingling can also be spine related. I certainly would recommend seeing a Mayo specialist. I am a Mayo spine surgery patient and at my first visit, I was evaluated by a neurologist first (with other tests and evaluations recommended by him), and then I saw the neurosurgeon. The neurologist can evaluate where nerves are being affected that bring on your symptoms, and that helps a spine surgeon understand more about the case (if it is a spine issue). They need to identify the source of the problem before treating it. Since my spine surgery, I have had a great recovery and I do not have vertigo or balance problems. I don't have spine related pain. I do also have thoracic outlet syndrome (TOS) which causes a compression of nerves and vessels to the arms which could be something else to look at for yourself. Mayo can evaluate that too. TOS is often misunderstood and there are not many places a patient can go to get help for TOS and my treatment for that is physical therapy. Let me know if I can answer anything else about my experience at Mayo.

Dear Jennifer,
Thank you for your thoughtful and detailed post. My Dr.'s and I had not considered your hypothesis. However, I recall that a chiropractor that I saw about 5 years ago took an X-ray of my neck and he said that there was some compression of my C3 and C4 neck vertebrae. Much of what you explain, especially about the arms weakness, makes complete sense. However, my neurologist, the one prior to seeing the Hopkins specialist for VM, did review the X-Ray but had no significant observations. I am so pleased to report that Dr. Robertson at Mayo only today agreed to see me; I am convinced that she order all kinds of head and cervical tests. And, I am sure she will consider TOS.

With respect to your diagnosis and surgery, I am pleased to hear that you are doing better. How was your experience with your Dr. and the neurology group over all?

Thank you again for taking the time to write to me.

Kind regards,

Kathryn

Dear Uldiver,

I had not and checked it out. I have spent a good part of the last year trying to identify triggers and to the best of my ability, the triggers do not appear to be food. I want to wait to see the Dr. at Mayo before proceeding with any vestibular rehab therapy as they accepted me today for an appointment with a neurologist. I appreciate your recommendation and thanks again.

Kind regards,

Kathryn

Kathryn,
I'm glad you'll be seen at Mayo. I was very impressed with all the providers there. They really take time and are very thorough and they evaluate all the issues you have that interconnect. I started with the neurology exam, and then the doctor ordered other tests and evaluations. He was in the spine center. I had never had complete MRIs of all of my spine, and they did that. (Some insurance now doesn't want to cover MRIs at hospitals, so check with your insurance before you go there.) They review your imaging with you. They schedule everything for you as you go along at your appointments. I was sent to a specialist for TOS and a doppler study where I had mini blood pressure cuffs on my fingers and they raised my arms and measured the changes in pressure with changing arm positions. I did have nerve conduction studies that went for about 2 hours. If they are booked for testing, you can wait in standby status and often get tests done early. The waiting areas have nice lounges with computers for your use and lots of wonderful artwork everywhere. There are pianos in the main lobby that people can play and it just doesn't feel like you're at a medical center. Make sure you see the Chihuly glass chandeliers over a stair case at the Gonda building. They are spectacular. You might need a few days there depending on how much they schedule for you. Some hotels are in walking distance and others have shuttles. I was also impressed that after I had the TOS evaluations, and an hour later while I was seeing the neurosurgeon, he received a call from the TOS specialist and they discussed my case while I was at my appointment. It is a team approach and the doctors consult each other. You might want to draw diagrams of where your pain is and what type of pain it is and take that with you to your appointment and a list of the questions you have. It's easy to forget to ask something and having it on paper helps. I love Mayo. My case had unusual symptoms and I was refused help by 5 surgeons before I went to Mayo. I chose them because I thought my TOS was confusing the diagnosis of my spine. I had spinal cord compression and TOS at the same time. Coming to Mayo changed my life. I was loosing the ability to hold my arms up and coordination of my hands. I'm an artist and I wasn't able to do my paintings and my surgeon gave that ability back to me. To thank him, I painted his portrait as a gift. I was so grateful for his kindness and compassion as well as his talent that it was what I wanted to do the most as I was recovering last year. His nurse scheduled one of my follow up appointments on a surgery day so I could get photos of him in scrubs. He was a good sport and I brought the finished painting to my one year follow up appointment and he loved it. I had been drawing sketches of him prior to surgery to help me get through it and using my own artwork to stay calm. This was huge milestone for me as I had never had major surgery before. I am so glad I came to Mayo and if I have more spine issues in the future, I won't go anywhere else. I had a great recovery and even now, I am working to rebuild muscle that I lost before my surgery and painting again. Please check in and let us know how you're doing. I hope you enjoy your time there as it's a lot more than doctor's offices. I loved the beautiful historic Plummer building too. ( You can find some videos of it on the website.) I have enjoyed all my visits there and its' a special place to me.

