A Guide to Vestibular Migraine

Medically Reviewed By Susan W. Lee, DO
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Vestibular migraine is one of several variants of migraine. “Vestibular” refers to the inner ear and its effect on your sense of balance. The main trait of this variant is vestibular symptoms, including vertigo and dizziness, that occur with other migraine symptoms. However, a headache does not have to be present for a doctor to diagnose vestibular migraine.

Doctors do not know exactly what causes vestibular migraine. Treatment is similar to other types of migraine, with lifestyle changes, drugs to treat symptoms of an episode, and preventive medications all forming a key part.

Vestibular migraine usually affects females in their 30s and 40s, but it can also affect males and children.

This guide looks at symptoms, causes, diagnosis, and treatments associated with vestibular migraine.

What is vestibular migraine?

Female with blurred background
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Vestibular migraine is a subtype of migraine. The hallmark of this form is the presence of vestibular symptoms, namely vertigo. Vertigo is the sensation that you are moving when you are still or that the world is moving around you. In fact, according to the American Migraine Foundation, vestibular migraine is the second most common cause of vertigo in adults.

Like other forms of migraine, vestibular migraine tends to affect females more than males. Children can also experience vestibular migraine. Most people with vestibular migraine have a history of migraine headaches or motion sickness.

Other names for the condition include migraine-associated vertigo/dizziness, migraine-related vestibulopathy, and migrainous vertigo.

What are the symptoms of vestibular migraine?

The main characteristic of this type of migraine is vestibular symptoms. These include:

  • head motion-induced dizziness with nausea 
  • head motion-induced vertigo
  • positional vertigo
  • spontaneous vertigo, either internally like you are moving or externally like the world is moving around you
  • visually induced vertigo

Vertigo can be moderate and limit daily activities or severe and prevent activity. It can last between 5 minutes and 72 hours and occur at any phase of a migraine episode.

A headache may or may not occur. If it does, some people have vertigo after the headache subsides. Rarely, vertigo starts during the aura phase, which typically occurs around 5–60 minutes before the headache or immediately before the headache. However, vertigo is not technically part of the aura.

Some other possible vestibular migraine symptoms include:

What causes vestibular migraine?

Scientists are yet to be able to explain the exact cause of migraine in general. The same is true for vestibular migraine. However, researchers have some theories. For example, they believe that vestibular migraine involves both central and peripheral factors.

Central factors include areas of the brain involved in balance and orienting your body in space. Peripheral factors relate to the inner ear and the nerves that transmit information to and from the brain.

It could be that any or all of these structures are overly sensitive to stimuli. 

What are the risk factors for vestibular migraine?

There are several factors that increase the risk of developing vestibular migraine, including:

  • being aged between 30 and 40 years, though the condition can affect those as young as 8 years old as well as older adults
  • having a family history of migraine headaches or episodic vertigo or dizziness
  • being female, with the condition being five times more common in females than in males 
  • having a personal history of migraine headaches or motion sickness

Some triggers of vestibular migraine may include:

  • certain foods, including chocolate and food additives, such as monosodium glutamate
  • complex or moving visual stimuli
  • dehydration
  • fatigue, a lack of sleep, or poor sleep quality
  • hormonal changes
  • hunger or missing meals
  • motion
  • stress or anxiety
  • weather changes, especially changes in barometric pressure

How do doctors diagnose vestibular migraine?

To diagnose vestibular migraine, doctors rely on a medical history and the results of a physical exam.

Some questions that your doctor may ask about your medical history include:

  • How many episodes of vertigo have you had?
  • How severe is the vertigo? Does it limit or prevent your daily activities?
  • How long does the vertigo last?
  • What other symptoms occur with the vertigo?
  • Do you get headaches with or near the time of the vertigo?
  • Do you get motion sickness?
  • Does anyone in your family experience migraine headaches or have vertigo?

