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The problem of dizziness is often vestibular migraines

The vestibular migraine, which is a more common cause of dizziness than many experts long thought, has been attracting more and more attention lately. In a vertigo clinic, this diagnosis can now be made in around every tenth vertigo patient, as data from the Munich University Clinic show. Vestibular migraine is a special form of migraine that occurs as a result of circulatory disorders in the brain stem. Although these are nothing more than migraine attacks that are accompanied by dizziness, vestibular migraines are often not recognized. Because around a third of dizziness occurs without a headache, which is why nobody thinks of a migraine at first. In the meantime, it is therefore recommended, if the cause of dizziness is unclear, to ask about simultaneous sensitivity to light and noise, as this typical migraine accompanying symptom makes the diagnosis of vestibular migraine very likely, as dizziness specialists emphasize. The same applies to cases in which a history of migraine is already known, which is often also a good indicator for this diagnosis.

From a therapeutic point of view, vestibular migraine, the duration of which can vary greatly from seconds to hours, differs only slightly from other migraine ailments. In many cases, beta blockers such as metoprolol or valproic acid are suitable for preventing attacks.

Concomitant symptoms reveal central dizziness

Apart from vestibular migraines, there are a number of other forms of vertigo, which are also based on disorders of the central nervous system and are accordingly referred to as central vertigo. This includes, for example, dizziness that can be traced back to a stroke or is caused by its precursor, the transitory ischemic attack. Other examples are brain tumors or multiple sclerosis diseases when structures of the equilibrium system are affected. With a little observational skill, you can often guess whether vertigo symptoms are centrally caused, even if you don't know the patient's medical history in detail. Because the underlying disease usually causes other disorders that become apparent on closer inspection or inquiries. In the case of strokes, for example, paralysis, a disturbed movement pattern, sensitivity disorders or problems speaking or, in the case of multiple sclerosis, spasticity and double vision.

What vertigo did Julius Caesar suffer from?

Very often, dizziness is also caused by Menière's disease, which is said to have suffered from famous personalities such as the general Julius Caesar or the reformer Martin Luther. This vertigo can often be recognized by the classic triad of vertigo, hearing loss and tinnitus. A feeling of pressure or fullness in the ear area, which often precedes the attacks, is also characteristic. Many sufferers also complain of nausea with or without vomiting. Menière's disease is caused by endolymphatic hydrops in the inner ear, which represents an increase in fluid and pressure in the endolymphatic space of the auditory and equilibrium organs. The sudden attacks lasting from minutes to hours can be explained by the fact that if the pressure in the endolymphatic space is too high, the separating membrane to the surrounding perilymphatic space ruptures and electrolytes pass over, which massively irritate the balance and auditory nerves.

Herpes viruses as causes of dizziness

The vertigo symptoms of vestibular neuritis can also be extremely agonizing. The main symptom is severe constant vertigo with nausea and vomiting, which can last for days up to a few weeks and often initially confines the affected person to the bed. The cause is now assumed to be a local herpes virus infection, which is no longer treated with antivirals, as it is likely to come too late. Because according to current knowledge, the virus replication is already complete when the symptoms of dizziness begin and those affected start taking medication. Instead, treatment is now carried out with cortisone, which has proven to be clearly superior in studies: A prospective, randomized, double-blind study showed that methylprednisolone leads to a statistically significant improvement in symptoms, while antivirals were unsuccessful. In the meantime, the administration of cortisone has also been included in the official guidelines of the German Society for Neurology as the treatment of choice for vestibular neuritis. It is crucial that you start glucocorticoid therapy as early as possible and choose a sufficiently high dose. For symptomatic treatment of vestibular neuritis, antivertiginosa should only be used in the acute phase and for no longer than three days. This is because antivertiginous substances have a sedating effect and hinder the central compensation, which is extremely important for the healing process in vestibular neuritis. Those affected should get out of bed as soon as possible in order to train their sense of balance. On the first day only very few can do this, but by the third day this should be possible for 90%.

Extremely short dizziness attacks?

Time and again, dizziness is also based on vestibular paroxysmia, the attacks of which are typically extremely short and usually last only seconds to a few minutes. Another distinguishing feature is that the symptoms can often be triggered or influenced by changes in the position of the head. In addition, those affected often suffer from a simultaneous hearing loss with ringing in the ears. According to current knowledge, the cause of these extremely brief attacks of vertigo is compression of the auditory and equilibrium nerves shortly before entering the brain stem, which in most cases is probably due to an artery in the cerebellum. As a prophylaxis against these often very unpleasant attacks of vertigo, the German Society for Neurology recommends the intake of carbamazepine, as is also common in trigeminal neuralgia, which is also based on too close contact with the vascular nerves.

Medicines rarely cause dizziness

When customers complain of dizziness, it is sometimes worth taking a quick look at the medication they are currently taking. Because dizziness can also occur as a side effect of various drugs. Typical representatives are, for example, antihypertensive agents, anticonvulsants such as carbamazepine or dopamine agonists in the context of Parkinson's treatment. If the symptoms of vertigo are unclear, the question whether the symptoms began with taking a new medication or after changing the dose can help. Most of the time it is vertigo or orthostatic problems. B. when getting up. Spinning vertigo attacks rarely occur here.

Violent argument about cervicogenic vertigo

A controversial diagnosis of vertigo is cervicogenic vertigo. Proponents of this diagnosis assume that disorders of the sensitive nerves in the cervical spine can lead to dizziness. Opponents doubt, however, that pathological changes in the cervical spine are a possible cause of chronic dizziness. Rather, according to numerous vertigo specialists, cervicogenic dizziness is a diagnosis of embarrassment that would be made primarily by doctors who are not sufficiently familiar with all the major causes of dizziness. According to experts, this applies in particular to phobic vertigo, which many doctors are not sufficiently aware of and whose symptoms are then wrongly dismissed as cervicogenic vertigo, as vertigo specialists continue to complain about.



Guidelines of the German Society for Neurology: vestibular neuritis, dizziness, benign peripheral paroxysmal positional dizziness



Dr. med. Karl Eberius

Freelance medical journalist, copywriter

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