Migraine-Associated Dizziness Is Elusive to Diagnose

Another good choice is sustained-release verapamil 120, 180, or 250 mg/day. Other antihypertensive agents that may be helpful include propranolol, 160 mg to 240 mg/day, and atenolol, 25 mg to 50 mg/day.

If patients are hypertensive and on another antihypertensive agent, you will need to adjust medications. Be alert for low blood pressure, bradycardia, and low energy. Also, antihypertensive agents can exacerbate pre-existing depression, he said.

Topiramate, 50 mg twice a day in graduated doses, can also be used to treat migraine-associated dizziness. Side effects include paresthesias, nausea, fatigue, inattention, and weight loss.

If these medications are not effective, Dr. Goebel refers the patient to a neurologist. He emphasized that the triptans can abort acute migraine headache but are ineffective for migraine-associated dizziness.

Vestibular Rehabilitation for Migraine-Associated Dizziness

If migraine-associated dizziness is controlled with medications, then vestibular rehabilitation can be helpful, explained Kim R. Gottshall, PhD, Director of Vestibular Evaluation and Rehabilitation at the Spatial Orientation Center at the Naval Medical Center in San Diego.

Assessment tools include the following:

• Dizziness Handicap Inventory (25 questions about emotional and functional problems)
• Activity-Specific Balance Confidence scale (questions about tasks and confidence, such as walking up stairs, standing on toes, and walking up a ramp, escalator, icy sidewalk)
• Dynamic Gait Index (assessing walking straight ahead, pivotal turn, and up and down stairs)
• Tinetti Assessment Tool (assesses fall risk in elderly patients).

Once the patient is assessed using these tools, a customized exercise program can be developed for each patient. The various types of exercise address vestibulo-ocular reflex, cervico-ocular reflex, depth perception, somatosensory retraining, gait training, aerobic activity, core stability exercises, plyometrics, and return to sports and work.

©2007 The Triological Society