The dizzy spells that are actually migraines – without the headache
22:32 GMT, 25 June 2012
'My head felt heavy, as if it was a bowling ball,' said Toria Law
When Toria Law went to her GP complaining she felt dizzy and occasionally nauseous, he assured her it was an inner ear infection and said she’d be back to normal within a fortnight.
To deal with the nausea, he prescribed some anti-sickness medication and signed her off work for a week.
However, over the next fortnight, rather than improving, Toria, 29, a content manager for an internet firm, began to feel much worse.
‘Whereas before I felt a bit giddy when I walked and moved about, it became so bad that whenever I moved my head or neck even slightly, the room would start spinning,’ says Toria, who lives with her boyfriend in South-East London.
‘I had to just sit on the sofa — I couldn’t go anywhere or do virtually anything as it would set off the spinning sensation.
'The medication made no difference and I could barely eat because I felt so sick.
'My head felt heavy, as if it was a bowling ball.
‘It was incredibly frustrating because as well as working full time, I’m a keen long-distance runner and would normally go out training four times a week — sitting around is not what I do.
‘I had to go back to work after a week, but felt so giddy I had to feel my way along the wall at the office to help me keep in a straight line.
'It was so difficult because I felt unwell, but when I sat down I looked fine.’
Toria also struggled to concentrate and her memory was affected.
‘I couldn’t remember what I had and hadn’t done at work, which was out of character. I was getting really worried.’
A fortnight after her first visit she went back to her GP, who referred her to an ear, nose and throat specialist.
But rather than wait, she used her health insurance to see a specialist privately.
A few days later he gave her the surprising diagnosis: migraine-associated vertigo. This is a migraine that doesn’t cause a headache, but vertigo.
Memory problems: 'I couldn't remember what I had and hadn't done at work, which was out of character. I was getting really worried,' said Toria
Toria says: ‘I had no idea you could have a migraine without a headache.
'I’d had two migraines five years before and they’d made me feel sick and caused horrendous pain, but I hadn’t suffered vertigo at the time.’
Migraine-associated vertigo is surprisingly common; it’s one of the most common causes of vertigo and an estimated one per cent of the population is affected, according to a paper published in the Journal of Vestibular Research.
This would mean there are hundreds of thousands of sufferers in the UK.
The condition is caused in the same way as traditional migraine headache — by changes in the blood flow in the brain — probably as a result of unusual spasms and relaxation of the blood vessels.
But rather than affecting the pain centres, it targets the balance areas of the brain, leading to vertigo.
Generally, the patient will have suffered migraine or travel sickness in the past, says David Selvadurai, the ENT surgeon at The Lister Hospital in London, who treated Toria.
‘Why it should change like this during someone’s lifetime we don’t know.
'But often people who suffer from this will have a history of travel sickness which is also related to the balance system.
‘Typically, it affects women — although it can happen to men — who have had migraines in their teen years or 20s that then stopped,’ says Mr Selvadurai.
‘Some will have had only one migraine headache in the past.’
Children can suffer — and often develop migraines in later life, adds Dr Andy Dowson, director of Headache Services at King’s College Hospital in London.
As well as vertigo, patients may suffer other symptoms. Mr Selvadurai says: ‘They will feel constantly off-balance, may complain their brain feels foggy and may have an aversion to light, sound or, in rarer cases, smells.
‘Once the vertigo happens, the body’s balance system needs to reset itself, which can take weeks or months.
'Generally, the younger and fitter you are the quicker this happens because the more active you are, the more the body works at resetting the balance system.
Migraine-associated vertigo is one of the most common causes of vertigo and an estimated one per cent of the population is affected
‘However, if patients are getting migraine-related vertigo attacks every few weeks or more, then the balance system never gets an opportunity to do this.
‘The problem is the condition is often not picked up quickly. It gets regularly mistaken for ear conditions such as labyrinthitis (an infection deep in the inner ear) or Meniere’s disease (another condition thought to be related to the ears which causes vertigo).’
But unlike these conditions, migraine-associated vertigo is straightforward to treat, so this protracted misery is so easily avoidable.
Mr Selvadurai adds: ‘If you are having vertigo attacks and have a history of migraine — especially if you have some other features that often accompany traditional migraine, such as an aversion to lights or strong smells — then it is probably migraine-associated vertigo.’
The first treatment approach is as for conventional migraine, to avoid trigger foods such as caffeine, red wine, chocolate, citrus fruit and yoghurt. And it should work.
Mr Selvadurai adds: ‘There is a bit of a debate about how much diet is related to migraine, and with traditional migraine, diet does not seem to have much of an impact for many patients.
‘However, people with migraine-related vertigo do seem very sensitive to changes in what they eat.It is possible to reduce their symptoms by excluding these foods.
'I see women who start each day with a glass of hot water and lemon — just cutting out that citrus ends their symptoms.’
Others require migraine medication.
‘Normally we need to keep people on the medication for four to six months and this gives the body’s balance system time to reset itself and for the symptoms to settle,’ says Mr Selvadurai.
‘Vestibular vertigo physiotherapy — a type of physiotherapy that involves exercises to improve balance — can help speed up recovery and this is useful for older patients who aren’t very active.’
However, there is a chance the condition will recur as a result of physical or mental stress.
A month after her vertigo first began, Toria started on the food-excluding diet.
She says: ‘I saw the specialist on December 23 and it was hell avoiding red wine and chocolate over Christmas as those were things I really enjoyed.’
Although she felt less dizzy, after two weeks her symptoms had not improved and she continued to have a couple of bad attacks.
So she decided to go on the medication pizotifen, which is thought to stabilise the blood flow in the brain, preventing the changes that lead to migraine attacks.
‘It was tough for the first week as the tablets made me feel sleepy,’ Toria says.
‘However, I soon noticed that I didn’t feel dizzy or foggy-headed all the time and fewer things triggered it off.’
She has since finished the ten-week course of tablets and feels like her old self again.
‘Towards the end of my course, I cut down the number of tablets I was taking and had a couple of glasses of red wine and chocolate,’ she says.
‘I have to be careful — at Easter I ate too much chocolate and felt horrendous. I would now never have more than two chunks of chocolate in a day.
‘I am so relieved to feel normal. I had wondered if I was going to feel dizzy for the rest of my life.’
Contact the Migraine Trust on 020 7631 6970, migrainetrust.org.