Vestibular Migraine


Q: Do migraine patients tend to have an increase risk of benign paroxysmal positional vertigo (BPPV)?

Answer:

“Migraine patients tend to have an increase risk of BPPV. No one has looked at vestibular migraines to distinguish that from just migraines but migraine patients in general have a slightly higher risk of BPPV. And one possibility there is, if you go back to animal studies, trigeminal noxious, trigeminal stimulation, can actually induce inflammatory changes in the inner ear. That may be a possibility. I think there was a question on the pathophysiology of migraine. So migraine is a disorder of the trigeminal cervical system where each of the trigeminal nerves and the upper cervical nerves all combine to control sensation, control pain. And so if you keep getting migraine attacks, this recurrent trigeminal activation, that could proceed theoretically cause some inflammation in your inner ear. Over time, that may be the cause of the increased risks of BPPV.”

Faculty:

Shin Beh, MD

Q: Can concussions or brain injuries trigger vestibular migraines?


Answer:

“So concussions or brain injuries can actually trigger migraines and vestibular migraines. And so I suspect that people who are more prone to vestibular migraine are more prone to getting migraine if you have the genetics for it. Taking a good hit to the head or being in contact sports can trigger the migraines or the vestibular migraines to start for sure.”

Faculty:

Shin Beh, MD

Q: What if you have PPPD and vestibular migraine at the same time?

Answer:

“Great question there. And, the question would be, I can rephrase it to, what if you have both PPPD and vestibular migraine at the same time? So, with PPPD you have constant dizziness. And, PPPD can be triggered by anything that causes vertigo. Vestibular migraine obviously causes vertigo. And, a lot of my vestibular migraine patients, I think at least off the top of my head, over a half of them also have symptoms of PPPD.

And, so what I typically find is treating the migraines by reducing the number of vertigo attacks. That leads to an improvement of the PPPD symptoms as well. In some of the patients, who the PPPD symptoms don’t really get much better or don’t go away, those are the ones I consider sending for vestibular therapy to really help them get back to normal. They tend generally to be those patients who are more anxious, a little bit more prone to distress. That’s what I notice in general.”

Faculty:

Shin Beh, MD

Q: Which vestibular tests are you currently relying on most for helping differentially diagnose vestibular migraine?


Answer:

“So there are no tests that help confirm your diagnosis. The tests help you distinguish other conditions. So let’s say if you’re worried about Meniere’s disease, then you do the audiograms that look for the unilateral, low frequency, sensorineural hearing loss. But there is no single test that will help diagnose vestibular migraine. It is a clinical diagnosis pretty much like Triple-P-D, MdDS. You need to take a good history, do an exam, make sure you don’t have any other problems before you make the diagnosis of vestibular migraine.”

Faculty:

Shin Beh, MD



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FACULTY BIOs:

​Shin Beh, MD​

Shin C. Beh, M.D., is an Assistant Professor in the Department of Neurology at UT Southwestern Medical Center. A neurologist, Dr. Beh is the founding Director of UT Southwestern’s Vestibular Neurology and Neuro-Visual Disorders Clinic and serves on the faculty of the Multiple Sclerosis and Neuroimmunology Clinic. Dr. Beh’s research interests include vestibular migraine, and various other neuro-otologic disorders. He has published a number of scholarly articles and book chapters and presented nearly 40 abstracts and invited lectures related to his specialty. Dr. Beh serves as a reviewer for journals that include JAMA NeurologyJournal of Neurology, Neurosurgery & PsychiatryTherapeutic Advances in Neurological DisordersThe Neurologist; and Neurodegenerative Disease Management.