Researchers at Emory University School of Medicine have found a more precise way to diagnose migraine-associated dizziness, which should greatly help in the treatment process of this debilitating condition. By identifying abnormal eye movements during a dizzy spell, doctors can quickly determine a diagnosis of migraine and treat the patient more competently. The results of this study were presented at the American Academy of Neurology in San Francisco on April 26.
"Migraine is a diagnosis of exclusion," says Sharon Hartman, MD, associate in Emory's Department of Neurology. "The condition is hard to diagnose because the symptoms resemble other similar conditions, such as Meniere's disease or benign paroxysmal positional vertigo (BPPV) - both conditions associated with vertigo and dizziness. Abnormal eye movement - often beating from side to side or up and down, called nystagmus, is specifically associated with migraine and dizzy spells. By identifying the nystagmus during a spell, we can definitively say the patient is having a migraine."
Migraine headaches affect 28 million Americans, according to the National Headache Foundation. Migraine can be characterized by throbbing head pain usually located on one side of the head, nausea, dizziness or vertigo, and sensitivity to light and/or sound. Some sufferers may even experience what is known as "aura" -- light flashes, blind spots and numbness.
Based on a retrospective review of patients with migraine and dizziness seen in Emory's Dizziness and Balance Center during the past year, the researchers found 26 participants that exhibited signs of nystagmus during migraine/dizzy spells or within 24 hours of the spell. All participants were asked to come to the center during a spell or within 24 hours of the spell occurring. Goggles with an infrared video camera were placed on the participants while in a dark room so their eye movements could be monitored and recorded.
All patients had been previously examined and found to have no abnormal eye movement when they were not having a spell. The researchers say this aspect is important, because if they had abnormal eye movement all the time, then they wouldn't be able to tell what was a spell.
"The uniqueness of this study is that we were able to observe patients on the day of their spell to catch the nystagmus," says Ronald Tusa, MD, PhD, professor of neurology and director of Emory's Dizziness and Balance Center. "Very few centers in the country have tried this approach, but we feel it is the best way to find answers for this condition."
Once diagnosed properly, migraine sufferers are often put on an avoidance diet to help prevent spells of dizziness. Migraine is frequently associated with triggers, so once patients identify their trigger points, migraines can be managed much more effectively. "We advise patients to avoid some know triggers, such as: don't stay up all night, don't skip meals, avoid certain foods like caffeine, chocolate, red wine, cheeses and reduce stress," Dr. Hartman explains. "If patients can avoid these triggers, they can avoid medications altogether."
Dr. Tusa notes it is ironic that foods that trigger migraine are the same foods that women crave around the time of their menstrual cycles. He goes on to say the foods that make you feel good actually do harm if you are a migraine sufferer. The most common type of migraine sufferer in this study was the perimenopausal female.
In addition to abnormal eye movement, some related symptoms can be beneficial in diagnosing migraine. They are headaches, motion sensitivity and anxiety. Some people may only experience several of these symptoms, while others may experience all.