Meniere's Disease and Migraine

Meniere's Disease and Migraine

Posted by Greg Bullock on 7th Sep 2019

Meniere’s disease and migraine are clinically unique syndromes that also share an extensive and often-complicated relationship with one another. In fact, it can be hard for doctors to distinguish between the two conditions, much less the patients who have to endure their symptoms. In this post, we break down the similarities and differences between both disorders.

Diagnostic Differences

Meniere’s disease and various migraine types frequently have overlapping symptoms like dizziness, tinnitus and even headaches, which can be an impediment to accurate diagnosis. However, medical professionals have worked hard to provide separate criteria for the identification of each condition. Let’s take a look at these clinical definitions.

In order to be definitively diagnosed with Meniere’s disease, patients must have:1

  • Episodic vertigo that persists between 20 minutes and 12 hours
  • Hearing loss caused by a problem in the inner ear
  • Other hearing-related symptoms, such as tinnitus (ringing in the ear)

On the other hand, migraine (both with and without aura) looks quite different on the surface. According to the ICHD-3 classification, a proper migraine diagnosis requires that a person have the following physical complaints over the course of at least five attacks:

  • Headache that lasts anywhere from 4 to 72 hours
  • Headache pain that is singularly located, pulsating, of moderate or severe intensity, and/or worsened by physical activity
  • Other sensory symptoms, such as light and/or sound sensitivity, nausea and/or vomiting

If you are looking at those definitions, then you might think the boundaries are pretty clear. But as we explain below, the real-life experiences of patients do not neatly fall into those categories.

Overlapping Symptoms

As most Meniere’s patients can probably attest, they are not strangers to the pain and other feelings of a migraine attack—even if they have never been diagnosed with a headache disorder and do not otherwise meet the criteria for one. A small study showed that at least half of people with Meniere’s disease deal with migraine-like head pain; and amazingly, 95% of those same individuals dealt with other typical migrainous symptoms—such as photophobia and phonophobia (light and sound sensitivity, respectively), motion sickness and brain fog.2

Here’s how one patient describes the experience:

"This comes on suddenly with no warning. As the spinning happens, there is a rush of pressure to my head, I get very hot and more often than not, sweat profusely. Sound is tunnel like and to top it off, tinnitus comes in at some point. Now recall, that all of this happens without warning and lasts 20 [minutes to several] hours. One minute you're having dinner with friends and a moment later you are on the floor with everyone wondering if you are dying. Often I become light sensitive and then I sleep for a day, because it leaves you physically exhausted." (source)

Additional evidence suggests that people with Meniere’s simply have a higher risk for developing episodic or chronic migraine, with perhaps more than half meeting the medical definition for it.3 Many with Meniere’s disease also report a family history of migraine or other headache disorders and also typically respond well to migraine-related treatments—furthering the link between the two.4 Certain experts have even gone so far as to label Meniere’s disease as an "atypical variant of migraine."

Similarly, those who have been diagnosed solely with migraine frequently deal with symptoms that resemble Meniere’s. Dizziness and vertigo is known to affect between 30-50% of migraineurs, and more than one-third of migraine patients have tinnitus or ringing in the ears.5,6 Hearing loss seems to be the most identifiable difference as it is less likely to manifest for those with migraine, but it can still occur, especially for those with sensory aura and/or prodromal or pre-attack symptoms.7

Rachel is a patient advocate who was diagnosed with migraine-associated vertigo and whose own story aligns with these findings:

Years passed, with her symptoms increasing from initial episodes of ‘just’ vertigo to a plethora of somehow worse problems, such as extreme fatigue, all-day headaches and difficulty driving, concentrating, and reading...About three years after Rachel’s first vertigo episode she became aware that her life had completely changed." (source)

This narrative also highlights the fact that the onset of migraine and corresponding vestibular symptoms often do not appear at the same time. People may be living for years with migraine before they ever have their first dizzy or lightheaded spell; similarly, some may deal with constant vertigo in absence of headache well before it is ever linked to migraine.

Meniere’s Disease vs Vestibular Migraine

We cannot discuss Meniere’s disease without also acknowledging its connection to vestibular migraine, a specific subtype of the headache disorder. With the high prevalence of vertigo and dizziness associated with migraine, the medical community needed a diagnostic tool that directly addressed the experiences of patients. However, even then, there has been reluctance to accept vestibular migraine on its own due to the sheer volume of shared symptoms with other vestibular disorders like Meneire’s disease.8

Regardless, its classification does not change the fact that vestibular migraine often comes with Meniere’s-like complications and characteristics.

