For decades inner ear vertigo without hearing loss was diagnosed as “vestibular Meniere’s disease.” However, as Phillips and associates contend in an article entitled “Vestibular migraine: a marriage of convenience?” the diagnosis of vestibular migraine is simply a convenient label to fill the void left when vestibular Meniere’s disease was officially dropped as a diagnosis. Indeed, for many years I saw patients who were diagnosed with vestibular Meniere’s disease who in fact had an easily correctable dysfunction of the temporal bones of their skull. Then (mysteriously to me at the time) people started showing up with the diagnosis of “vestibular migraine.” What really drives people crazy is that they often receive this diagnosis even in the absence of headaches! Worse than that, doctors talk condescendingly to their patients if they question the logic of the diagnosis.
Yet these doctors freely experiment with everything from vitamins, diet and life-style changes, sleep studies and psychotherapy to the use of heavy duty drugs such as tricyclic antidepressants, anti-epileptic, and anti-Alzheimer drugs, all without any idea of what causes the vertigo and sometimes without even understanding how the drugs work, not to mention the utter lack of explanation of how such a diverse cartload of treatments could all be affecting the same thing.
Phillips’ article appeared in the journal, Headache in 2010. In the first place, say the authors, the occurrence of vertigo with migraine is so rare that a link appears improbable. More importantly, the diagnosis is biologically implausible. The parts of the brain that affect the vestibular system in the inner ear causing vertigo are different from the parts of the brain that cause migraines. The symptoms of patients labeled with vestibular migraine are consistent with an inner problem but not with a brain stem dysfunction seen in migraines. Finally, the types of abnormalities seen in vestibular tests such as electronystagmography, rotational chair testing and postural control assessment are no different than those noted in a variety of inner ear disorders.
This explanation certainly squares with my experience as a craniosacral therapist. Years ago I often saw people diagnosed with Vestibular Meniere’s or simply Meniere’s Disease even though they did not have the hearing loss typically associated with Meniere’s disease. Invariably these people had a temporal bone imbalance that was easily corrected with craniosacral therapy. Now that vestibular Meniere’s is no longer accepted as a diagnosis I frequently encounter people diagnosed with migraines even though they don’t have headaches. And yet the craniosacral evaluation is the same: out of phase movement of the temporal bones which is almost always easy to correct with the gentle touch of craniosacral therapy.