How to treat the intractable dizziness and balance disorder Dizziness with headache

Abstract

Headaches are a similar physical complaint to dizziness that is a functional disorder and it is difficult to ascertain any physical abnormality in such subjects. In addition, both of the symptoms may be caused by a possible fatal illness. Headaches are quite common in healthy subjects and it is a common comorbid disorder with dizziness. We found out that 163 (40%) of 403 patients with intractable dizziness complained of some type of headache. So far the relationship between headache and dizziness has not been intensively investigated. One reason for this is that the physicians who are specialized in vestibular disorders usually focus on the dizzy symptom and do not have much interest in the comorbid headache in the same patient. Recently the relationship between migraine and dizziness has attracted more interest than before and the diagnostic criteria of vestibular migraine have been proposed by the ICHD (International Classification of Headache Disorders). It is important to have basic knowledge concerning headaches to understand the vestibular migraine. Migraine and tension type headaches are important primarily headache disorders. It is well known that the patients with migraine are at a higher risk of having dizziness as a complaint. When we treat the dizzy patients with headache, it is important to identify the type of the comorbid headache. The prophylactic treatment is more important than the acute treatment. The point is to promote the life style change and pharmacotherapy. The first line of medical treatment is a Ca blocker, such as lomerizine hydrochloride, followed by valproic acid, and amitriptyline. Collaboration with headache specialists is also an important strategy.