[size=150]Migraine–anxiety related dizziness (MARD): a new disorder?[/size]
J Neurol Neurosurg Psychiatry. 2005 Jan;76(1):1-8
Furman JM, Balaban CD, Jacob RG, Marcus DA.
This editorial will focus on the pathophysiology and clinical issues relating to MARD, including the interfaces among balance disorders, migraine, and anxiety. We use current epidemiological data and studies of pathogenesis to develop comorbidity models. These models serve as hypotheses that may lead to possible treatment options for many patients with dizziness, including those with MARD.
It is not surprising that some patients with dizziness may suffer from a combination of a balance disorder, migraine, and an anxiety disorder, a symptom complex the authors propose to name migraine–anxiety related dizziness (MARD). Dizziness or vertigo occur in 54.5% of patients with migraine, compared with 30.2% of patients with tension-type headache.
Migraine related dizziness is a bona fide disorder.
The authors speculate that some episodes of vertigo in patients with MARD represent migraine aura without headache.
[size=130]Why are the three so tightly connected?[/size]
Fundamental to the pathophysiology of migraine is the trigeminovascular reflex.
Vestibular pathways can contribute to both central and peripheral migraine mechanisms. The reciprocal connections between the inferior, medial, and lateral vestibular nuclei and trigeminal nucleus caudalis suggest that vestibular and trigeminal information processing may be altered concurrently during migraine attacks, and that vestibular signals may directly influence trigeminovascular reflex pathways … changes in monoaminergic activity due to vestibular activation may both trigger migraine related symptoms and modulate activity in both pain related and anxiety related pathways.
In plain English: migraine, vestibular and anxiety neural pathways intersect in the brain. If one is stimulated, the others are impacted.
The previously held assumption that the presence of anxiety automatically implied a ‘‘psychogenic’’ cause for dizziness is no longer valid. It is for this reason alone that this condition is misdiagnosed so often!
The additive central effects of migraine, vestibular, and anxiety related circuits on perceptions of pain, vertigo, postural instability, passive coping, visual dependence, and space and motion discomfort are subject to considerable individual variations. [No two people are alike]
If anxiety is the predominant feature in the triad then a combination of an antidepressant and a benzodiazepene is the way to go. If migraine is predominant then any of the anti-migraine meds according to these guys.
The smart choice might be to use a med that tackles both migraine and anxiety all at once – the tricyclic antidepressants and Effexor fit this by killing two birds with one stone thus leaving the vestibular system alone and stopping all of the symptoms we love so much. On the other hand, it could be split in two so that one med tackles anxiety only and another the migraine if neither Effexor nor the tricyclics are a possibilty.