The physical exam will focus on ruling out other causes of vertigo. Two closely related causes of vertigo are benign paroxysmal positional vertigo and Ménière’s disease. Testing usually involves audiology exams and vestibular function tests.

The International Headache Society diagnostic criteria for vestibular migraine include:

  • at least five episodes of moderate-to-severe vestibular symptoms lasting from 5 minutes to 72 hours
  • a current or past history of migraine with or without aura
  • at least half of the episodes having at least one of these features: 
    • a headache with two of the following:
      • one-sided location
      • pulsating quality
      • moderate-to-severe intensity
      • aggravation by routine physical activity
    • sensitivity to light and sound
    • visual aura
  • not explainable by another migraine diagnosis or vestibular diagnosis

How do you prevent vestibular migraine?

Prevention is an important part of managing vestibular migraine. One of the main strategies is avoiding triggers. So, the first step is to identify them.

You can do this with a headache diary. Keep track of what you are doing or experiencing before each episode. It can take time to find all your triggers, but once you do, it can give you some control over your episodes.

That said, there is not always a trigger. For episodes that do not have identifiable triggers, taking preventive medications may help. These include:

  • anticonvulsants, such as topiramate (Topamax)
  • antidepressants, such as nortriptyline (Pamelor) or venlafaxine (Effexor, Effexor XR)
  • beta-blockers, such as propranolol

Vestibular rehabilitation can also be part of the overall management and prevention of this type of migraine. This is a kind of physical therapy that trains your brain, eyes, and inner ear to work together. It aims to improve balance and proprioception, or the perception of your body’s position and movement in space.

What are the treatments for vestibular migraine?

Once an episode begins, vestibular migraine treatment aims to relieve symptoms. Resting and drinking fluids to stay hydrated are important.

There are also some medications that can help treat the symptoms, including:

  • antihistamines, which can help relieve vertigo
  • antinausea drugs
  • benzodiazepines
  • pain relievers, including acetaminophen (Tylenol) and ibuprofen (Advil, Motrin)

There is also some evidence to suggest that vagus nerve stimulation (VNS) can quickly relieve the episodes of vertigo. However, studies into the effectiveness of VNS for vestibular migraine are ongoing and are not yet conclusive.

What are the potential complications of vestibular migraine?

Migraine itself can be a debilitating condition. With vestibular migraine, the addition of vertigo can compound the problem. When vertigo is severe, it can prevent people from participating in daily life and their regular activities. For about 30% of people with this form of migraine, the episodes can last for days. 

It can also be very challenging for doctors to make an accurate diagnosis. It is common to see several different types of specialists before getting a diagnosis. This can take time, but getting a second opinion may give you more information and answers.

Other frequently asked questions

Below are some other questions people have asked about vestibular migraine. Dr. Susan W. Lee, D.O., has provided these answers.

How long does vestibular migraine last?

Vestibular migraine episodes typically last minutes to hours, though some may last longer than 24 hours. For example, there may be lingering symptoms of unsteadiness or motion sickness that persist for a day or more.

What is the most common trigger for vestibular migraine?

Dietary, lifestyle, and behavioral factors may trigger a vestibular migraine episode. Some of the most common triggers include caffeine, insufficient sleep, weather changes, and stress.

Does vestibular migraine show up on an MRI scan?

An MRI brain scan cannot detect or diagnose vestibular migraine. Undergoing a clinical evaluation by a neurologist is the best way to diagnose and treat vestibular migraine.

Summary

Vestibular migraine is a subtype of migraine with episodes of vertigo. Like other forms of migraine, it is more common among females in their 30s and 40s.

Treating vestibular migraine is similar to treating other forms of migraine. Prevention is a key part of managing the condition. Making lifestyle changes, taking medications, and undergoing vestibular rehabilitation can all be components of a prevention plan.

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Medical Reviewer: Susan W. Lee, DO
Last Review Date: 2022 Apr 28
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