What is a Vestibular Migraine?

Claire Sissons / Reviewed by Elaine K. Luo, MD

Many people who experience migraines also have feelings of dizziness or vertigo. When this happens repeatedly, it is known as vestibular migraine. The causes of vestibular migraine are not always clear but relate to the inner ear, nerves, and blood vessels. The vestibular system of the inner ear and brain controls balance and how people understand the space they are in. When this is affected, someone may experience feelings of vertigo, unsteadiness, or dizziness, which can be triggered by movement.

Vestibular migraine is diagnosed when the vestibular system is repeatedly affected, in episodes lasting for minutes or hours, in someone who has a history of migraine. The sensation may be experienced alongside other migraine symptoms, such as an intense headache or nausea, or on its own. Around 40 percent of the people who suffer from migraine also have vestibular symptoms.



Key symptoms of vestibular migraine are dizziness, vertigo, and difficulties with balance, but symptoms can also include: neck pain, discomfort turning, bending down, or looking up, feeling of pressure in the head or the ear, tinnitus, partial or complete loss of vision and visual disturbances, such as flashing lights, spots, or blurring.

These symptoms may appear alongside a headache but can also appear on their own.


Causes, Triggers and Diagnosis

The causes of migraine are not completely understood. They are likely to relate to an unusual electrical charge in the neurons that sets off the brain's pain receptors. Triggers may vary from person to person. Keeping a record of factors leading up to a vestibular migraine can aid a diagnosis and help avoid an episode.

Common triggers include: stress and anxiety, food or drink, such as caffeine, alcohol, or dairy products, lack of sleep or too much sleep, bright artificial lights, and hormonal changes.


Treatment and Living with a Vestibular Migraine

Eating a healthful diet; getting the same amount of sleep each night; trying to reduce stress; exercising regularly; and avoiding any food or drink that can be a trigger help manage the condition. During a migraine episode, many people will find that lying down in a dark room or sleeping can help. Taking over-the-counter pain or nausea-relief medication at the first sign of migraine may reduce the severity of the episode.

Vestibular rehabilitation may help with regular or particularly bad episodes. This treatment can include exercises to stabilize the gaze and improve the ability of the eyes to track movement. It can also incorporate tasks to improve balance and hand-eye coordination.

Lifestyle changes, consulting a specialist, preventative medication and avoiding triggers can contribute to reducing the number of vestibular migraine episodes for many people. Medication is also available to help if vestibular migraine is severe and happens regularly enough to interfere with a person's life.



Elaine K. Luo, MD is a board-certified internal medicine physician who graduated from Tufts University School of Medicine in Boston, Massachusetts. She has experience in utilization management and has worked as a hospitalist and an outpatient primary care provider.