Meniere’s Disease vs. Vestibular Migraine1
  Meniere’s Disease Vestibular Migraine
Age of onset 48 years 43 years
Duration of vertigo symptoms 47 hours 19 hours
Tinnitus 83% 46%
Fluctuating or progressive hearing loss 78-93% 14-22%
Headache 41% 95%
Headache duration >24 hours 8% 43%
Moderate or severe headache pain 26% 96%
Photophobia or light sensitivity 41% 80%
Phonophobia or sound sensitivity 62% 80%
Vomiting 84% 69%
Aura 11% 32%
Anxiety symptoms 78% 91%
Family history of migraine 26% 61%

This information illustrates that there are clear differences between both syndromes, but they are often subtle and therefore challenging to make definitive declarations from a diagnosis perspective. Further compounding the muddiness is the fact that one out of every four patients diagnosed with either condition actually have comorbid vestibular migraine AND Meniere’s disease. And the connections run so deep that some have even proposed a new clinical definition for patients with both disorders.9,10

Overlapping Triggers

If you have Meniere’s disease, migraine (vestibular or other), or both, you are likely to have vestibular and/or migrainous symptoms triggered by various factors. Some of the shared triggers include:11

  • Bright or flashing lights
  • Dietary choices, skipping meals
  • Head position, rapid head movements
  • Physical exertion, exercise
  • Stress
  • Weather

While the scientific link varies between these items and the actual likelihood of triggering either or both conditions, we must accept that they are a core aspect of the patient experience.

Long-Term Prognosis

There is no cure for migraine or Meniere’s disease, and so they will likely be a lifelong companion for the vast majority of patients. However, it is encouraging to note that longer term outcomes for patients suggest a general decrease in the core vestibular symptoms, notably vertigo and dizziness. And the relief from these issues may be even more substantial for those with Meniere’s.8 Furthermore, as with any chronic illness, proper treatment can result in a significant improvement in quality of life.

Conclusion

Experts do not have an exact understanding of why it happens, but overwhelming research supports the extensive connection between Meniere’s disease and migraine—especially vestibular migraine. Symptoms, triggers, and broader experiences can all overlap and make diagnosis particularly difficult. This has ultimately led to valid questions over exactly how to classify and diagnose both conditions in order to provide the best treatment for patients.


Additional reading:

The 9 Most Common Symptoms of Vestibular Migraine

Everything We Know about Vestibular Migraine and Light Sensitivity

Top Triggers of Vestibular Migraine

Light Sensitivity and Dizziness


References:

1Lopez-Escamez JA, et al.; Classification Committee of the Barany Society; Japan Society for Equilibrium Research; European Academy of Otology and Neurotology (EAONO); Equilibrium Committee of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS); Korean Balance Society. Diagnostic criteria for Menière's disease. J Vestib Res. 2015;25(1):1-7. doi: 10.3233/VES-150549.

2Ghavami Y, Mahboubi H, Yau AY, Maducdoc M, Djalilian HR. Migraine features in patients with Meniere's disease. Laryngoscope. 2016 Jan;126(1):163-8. doi: 10.1002/lary.25344. Epub 2015 Jun 24.

3Radtke A, Lempert T, Gresty MA, et al. Migraine and Ménière’s disease. Neurology 2002 Dec;59(11):1700-1704; doi: 10.1212/01.WNL.0000036903.22461.39.

4Ghavami Y, Haidar YM, Moshtaghi O, Lin HW, Djalilian HR. Evaluating Quality of Life in Patients With Meniere's Disease Treated as Migraine. Ann Otol Rhinol Laryngol. 2018 Dec;127(12):877-887. doi: 10.1177/0003489418799107. Epub 2018 Sep 9.

5Stolte B, Holle D, Naegel S, Diener HC, Obermann M. Vestibular migraine. Cephalalgia. 2015 Mar;35(3):262-70. doi: 10.1177/0333102414535113. Epub 2014 May 20.

6Kırkım G, Mutlu B, Olgun Y, et al. Comparison of Audiological Findings in Patients with Vestibular Migraine and Migraine. Turk Arch Otorhinolaryngol. 2017;55(4):158–161. doi:10.5152/tao.2017.2609

7Lee H, Whitman GT, Lim JG, et al. Hearing Symptoms in Migrainous Infarction. Arch Neurol. 2003;60(1):113–116. doi:10.1001/archneur.60.1.113

8Liu YF, Xu H. The Intimate Relationship between Vestibular Migraine and Meniere Disease: A Review of Pathogenesis and Presentation. Behav Neurol. 2016;2016:3182735. doi:10.1155/2016/3182735

9Neff BA, et al. Auditory and vestibular symptoms and chronic subjective dizziness in patients with Ménière's disease, vestibular migraine, and Ménière's disease with concomitant vestibular migraine. Otol Neurotol. 2012 Sep;33(7):1235-44. doi: 10.1097/MAO.0b013e31825d644a.

10Murofushi T, Tsubota M, Kitao K, Yoshimura E. Simultaneous Presentation of Definite Vestibular Migraine and Definite Ménière's Disease: Overlapping Syndrome of Two Diseases. Front Neurol. 2018;9:749. Published 2018 Sep 10. doi:10.3389/fneur.2018.00749

11Kirby S, E, Yardley L: Physical and Psychological Triggers for Attacks in Ménière’s Disease: The Patient Perspective. Psychother Psychosom 2012;81:396-398. doi: 10.1159/000337114

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