VM fact sheets

New discussion on all things to do with Vestibular Migraine (VM) and Meniere's disease (MM).

VM fact sheets

Postby scott on 27 Jul 2009, 19:57

Hi All,

This sticky thread will be dedicated to collecting all of the best information available from various sources to help describe what this condition/illness/disease is all about. I'm hoping that any new people arriving here will finally get a handle on what it is that has been plaguing them if they were misdiagnosed or perhaps not diagnosed at all. These articles might also be a point where you can start before you follow-up with a specialist if necessary. Print these articles off and give them to your doctor if you feel it's appropriate or they are just not "getting it". There's nothing worse then coming across a physician who is in the dark about MAV and settles for telling you that you're "just anxious" or "it's all in your head (well, they'd be at least partially right!)".

Best ... Scott 8)
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Re: Essential MAV fact sheets

Postby scott on 27 Jul 2009, 20:08

Migraine Facts – Marcello Cherchi MD, PhD

Molly was given this paper by Dr Hain's group. It's a great piece of information.

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Click this link for the full handout (PDF) or read below.
http://www.mvertigo.org/articles/migraine_page_for_patients.pdf

Scott 8)

Migraine is very common
Migraine is a very common disease, estimated by some studies to affect as much as 10% of the general population. It is sometimes difficult to diagnose migraine because it can have a wide variety of symptoms (Buchholz and Reich 1996).

Migraine is poorly understood
The underlying pathophysiology of migraine remains incompletely understood despite considerable research efforts. Some of the proposed explanations include abnormal electrical activity in the brain, abnormal constriction of the cerebral blood vessels, and abnormal reactivity of those parts of the brainstem that process sensation from the face and head. The fact that migraine is poorly understood has made it difficult to come up with good treatments.

Migraine is often misdiagnosed because it can masquerade as other diseases
Often patients do not receive appropriate medical treatment because they do not recognise that they have migraines (Cady and Schreiber 2002; Kaniecki 2002; Schreiber et al. 2004). A recent survey of several thousand people reported the startling statistic that 46.6% of patients who met the criteria for migraine actually thought that they had some other kind of headache. The most common erroneous self-diagnoses were “sinus headaches” or “tension headaches” (Lipton et al. 2002).

Migraine can manifest with non-pain symptoms
A common misperception of migraine is that it is just a “really bad headache.” While it is true that many people with migraines find the headache to be the most incapacitating part of their migraines, it is very important to understand that migraine often involves non-pain symptoms. These non-pain symptoms are quite variable, and can include things such as visual changes, numbness or tingling, weakness of part of the body incoordination, language impairment, cognitive changes, and even alterations in consciousness. One of the most common non-pain symptoms of migraine is disequilibrium in its various forms, such as unsteadiness, dizziness, lightheadedness, or vertigo (Kayan and Hood 1984).

Migraine is the most common brain-related cause of dizziness
Unsteadiness can be caused by problems in a variety of body systems, including the ears, eyes, neck, joints, muscles, cardiovascular system, and peripheral nerves. Unsteadiness can also result from brain problems, and when this is the case, the cause is usually migraine (von Brevern et al. 2005).

The pain and non-pain parts of migraine can behave independently
Migraine is sometimes difficult to recognize because the pain part (the headache) and the non-pain part (whether it is dizziness, visual changes, weakness, etc.) do not necessarily occur simultaneously. In fact, the pain and the non-pain parts of migraine can follow completely separate schedules (Bisdorff 2004). Sometimes the non-pain parts of migraine have a rather chronic nature, and can even go on for several months, totally independent of actual headaches.

Migraine can occur even without headache
Though rare, some people have migraines that rarely or never involve headaches. In other words, their migraines only have non-pain symptoms. You may have heard of so- called “ocular migraines,” and this is one example of a migraine that only has only non-pain symptoms (namely, visual symptoms) and no headache whatsoever. But any of the other non-pain symptoms mentioned above can also be the sole manifestation of migraine (Amos and Fleming 2000; Freedom and Jay 2003).

Migraine characteristics can change over one’s life
The symptoms of migraine can change over the course of one’s life, and this is probably one of the features that make it difficult to recognize. Migraines can come and go; they can change in intensity, frequency or duration; and their non-pain characteristics can also change (Bigal et al. 2006; Kelman 2006).

Migraine patterns are sometimes associated with hormonal fluctuations
It is fairly common for migraine patterns to coincide with other physiologic changes. A common example is that migraine can be affected by hormonal changes such as those that occur during the menstrual cycle (Brandes 2006).

