There's a lot of similarities from the vestibular migraine world with Havana Syndrome.
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1:17 - It [= vestibular migraine] is the second most common cause of vertigo in adults and can affect up to about 3% of the population. It tends to affect women more than men, and if you look at the studies, there is a difference in the reported numbers. So it can range anywhere from one and a half to almost six times more in women.
It tends to affect people of a slightly later age compared to migraine headaches. You know, so migraine headaches, it tends to affect the late teens, the 20s, early 30s, whereas vestibular migraine tends to affect people in the late 30s to the mid-40s.
Often people who have vestibular migraine tend to have a history of migraine headaches and have a very strong history of motion sickness as well.
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6:27 - The ear symptoms, although they are not part of the diagnostic criteria for vestibular migraine, are actually pretty common. In our case series at UT, we found that, you know, two thirds of our patients experienced some form of hearing symptoms during their vestibular migraine attacks. Most of them reported some degree of tinnitus, ear pressure, muffled hearing. Some reported even ear pain or some very unusual sensations. You know, some vibrating, bubbling, pulsating sensations inside the ear. Very nonspecific sensory symptoms like vibrating sensations of the head, tingling, numbness all over the body, or even pain can be experienced as well.
Now here is where the link or the relationship with Havana Syndrome also comes into play. Neuropsychiatric symptoms like brain fog or trouble thinking, you know, fatigue emotional liability. So, you know, you feel either, you know, really depressed or, you know, even euphoric and even some very unusual sensations, what we call the Alice in Wonderland symptoms. So Alice in Wonderland symptoms refer to misperceptions, or, you know, illusions of, sudden illusions or hallucinations that occur as part of migraine attacks. Some people experience feeling as if they grow larger, feeling as if they actually shrink, kind of like Alice in Wonderland, or feel less, as if things in the environment grow larger, smaller, appear closer, appear further away. Some experience out-of-body experiences where, you know, they actually leave the body, see themselves outside their bodies.
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8:24 - Visual symptoms, which are also pretty common in Havana Syndrome, are also extremely common in people who have vestibular migraine. Blurry vision. I hear that quite a lot. The feeling of eye strain. Visual snow is slightly less common, but it's a pretty remarkable, distinct symptom of migraine. So people, you know, appear to see like little pixels in their visions. Everything looks a little bit pixelated kind of like, you know, static on an old TV. Some also experience double vision as well.
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12:00 - Ear symptoms are also very common, you know, in the interictal phase. Noise sensitivity, a lot of patients experience that. Tinnitus, muffled hearing, ear pressure as well. Brain fog and fatigue are extremely common symptoms that I hear about in vestibular migraine. Anxiety, depression, insomnia also are not infrequently reported. In fact, 70% of patients with vestibular migraine experienced some form of anxiety. And in Dr. Teggi's Italian study, he went into a mental hospital and looked among the patients and found that, in fact, among those with depression, the complaints of dizziness was very low. But among those who have, who admitted for anxiety, the complaints of dizziness were really, really high.
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14:01: Now, I won't belabor this slide too much, but to, you know, recap some of the acute symptoms that have been reported with Havana Syndrome include, you know, the novel sound and the onset, ear pain, tinnitus, and of course our vestibular symptoms. You know, unsteadiness, vertigo, dizziness, headache, trouble thinking, nausea, head pressure, irritability. Again, there are a lot of similarities with vestibular migraine. The persistent symptoms. So, you know, once the acute phase is over and they enter into the persistent phase, a lot of patients with Havana Syndrome described the following. They have headaches, vestibular symptoms, aural symptoms, or ear symptoms, nausea, the visual symptoms, neuropsychiatric symptoms, and sleep disturbances. And again, looking at this slide and comparing it with some of our ... the experiences of some of our patients with vestibular migraine, you know, there is a
lot of similarity here.
14:52 - So what do we think is going on? How do we tie the two together?
So I think vestibular migraine can be incited by several different things. So the phenotype of vestibular migraine, the final diagnosis of vestibular migraine, I think that many things can lead to that diagnosis.
There is usually some form of inciting event. So a lot of my patients who, you know, end up seeing me describe some form of really bad stress at the beginning of it or some form of hormonal changes, either they had just delivered or they're going through menopause or depression, some serious medical illness,
and more recently, a lot of people who have had COVID-19 infections end up getting the symptoms of vestibular migraine.
15:34 - So what I think is happening is people who are genetically predisposed. You must have the genetics for it. And if you have some endogenous predisposition. Say, a good example, low vitamin D, low serotonin levels.
I think some inciting event will eventually push you over the edge to getting vestibular migraine. So like, the ones that I commonly see, you know, stress, hormonal changes, depression, medical illness, or even, you know, getting infected with COVID, and also concussions. So in people who are predisposed to vestibular migraine, I've even seen football players, you know, have a ... they have a history of migraine. They have a family history of migraine. And then after, you know, some very minor concussions, develop the symptoms of vestibular migraine.
16:20 -
And, of course, directed pulse radio frequency energy. Could it be, you know, that in some people who are exposed to such radio frequency energy, do they may not go on to develop vestibular migraine? Possibly. Could a subset of patients go on to develop vestibular migraine? Of course. And I think it's not been mentioned yet, but an interesting suggestion from our colleagues in Canada suggested that possibly organophosphate poisoning could also account for some of the symptoms. And, you know, looking at the patients who had recovered from the sarin attack in Japan and in some of the survivors, you know, organophosphate poisoning. It is possible that some of these patients also could go on to develop some symptoms suggestive of vestibular migraine.
17:07 - Of course, we need to investigate this further. We need a lot more studies into this. We need to understand, you know, do all patients with Havana Syndrome have vestibular migraine? Obviously not. Do a subset have vestibular migraine? I suspect so.
Vestibular Migraine (UT Southwestern, Feb 10, 2022)
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