Holistic treatment needed to help patients who suffer from migraine with recurrent dizziness
6 March 2018 (The Straits Times) - I first saw Madam Ang, a 69-year-old retiree, in April last year. She had endured a rough year of three hospitalisations.
The cause for each admission was the same: severe bouts of dizziness and vertigo that resulted in severe vomiting and affected her ability to walk.
Another patient, Ms Boh, 34, had been suffering from dizzy spells for 10 years. The symptoms spiralled from bad to worse, forcing her to take a break from her job.
Then there was Mr Chong, 25, a professional dancer who struggled with performing his dance routines as he was hampered by frequent bouts of dizziness.
These three patients from different walks of life were among the 170 patients diagnosed with vestibular migraine at the multi-disciplinary balance clinic at Tan Tock Seng Hospital in the past two years.
Vestibular migraine is a condition that describes migraine with recurrent dizziness.
The criterion for diagnosing a person with vestibular migraine is strict. For example, other causes of chronic repeated dizziness have to first be ruled out.
All 170 patients also have current or previous attacks of headaches, which is another diagnostic criterion for migraine.
Most of them have never been formally diagnosed with migraine, but, interestingly, many suspected they have the condition. Nearly all of them did not know that migraine can be linked to chronic dizziness.
Many of the older patients said they had recurrent headaches when they were younger. The headaches subsided as they aged, only to be followed by dizzy spells that grew more intense and occurred more frequently over time.
More than half of the 170 patients have family members who suffer from recurrent headaches or dizziness.
"Common lifestyle triggers for migraine, such as dehydration, insomnia, stress, fatigue and negative emotions like anxiety, need to be addressed. Patients should also keep an eye on what they eat. For instance, consuming too much MSG, salt, caffeine, chocolate, cheese and alcohol can trigger a dizzy spell."
Patients with vestibular migraine often have “active” periods, during which they get bouts of dizziness, followed by periods when they are relatively normal. Each active period can last from a few days to several weeks, and an attack of dizziness may range from five minutes to several hours – or even one or two days, although this is rare.
Women frequently report that the dizzy spells coincide with their menstrual cycle. After that, they would be free of problems for a few weeks
Many patients have had symptoms stretching years or decades. For example, an 81-year-old woman reported symptoms over a 60-year period before the diagnosis of vestibular migraine was made..
Avoiding the Triggers
When dizziness strikes, it can cripple a person’s daily life. Some people cannot exercise and others even struggle to cross the road. This is partly because the dizzy sensation can be triggered by rapid movement of their heads.
People with vestibular migraine usually cannot tolerate being in a crowded place, such as an MRT station or a market; watching action movies; and walking along supermarket aisles or corridors that have repetitive patterns on the floor.
Almost all sufferers would say they have experienced motion sickness when riding in vehicles that travel on bumpy roads.
Whenever they feel uncomfortable, they tend to seek out dark and quiet places to rest. Upon careful questioning, many patients whom I have treated said they struggled to be productive at work. It was not uncommon for them to obtain medical leave.
Overall, their quality of life suffered greatly. Some were unable to carry on with their work, and many more had a difficult time trying to fulfil their responsibilities, such as caring for family members. To help this group of patients better, a holistic and personalised treatment approach is the way to go.
Common lifestyle triggers for migraine, such as dehydration, insomnia, stress, fatigue and negative emotions like anxiety, need to be addressed.
Patients should also keep an eye on what they eat. For instance, consuming too much MSG (monosodium glutamate), salt, caffeine, chocolate, cheese and alcohol can trigger a dizzy spell.
Those who develop anxiety as a result of their dizziness may be treated with cognitive behavioural therapy under a psychologist.
There is also effective medication to reduce the number and intensity of attacks during the active dizzy periods. The medication is also helpful in allowing patients to undergo “habituation” by vestibular therapists. This is where patients are taught a series of exercises that help to desensitise them to their own head movements or the movements around them.
With proper management, the patients will be able to live well with the condition.
This is especially important for older people as they may have other medical conditions that aggravate their dizziness and balance problems.
Dr Ho Eu Chin is a consultant at the Department of Otorhinolaryngology at Tan Tock Seng Hospital.