Migraine often occurs in association with other diseases
Migraine seems to occur in association with certain other diseases more frequently than would be expected by chance. For instance, migraine is found with greater than average frequency in people with thyroid problems, benign paroxysmal positional vertigo, seizures, Ménière’s disease, and mal de debarquement syndrome. This does not mean that they are the same disease. The reasons for these assocations are not clear.

Migrane patients usually have normal neurological examinations
If a person with migraines has no other medical problems, then his or her physical examination is usually normal. One exception to this is that people with migraines sometimes have subtle abnormal eye movements which we can observe in clinic using infrared video Frenzel goggles (Kayan and Hood 1984; von Brevern et al. 2005). Sometimes migraine patients also have eye movement abnormalities that can be detected by a test we use in the clinic called electronystagmography (Szirmai 1997).

There are no good tests for migraine
We diagnose migraine primarily based on the patient’s description of the symptoms. We rely on this because there is no blood test for migraine, and for the most part there is no CT or MRI that detects migraine. The only exception to this is that a small percentage of migraine patients will have small abnormalities on brain MRI (Swartz and Kern 2004). However, those abnormalities can also occur in certain other diseases, so the mere presence of the abnormalities does not make the diagnosis of migraine definitive.

Keeping a diary may help make the diagnosis and identify triggers
Since the diagnosis of migraine relies on the patient’s description of the symptoms, it is often helpful if a patient keeps a diary. The diary should include a detailed log of the particular symptoms, including when they start, when they end, how intense they are, and whether a particular episode has any unusual characteristics. It is also helpful to include in the diary things such as foods eaten, activities, and sleep schedules, because sometimes a pattern emerges which helps identify potential triggers for migraines (Tepper et al. 2004).

Migraine must be distinguished from other types of headaches
As discussed earlier, migraine can have a broad range of symptoms. This can make it difficult to distinguish from other diseases, including other types of headaches, particularly since the International Classification of Headache Disorders identified 184 distinct types of headache under 14 major headings (2004). Your doctor will work with you in trying to determine whether your symptoms might be related to migraine.

See all references in the PDF above.
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Re: Essential MAV fact sheets

Postby scott on 27 Jul 2009, 20:46

Joan kindly sent me the following information that was given to her as a handout by her doctor at Mass Eye and Ear regarding Migraine. It was written by Drs. Michael Teixido and John Carey at Johns Hopkins Otolaryngology and is called "Migraine - More Than a Headache". There's a page describing the migraine diet and also a page about vitamins and dietary supplements. Joan found it helpful and thought others might also.

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Thanks for sending this to me Joan. The more information we can amass here on the site from the top docs in the field the better our understanding will be on this junk. I also noticed they mention our forum on page 6 as a resource for people to use for more information and support. Great to see Carey knows about the forum!

http://www.mvertigo.org/articles/more_than_a_headache.pdf

Best ... Scott :)
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Re: Essential MAV fact sheets

Postby scott on 27 Jul 2009, 21:11

This information sheet is given to patients at Johns Hopkins under the guidance of John P. Carey, MD.

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http://www.mvertigo.org/articles/migraine_jhopkins.pdf
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Re: Essential MAV fact sheets

Postby scott on 27 Jul 2009, 22:57

From the University of California Health Services, these lists help to narrow down the foods to avoid when trying to root out migraine triggers.

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http://www.mvertigo.org/articles/migraine.triggers.pdf
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Re: Essential MAV fact sheets

Postby scott on 04 Oct 2010, 14:25

From The Walton Centre for Neurology and Neurosurgery
Dr Nicholas Silver

Chronic Migraine

"Chronic Migraine is a condition that may cause many different symptoms, usually including headache and/or facial pain. Patients usually experience some headache on at least half of the days each month.

Although headaches are often the most prominent feature of chronic migraine, some people experience relatively little discomfort. Some patients with chronic migraine present with other predominant complaints (e.g. chronic fatigue, neck or back pain, generalised body pains and tenderness, dizziness, vertigo, blackouts, poor memory and forgetfulness, excess sensitivity to noise or light, numbness down one side of the face or body, neck pain, exacerbation of irritable bowel symptoms, depression, irritability, etc.). In such people, it is important to recognise that features of chronic migraine are also present and that vigorous and appropriate treatment of this condition may provide significant alleviation of these symptoms."

See the full paper here:

http://www.mvertigo.org/articles/chronic_daily_migraine.pdf
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