Vertigo (cont.)
Vestibular migraines
Dizziness as a symptom of migraine is a common and often ignored cause of
balance disorders. Migraine is a blood vessel (vascular) disease characterized
by periodic, usually one-sided, headaches. These headaches are often preceded
for a variable time by associated neurological symptoms, called the aura.
Dizziness and vertigo can occur in individuals with migraine as part of the
migraine aura or separately. Furthermore, dizziness may not occur at the same
time as the headache and can even occur as an isolated event. Particularly in
younger patients, dizziness or vertigo may predate the onset of headaches
entirely.
A family history of migraine is very common. Indeed, a family history of
migraine should alert a person that a balance disorder may be migraine related.
Migraine is estimated to affect nearly 25% of women, 15% of men, and 5% to 10%
of children. Vertigo is very common in persons with migraine, occurring in about
25% of them. Actually, in one series, 42% of migraine patients experienced
vertigo not in association with their headaches.
The management of migraine is divided into two categories: symptomatic and
preventive treatments. Acute attacks can be treated and stopped (aborted) with
various medications including Fiorinal, Midrin, and sumatriptan (Imitrex).
Preventive treatment is most frequently accomplished with propranolol (Inderal).
Amitriptyline, calcium channel blockers, and acetazolamide (Diamox) are also
used. Acetazolamide has been particularly effective in treating patients with
vestibular symptoms associated with migraine. For more please read the
Migraine
Headache article.
Inner ear trauma
Trauma to the inner ear can occur from penetrating injuries, blunt skull
trauma with skull base (temporal bone) fracture, concussion damage to the inner
ear, and sound or pressure trauma (barotrauma). The ear trauma itself can cause
balance symptoms. But, in addition, head trauma can dislodge particulate matter
that becomes free floating within the inner ear and causes positional vertigo
(see benign paroxysmal positional vertigo in this article). Treatment is directed toward the
underlying injury. Vestibular rehabilitative therapy is often helpful.
Perilymphatic fistula
The perilymphatic fluid baths the membranous structures (vestibule,
semicircular canals, and cochlea) of the inner ear. (These structures are filled
with another fluid called the endolymph.) A perilymphatic fistula occurs when
there is leakage of the perilymphatic fluid from a hole between the inner ear
compartment and the middle ear or mastoid. This hole can result from surgery,
trauma, infection, developmental (before birth) abnormality, or a sudden change
in pressure. In rare situations, it can occur without any apparent cause.
Patients with a perilymphatic fistula usually complain of a sudden onset of
vertigo or dizziness. In more than 50% of patients, a complete loss of hearing
also occurs. The diagnosis can only be confirmed at surgery when the hole is
actually seen. Although most perilymphatic fistulas will heal spontaneously with
rest, in some situations, surgery is performed to patch the hole.
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