Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD
Imagine standing on stage, the music pulsing, the lights flashing, thousands of people at your feet, and all of a sudden, the world starts to spin and your head throbs. Trying to sing takes second place to trying to stand up straight and not vomit. Imagine being Janet Jackson in the midst of a vestibular migraine.
For many people, migraine equates to a bad headache. But migraines are much more than a lot of pain; they are a set of headaches associated with irritability of blood vessels, and changing blood flow patterns to the brain. The sequence often begins with an aura, a sensory clue that a migraine is about to start. Flashing lights, wavy lines, or funny smells may precede the throbbing headache. The aura occurs as blood vessels to parts of the brain start to constrict and decrease blood flow.
In some people, the blood flow can decrease so much that parts of the brain lose their blood supply and stop functioning. When part of the brain stops functioning, then the part of the body it supplies stops functioning as well. If this sounds like a stroke, it's because it in effect is. Fortunately, as the migraine headache resolves along with the blood flow issues, function returns to the brain and the body. But imagine how frightening this is for the migraine sufferer?
Janet Jackson has vestibular migraines. In her case, the part of the brain controlling balance is affected and causes vertigo, the sensation that the room is spinning. Vertigo can be miserable. It is associated with vomiting (think about riding a roller coaster), and the inability to walk without losing balance. Other symptoms can include ringing in the ears, decreased hearing, and loss of coordination. Individually, migraine headaches and vertigo are difficult symptoms to endure. Together they are doubly miserable.
The diagnosis of migraine is usually made by taking a history from the patient, but when the headache is associated with stroke-like symptoms, the patient needs to be thoroughly evaluated to make certain that it is a migraine, and not something catastrophic in the brain like bleeding, tumor, or a true stroke.
Once the diagnosis is established, migraine headaches should be considered as a long-term illness that the patient will need to manage. If the headache occurs rarely, then medications like tryptans [for example, sumatriptan (Imitrex), rizatriptan (Maxalt) or zolmitriptan (Zomig)] can be prescribed to abort the headache just as it begins. If they fail, then rescue medications can be used to control the pain. If the headaches occur more frequently, medications and lifestyle changes can be used to prevent future headaches.