Vestibular Migraine: Symptoms, Causes, Treatment

Most of us know what it’s like to feel dizzy. You feel faint and woozy, and you get that strange sensation that the world is moving or spinning, even though you know it is not. It’s common and completely normal to feel dizzy after getting off a ride that spins you in circles, or after climbing off a rocking boat. What’s not normal is to experience bouts of dizziness, lasting hours or even days, for seemingly no reason at all.

Those bouts of dizziness could be migraines! Specifically, they could be a type of migraine known as a vestibular migraine. The vestibular system refers to the inner ear, which plays an important role in maintaining your sense of balance.
Within this system, your brain has to figure out where your head is in space. When something is amiss in this signaling, the brain perceives the wrong signal and thinks the head is up for example, when in fact it is neutral.

We in the scientific community think migraines cause more aberrant signaling and can cause dizziness even without a headache! A vestibular migraine, then, is a migraine characterized by changes in balance and feelings of dizziness — the general symptoms to be expected when something is amiss with your inner ear or its connections to the brain.

What Are the Symptoms of Vestibular Migraine?

As with any other type of migraine, symptoms vary between patients. For some patients, the only symptom is that nagging feeling of dizziness and unease. Often, however, the dizziness is accompanied by:

  • Sensitivity to sound and/or light, and/or odors
  • Feelings of confusion or disorientation
    Nausea
  • Extreme sensitivity to motion; you may not want to walk or even turn your head


Although people tend to think “headache” when they think of migraines, not everyone who suffers from migraines experiences a headache. For some patients, the vestibular symptoms are a precursor to the headache. For others, they occur at the same time as the headache. And still there are others who experience bouts of vertigo, photosensitivity, and unease due to migraine without actually experiencing a headache.

What Causes Vestibular Migraine?

Although researchers do not completely understand what causes migraines in general or vestibular migraines specifically, it is thought that changes in hormone levels — primarily serotonin levels — cause blood vessels in part of the brain to swell. This places pressure on nerves and leads to the symptoms of migraine. In some patients, the part of the brain that is affected is closely related to the inner ear, which leads to symptoms of vertigo and dizziness.

There does seem to be a genetic component to vestibular migraines. If a close relative suffers from them, you’re more likely to also have them. This is something your doctor will consider when diagnosing you.

How Is Vestibular Migraine Diagnosed?

There is no single test to determine whether you’re having vestibular migraines. Rather, your doctor will rely on your symptoms and health history in order to make a diagnosis. The International Headache Society lays out specific criteria for the diagnosis of vestibular migraine, which can be summarized as follows:

  1. Five or more episodes of vestibular symptoms (such as dizziness, vertigo, loss of balance) that last anywhere from 5 minutes to 72 hours.
  2. Half of these episodes are accompanied by headaches, sensitivity to light or sound, or an aura.
  3. A history of migraine or currently suffering migraines.
  4. No other vestibular disorder diagnosis better explains your symptoms.

Many sufferers of vestibular migraine are patients who had migraines in the past — perhaps during childhood or adolescence — and are now experiencing a recurrence of migraines, although in a different form. For this reason, it’s important to tell your doctor about any history of migraines, even if you have not had one in years.

Other Conditions

As you can see, one of the criteria above is that your symptoms are not better explained by another diagnosis. So what are these other vestibular disorders that your doctor must seek to rule out? Here are a few of the most common ones.

Meniere’s Disease is a condition in which abnormal fluid balance in the inner ear leads to hearing loss and bouts of dizziness. Vestibular migraines are often misdiagnosed as Meniere’s disease, so if you’ve been diagnosed with Meniere’s and have a history of migraine, it’s worth seeing a migraine specialist for a second opinion.

Benign Positional Vertigo occurs when crystals of calcium carbonate enter the semicircular canal, a part of your ear canal. This interferes with the messages your brain receives from your ears, leading to feelings of dizziness.

Transient Ischemic Attacks are essentially mini-strokes that can lead to periods of vertigo, weakness, and slurred speech. It’s important to rule these out since they can be a precursor to a stroke.

How Common Are Vestibular Migraines?

There are many people who deal with periodic bouts of vertigo and have not sought a diagnosis because they feel alone or helpless. But here’s the thing: vestibular migraines are more common than you think, and as such, they’re pretty well-researched with a lot of well-established treatment options available.

Vestibular migraine is the most common cause of spontaneous, recurrent bouts of vertigo, and at least 10 percent of all migraine sufferers experience vestibular symptoms.

Dizziness is also one of the top five symptoms that brings patients to the doctor. So you’re not alone, your symptoms are not all that rare, and there are definitely treatments available.

How Is Vestibular Migraine Treated?

As with any type of migraine, there can be some trial and error involved in order to find the combination of treatments that works best for you. Most patients benefit most from a combination of lifestyle changes and medications.

Lifestyle Changes to Avoid Triggers

Vestibular migraine patients often find that their migraines are triggered by certain factors. Your doctor can guide you through the process of keeping a diary in order to identity your personal triggers. Then, working to avoid those triggers should reduce the frequency of your migraines. Common triggers for vestibular migraines include:

  • Lack of sleep
  • Dehydration
  • Stress and anxiety
  • Hormonal changes, such as those that occur during menstruation
  • Fermented foods such as aged cheese, yogurt, and sourdough bread
  • Alcohol and caffeine
  • Changes in barometric pressure


Vestibular migraines are more common in women than in men. They tend to occur during or just before menstruation, and also during menopause. If this is the case for you, talk to your doctor about using birth control pills or hormone replacement therapy to help control your migraines.

Medications

When lifestyle changes alone are not able to control your vestibular migraines (which is common) there are a number of medications your doctor can prescribe, including:

Beta blockers, which work by preventing the dilation of blood vessels, which is thought to contribute to the development of migraines.

Calcium channel blockers, which inhibit the movement of calcium across cell membrane walls to keep artery walls from contracting and constricting.

Various antidepressants, which help alleviate the effects of stress and anxiety, including migraines, which can be a consequence of stress. These medications also regulate serotonin levels, which can directly decrease the frequency of migraines.

Note that as with any type of migraine, home remedies like essential oils and herbal blends are not backed by research and are unlikely to offer the relief you seek. Only a doctor can properly diagnose your vestibular migraines and prescribe the most effective treatments.

If you suffer from bouts of dizziness that you think may be due to vestibular migraine, contact me, Dr. Risa Ravitz. Book an appointment, and we can work together virtually to examine your symptoms and health history and arrive at a diagnosis.