Jennifer, your account of how Mayo healed you moved me. I find it astonishing that five prior surgeons did not want to take on your case. From what I continue to learn about Mayo, they seem to be the last resort for patients with troubling medical issues but, more importantly, they know how to diagnose and treat, with expertise and compassion. I also enjoyed learning that you are an artist and that Mayo enabled you to return to your passion: I am so happy for you. Thanks to your account of your experience with Mayo, I am looking forward to my visit. My husband will be with me, so I am now confident that it will be a revealing experience, in all senses. I will keep you posted! best and paint away

Kathryn,

You as a patient have a lot of power over your own healing. Keep an open mind and an open heart. You are starting out fresh at Mayo. Kindness between both doctors and patients helps everyone. After the prior 5 surgeons had missed the real problem in my case, and I was reading the publications from my Mayo surgeon (before I became a patient there), I found terminology that I looked up, and it was in doing that, that I also found other medical literature that described unusual cases that were like mine. I had just been dismissed after sending a message about having had a vertigo episode to a neurosurgeon at another medical center that I had been seeing for 6 months. I had done all the tests he wanted, but he didn't know if surgery would make me better or worse. He had his nurse send me a message that he wasn't going to offer surgery, and I cried. I tried to get the help from my other doctors at the same medical center to send the literature I had found to the surgeon who refused me, and none would contact him on my behalf. I was afraid to try to contact him myself because everything went through his nurse who was very hard on me, and she had actually refused to make appointments. I talked to my neurologist about going to Mayo and she thought it would be good to go there.

I sent the literature I found with my request to be seen at Mayo to the surgeon who's paper I had read. The dismissal had been a blessing in disguise because during this time I was also caring for my elderly disabled parents and my dad passed away. Right after his services, I got the call to come to Mayo, and I got help immediately from a confident, kind, compassionate surgeon who recognized and understood what the others had missed. During the last several years, I've also had the help of a skilled physical therapist who helped me understand and develop body awareness of my issues, and it was frustrating for me to be able to describe my issues in detail with correct medical terminology and not be listened to by the prior surgeons. I think that can be a problem with doctor/patient communication because patients can believe anything on the internet. I have enough background in understanding this because in addition to the art, I also have a biology degree and had worked in neuro-anatomy research at a University, and studied human anatomy in art school, and I read all the studies I could find in regard to spine surgery during the 2 years I was getting worse and looking for help. Patients need to be the best patients they can be and do what they can to help under the guidance of their doctors. I kind of think of it like a job interview. I made appointments with surgeons only after I had read about their interests and publications, and after meeting them and how my questions were answered (or not), I had a sense of who I could trust. I asked intelligent questions, and the only surgeon who really impressed me was the one I hired at Mayo. A lot of surgeons want to take cases they know will be successful, so when a patient shows up with unusual symptoms, they hesitate, and wait. Mayo is known for taking cases that others refuse. The others told me that some of my symptoms were not related to the spine problem, but that was not true.

Thanks for your kind words. I know how difficult my journey was for me, and if I can inspire someone else to better health with my story, I am more than happy to share that. During my journey, I had to advocate for myself even when I was afraid of having surgery. It was also a journey in learning to overcome that fear. Having a compassionate surgeon made it easier for me to have the courage to make the choice to better my life. My Mayo surgeon changed my life for the better and I will be forever grateful.

Jennifer, you are most welcome. And, you are spot on about being your own advocate. That is the reason why I am leaving Hopkins and, thank goodness, going to Mayo, because I just don't have the time, and energy, to waste being sick and having a Dr. who isn't solving the issue. I exercise as much as I can, have removed most stress in my life, eat very well, and feel ready, mind and body, to begin again with Mayo. Your posts have really helped me to approach my forthcoming appointment with trust and ease: thank you again! all the best

@klhe I was wondering how you are doing? Did you find a doctor who is helping you?

Hi there, I've also seen two ENT's, a neurologist, PCP, Pain specialist, PT, MT and Chiropractic. I SWEAR my vestibular issues are coming from my upper cervical spine which in turn are causing headaches. What were all your symptoms? What kind of spine surgery did you have? Ive been looking to talk with someone about their upper cervical issues and dizziness. I stopped going to a Chiropractor 3 months ago. Think he caused more damage. I have pain to the upper right side, back of neck below ear. Stiffness, lightheadedness and balance issues with neck movements. My ears, eyes and brain are fine! Wish I could get someone to see the root problem in my neck. I definitely have vestibular issues but I truly believe it's from my neck.