Dealing With a Migraine Like Janet Jackson's

A vestibular migraine involves the illusion of movement and can be disabling.


Hearing the news that singer Janet Jackson's bout with vestibular migraines would keep her from performing on tour for two weeks, some headache sufferers may wonder how to tell if they're experiencing this type of migraine. U.S. News talked to Richard Lipton, director of the Headache Center at Montefiore Medical Center in New York City, about vestibular migraines and how to prevent them. Edited excerpts:

What are vestibular migraines?
They're a form of migraine with aura [visual disturbances], in which the aura consists of imbalance or the illusion of movement. Vertigo is the most common feature, and it's usually defined as that illusion of movement, spinning, or swaying.

What causes this type of headache?
We know that as with other forms of migraine, people inherit a predisposition to migraine. Subtypes of migraines run in families, and vestibular migraines may. Beyond that, we don't know the specific cause. When people get vertigo, sometimes it's from disease in the inner ear and sometimes it's a problem in the brain stem. But we think what happens with vestibular migraine is that there are changes in the brain stem—not in the inner ear—that give rise to the symptoms.

Can vestibular migraines be prevented?
There are medicines that can be taken daily to prevent migraine. Four drugs are approved for migraine prevention—Topamax (topiramate), Depakote (divalproex sodium), Inderal (propranolol), and Blocadren (timolol).

When deciding whether to take these medications, patients and doctors should consider whether the attacks are frequent enough or severe enough to warrant taking medicine every day. If you're having attacks three or four days a month, then it's worth it, because headaches are affecting 10 percent of your days every month.

Can you treat vestibular migraines after symptoms have already set in?
Yes, they're treated like other types of migraine. The most widely used medications are from a family of drugs called triptans—including Amerge (naratriptan), Axert (almotriptan), Frova (frovatriptan), Imitrex (sumatriptan), Maxalt and Maxalt-MLT (rizatriptan), Relpax (eletriptan), and Zomig and Zomig ZMT (zolmitriptan). [In June, U.S. News listed other types of drugs used to treat migraines.] But the medications are better at relieving pain than relieving the vestibular (imbalance and vertigo) symptoms. Some people report that if they catch the headache early enough, they can prevent the vestibular symptoms.

Are vestibular migraines disabling?
Yes, they can be. For people who have auras, there are two components to the disability: the aura phase and the headache phase. The aura phase can involve vomiting, and sometimes the person can't walk. The pain phase that follows can also be disabling. There is also the post-headache phase, where people feel out of sorts.

If I think I am experiencing vestibular migraines, should I see a doctor?
Vestibular symptoms and headache can have causes other than migraine, so a good reason to see a doctor is to make sure of the diagnosis and to get treatment. If you have regular migraines, it's really a matter of how much the headache is affecting your life. If someone is missing work or school and living in fear of the next attack, then seeing a doctor makes sense.