If you are worried about how vestibular migraine might affect your mental health, you're not alone. 

Understanding the potential impact is essential. This article helps you explore how vestibular migraine can affect your mental health and discusses strategies for coping with its effects.

Vestibular migraine can impact mental health, leading to emotional distress, anxiety, and depression due to unpredictable symptoms and limitations in daily activities. However, with appropriate management strategies, migraine sufferers can cope effectively and improve their well-being. 
For further insights into how vestibular migraine affects mental health and effective management techniques, continue reading about this topic that affects the lives of many people.

Introduction

Vestibular migraine

Migraine is an ordinary, chronic condition characterised by intermittent episodes, with two primary subtypes: migraine accompanied by aura and migraine without aura.¹

Common Migraine, also known as migraine without aura, is the most prevalent form of migraine. Individuals affected by this type typically endure moderate to intense headache discomfort, frequently localised on one side of the head. The pain tends to be pulsating or throbbing and may be accompanied by symptoms such as nausea, vomiting, sensitivity to light (photophobia), and sensitivity to sound (phonophobia). Headaches can last from several hours to several days.²

Classic Migraine, also known as migraine with aura, manifests with specific sensory experiences preceding the headache. These are known as “auras”. Auras are transient and reversible disturbances that may involve visual phenomena such as flashing lights, zigzag lines, blind spots, sensory alterations like tingling or numbness in the face or limbs, and difficulty speaking clearly or forming words.²

Vestibular migraine (VM) manifests with bouts of vertigo and dizziness, which can be intense and incapacitating, resulting in challenges with balance and coordination.²

Due to the lack of clear diagnostic criteria, various terms (such as vestibular migraine, migrainous vertigo, and others) have been used to describe the combination of migraine and vestibular symptoms. Recently, the International Headache Society and other experts established consistent diagnostic criteria to address this issue, facilitating research and improving clinical management.³

Mental health impact

Migraine is a neurological condition, thus a brain issue. Mental health problems also stem from brain issues and often occur alongside migraine with genetic links between them. Whether a cause or a consequence, addressing mental health alongside migraine is crucial, and support, such as through peer support or psychological therapies, can play a life-changing role. Interventions can vary from brief (a few sessions) to long-term (years for complex situations).⁴

Causes

Migraines can have a range of different triggers. These include: 

• hormonal changes 
• dietary factors like certain foods, drinks, and food additives
• skipped meals or dehydration 
• stress and anxiety 
• changes in sleep patterns 
• physical exertion 
• sensory stimuli 
• weather changes 
• certain medications 
• hormone replacement therapy 
• caffeine withdrawal 
• altered routines 
• allergies 
• exposure to smoking or second-hand smoke

These triggers can lead to the onset of migraine symptoms and should be carefully managed to reduce the likelihood of migraine attacks. Understanding these triggers can help migraine-sufferers to take proactive measures to manage migraine symptoms effectively, and gain relief.²

Estimated to affect 1 to 3% of the population, vestibular migraine appears to be more prevalent in people assigned female at birth (AFAB) and may have a hereditary or genetic basis. Onset typically occurs around age 40, although people with a family history of migraine or vertigo may experience symptoms at a younger age. Additionally, VM often coincides with a history of motion sickness.⁵

The exact underlying mechanisms of VM are not fully understood. Most theories about how they might develop are similar to those of other types of migraine, but none provide a comprehensive explanation for the complex processes involved. Connections between the vestibular system and pain-processing brain regions suggest an interaction between the nociceptive and vestibular systems.³

Diagnosis

The Bárány Society and International Headache Society have established specific criteria for diagnosing vestibular migraine, which include experiencing at least 5 episodes of moderate to severe vestibular symptoms lasting between 5 minutes to 72 hours. Additionally, individuals must have a current or previous history of migraine with or without aura, according to the International Classification of Headache Disorders (ICHD). 

Furthermore, at least 50% of vestibular episodes must have one or more migraine features, such as headache with specific characteristics, photophobia and phonophobia, or visual aura. These criteria aim to ensure accurate diagnosis and differentiation from other vestibular or headache disorders according to established standards.⁵

Treatment options

Managing migraines involves different approaches aimed at both relieving symptoms during an attack and preventing future episodes. Preventive treatments focus on reducing the frequency and severity of migraines and may include:

•  recognising triggers
• various medications or 
• lifestyle changes like stress management, such as managing stress 
• maintaining regular sleep patterns
• staying hydrated
• eating well, and 
• exercising regularly

Additionally, complementary therapies such as biofeedback, supplements, and bodywork techniques like massage may also provide relief for some individuals.² As previously mentioned, psychological therapies such as cognitive behavioural therapy (CBT) may help to manage vestibular migraines.

Medical management of VM often involves consultation with various specialists such as neurologists, otolaryngologists, neurotologists, or headache specialists. Treatment typically includes medications aimed at alleviating symptoms and preventing migraine episodes.

