Are They Presentations of a Common Disorder?
Many patients present with dizziness as their only symptom. Whilst they are grateful they do not have to endure the awful pain of migraine or headache, significant dizziness can be disabling… and of course dizziness is another symptom that many with headache and migraine experience.
Many of those patients in whom dizziness was the only symptom have responded to correction of rotation of C2. This in turn removes noxious cervical afferent information from sensitising the brainstem.
So I am not surprised by the recent findings demonstrating migraine associated vertigo (dizziness) and Ménière’s Disease share a common condition.1,2 Furthermore, it appears that vestibular function in patients with vestibular migraine is normal.3
Just as in migraine (why!), the cause of Ménière’s Disease is unknown (and controversial) – could it be that the Ménière’s condition arises from a sensitised brainstem? My experience suggests that a skilled examination of the upper cervical spine (particularly C2-3) is crucial and the results (for many are) surprising.
1. Murofushi T, Ozeki H, Inoue A, Sakata A. Does migraine-associated vertigo share a common pathophysiology with Ménière’s disease? Study with vestibular-evoked myogenic potential. Cephalalgia 2009;29:1259-1266)
2. Neff BA, Staab JP, Eggers SD, Carlson ML, Schmitt WR, Van Abel KM, Worthington DK, Beatty CW, Driscoll CL, Shepard NT. Auditory and vestibular symptoms and chronic subjective dizziness in patients with Ménière’s disease, vestibular migraine, and Ménière’s disease with concomitant vestibular migraine. Otol Neurotol. 2012 Sep;33(7):1235-44.
3. Boldingh MI, Ljostad U, Mygland A, Monstad P. Vestibular sensitivity in vestibular migraine: VEMPs and motion sickness susceptibility. Cephalalgia. Aug 2011;31(11):1211-1219.