Surprisingly to most people, the most common cause of dizziness is migraine associated dizziness. It is extremely common and is quite commonly not associated with significant headaches in a relatively large percentage of patients. I tend to refer to this problem as brain and nerve sensitivity, as not only the brain can have areas of migraine activity, but also the nerves coming off of the brain.
This can not only lead to headache, but also symptoms across all aspects of the head and neck region and beyond. The presence of migraine activity can also worsen ENT symptoms when there are also other problems present in those regions.
Sinus headaches and sinus pressure, ear pain and ear pressure, light sensitivity and spots or flashes in the vision, throat irritation, and even irritable bowel syndrome can be associated with the presence of migraine activity. Of course, we don’t point to migraine as a primary cause of head and neck symptoms without proper investigation to rule out other causes.
With respect to the inner ear itself, there is even significant suggestion that migraine activity can lead to or exacerbate inner ear problems such as benign positional vertigo, Meniere’s disease, superior semicircular canal dehiscence syndrome, tinnitus, and even potentially sudden hearing loss.
When I think that migraine activity can be playing a role in a patient’s condition, the discussion turns to migraine triggers. Common triggers include stress, head trauma/concussion, neck problems, allergy/mold exposure, recent surgery in the head/neck region, poor sleep, irregular meals, dehydration, hormone changes, weather changes, and medications (especially regular use of over the counter and prescription pain medications, certain antidepressants, and sometimes other medications). Many of these triggers are not easily controlled. However, there are also dietary triggers over which patients can have some control.
I will usually start patients on some migraine dietary precautions and magnesium and vitamin B2 (riboflavin) supplements, 400mg each daily. I caution that magnesium can cause diarrhea – if excessive, less should be taken. There are many patients who say that magnesium glycinate and possibly magnesium citrate may cause less diarrhea. Vitamin B2 can cause the urine to turn bright yellow (not harmful). I also have been cautioning patients that if they try the diet, to avoid allowing the diet to bring in too much stress into their lives, as stress can worsen migraine activity. I also generally tell patients to try to get some light to moderate exercise 4 times a week or so. These interventions need to be done for at least 4-6 weeks before we can assess if they are being helpful.
If there is not sufficient improvement with dietary changes and supplements, patients can also be started on migraine preventative medications that are usually well-tolerated. These are not for short term suppression of headaches, but rather, are done with trigger reduction techniques to help increase the threshold at which the brain would then experience migraine symptoms. These are also taken for 4-6 weeks (if well tolerated) before changes are considered.
Please look at the following websites for more information regarding migraine, diet information, supplements, and other potential treatments/recommendations from Dr. Michael Teixido, Dr. Shin Beh, and Alicia Wolf aka “The Dizzy Cook”:
- Dr. Teixido’s general migraine associated dizziness information – https://entad.org/wp-content/uploads/2021/12/Migrainehandout.pdf
- Dr. Teixido’s general migraine information in Espanol – https://entad.org/wp-content/uploads/2021/12/MIGRAINE-%E2%80%93-MORE-THAN-A-HEADACHE-Espan%CC%83ol-4.pdf
- Other patient information from Dr. Teixido – https://entad.org/resources/patient-information-dr-teixido/
- The Dizzy Cook – https://thedizzycook.com/
- Information from Dr. Shin Beh – https://www.vestibularmd.com/
Brian Kung, MD 