Pharmacological treatment for vestibular migraines

Although there is a lack of concrete evidence of their effectiveness, individuals diagnosed with VM frequently receive treatment with migraine preventive medications. This is based on the belief that these medications may also help alleviate vestibular migraine symptoms. Among the drugs commonly used for prophylactic treatment of VM are calcium-channel blockers, specifically flunarizine and cinnarizine.¹

Medications such as triptans or nonsteroidal anti-inflammatories are used to reduce the intensity and duration of migraines when they occur, usually taken at the onset of an episode. Medications such as amitriptyline, topiramate, or SNRI/SSRI antidepressants may be prescribed to decrease the frequency of migraine episodes or break the cycle of chronic migraines, especially for those with anxiety or visual sensitivity. 

Certain supplements such as magnesium citrate, coenzyme Q10, or riboflavin (vitamin B2) have been studied for migraine management, but their efficacy and proper dosage should be discussed with a healthcare provider. Botox injections may be considered for chronic migraine headaches that are unresponsive to medications; emerging evidence suggests potential benefits for vestibular migraine. 

Non-pharmacological treatment for vestibular migraines

Additionally, non-invasive nerve stimulation devices, which stimulate the vagus or trigeminal nerve, show promise in treating acute vestibular migraine attacks. It is essential to consult with a doctor and pharmacist before starting any new treatment.⁵

Lifestyle modifications play a crucial role in managing and controlling vestibular migraines. Identifying and minimising triggers can significantly reduce the frequency of episodes, although it may take time to recognise individual patterns. 

Dietary adjustments may also help to prevent migraines. This might include avoiding:

• caffeinated beverages 
• foods containing nitrates and nitrites 
• aged cheeses 
• cured meats 
• alcohol

Ensuring proper hydration is essential, as dehydration can act as a trigger for migraines. Managing stress through mindfulness, breathing exercises, and relaxation techniques is crucial too, as stress can exacerbate migraine attacks. Engaging in low-impact physical activities, under the guidance of a physiotherapist, can be beneficial for reducing the frequency and intensity of migraines. However, it's important to gradually increase physical activity levels to avoid triggering migraines, and modifications may be necessary for activities that involve head or body movements.⁵

Correlation

Migraine and depression 

Migraine and depression often coexist, with higher rates observed in people assigned female at birth. Various studies have consistently shown an increased occurrence of both disorders in people compared to chance alone. For example, research has indicated a stronger association between depression and migraines with aura compared to those without aura. Additionally, longitudinal studies have demonstrated a bidirectional relationship between depression and migraine, suggesting that one condition may predict the onset of the other.⁶

Migraine and anxiety

Anxiety, like depression, is a prevalent mood disorder often linked to migraine, with higher rates observed in people assigned female at birth (AFAB). Various studies have highlighted an association between migraine and anxiety disorders, including generalised anxiety disorders (GAD), panic disorders, and social phobias. 

People who experience migraines have been shown to exhibit increased chances of having GAD and other anxiety disorders compared to people who do not get migraines. Moreover, the likelihood of GAD in people who experience migraines increases with the frequency of migraine headaches. 

Studies have also suggested that the association of anxiety and depression with migraine is stronger in people AFAB with aura compared to those without aura. Additionally, people who get migraines and have anxiety or depression experience greater disability and a poorer quality of life than those without either disorder. 

Furthermore, people who experience migraines and have anxiety or depression tend to have a poorer response to treatment and incur higher health-related costs. This means that there are greater financial consequences for both society and for the individual.⁶

Migraine and mood disorders

Various lines of evidence suggest a connection between mood disorders and migraine, particularly concerning estrogen. This association is further supported by the higher prevalence of both migraine and mood disorders in people AFAB compared to people assigned male at birth, especially during hormonal fluctuations. 

People AFAB are also at risk for oestrogen withdrawal disorders like premenstrual dysphoric disorder and postpartum depression, along with conditions like menstrually-related migraine. Although oestrogen's role in medical conditions primarily focuses on people AFAB, it's noteworthy that all genders possess oestrogen and oestrogen receptors. Ostrogens play vital roles in mood-related functions such as growing new nerve networks, and in synaptic modulation in both people of all genders. 

Additionally, oestrogens regulate chemical messengers called neuropeptides that are associated with migraine and mood disorders. These include serotonin, dopamine, and glutamate. This suggests that mood disorders and migraine could be linked through shared pathways involving oestrogen and its receptors.⁶

FAQ’s

Do migraines impact mental health? 

Mental health conditions such as depression, anxiety, and bipolar disorder are more prevalent among migraine sufferers compared to others, occurring more than twice as frequently.

What happens in the brain during a vestibular migraine?

During a vestibular migraine, the brain struggles to process signals related to balance and motion perception. This causes heightened sensitivity to movement, often observed in people with a history of motion sickness.

Are vestibular migraines curable?

While migraine symptoms may lessen over time, vestibular symptoms tend to worsen, affecting daily activities like driving, working, and travelling. Although there's currently no cure for vestibular migraines, people who experience them can effectively manage their triggers with guidance from a skilled headache specialist.

Summary 

Migraine, a common neurological condition, includes subtypes like vestibular migraine that are characterised by vertigo. Triggers range from hormonal changes to stress. Accurate diagnosis relies on specific criteria that can also rule out other causes of symptoms. Treatments involve medications, lifestyle changes, and receiving psychological support. 

Depression and anxiety often coexist with migraine, particularly in people assigned female at birth, because of oestrogen’s relationship with neurotransmitter activity. Understanding these connections informs personalised and effective treatment approaches.