What to Know About Vestibular Migraine

Learn about the symptoms, treatment options, and action steps vestibular migraine that affects balance

For many people, a migraine attack includes severe head pain. It’s the kind that makes you want to lay in a dark room until it passes. But it’s important to remember that not all types of migraine look or feel the same. Vestibular migraine, for example, affects your sense of balance. Often during an attack, you can feel like you’re moving, falling or spinning when you’re actually sitting still. We call this sensation vertigo. Alongside vertigo, a vestibular migraine can also include more typical migraine symptoms such as sound sensitivity, light sensitivity and often ear pain, pressure or ringing—but not necessarily headache. We turned to Dr. Shin Beh, founding director of UT Southwestern Medical Center’s Vestibular and Neuro-Visual Disorders Clinic, to give us insight into this particular type of migraine.

What is vestibular migraine?

The word vestibular relates to the inner ear and the balance systems of your body. It is associated with symptoms of vertigo. Vertigo is the sensation that you’re moving, falling, or spinning when you are sitting still. It can also be the sense that the world is moving around you. The condition can come on spontaneously or can be triggered by specific factors such as moving your head, looking at specific patterns or moving objects, or placing your head in a specific position. Some people who experience migraine can also experience an unusual symptom called “Alice in Wonderland“ syndrome, where things can look bigger or smaller than they actually are.

Vestibular migraine is the second-most common cause of vertigo in adults. Vertigo can happen at any point during a migraine attack.

“The key is to find the relationship,” says Dr. Beh. “If you notice a consistency between a vertigo attack and migraine symptoms, regardless of when the vertigo occurs during the migraine attack, if they are linked in time, then you can make the diagnosis of vestibular migraine.”

A headache isn’t always present during vestibular migraine attacks. Depending on the study, anywhere from 25-75% of patients have headache during a vestibular migraine attack, according to Dr. Beh. Since headache isn’t a consistent symptom, patients should also look for other migraine-type symptoms like light sensitivity and sound sensitivity to help their doctor diagnose their condition. Many with vestibular migraine also report a history of motion sensitivity or motion sickness beginning in childhood.

In addition, patients can experience brain fog, fatigue or difficulty finding words as well as other symptoms such as dry mouth, sweating, diarrhea, excessive yawning, tingling, scalp tenderness and visual blurring.

The impact of vestibular migraine

Vestibular migraine affects up to 3% of the adult population and affects up to 5 times more women than men. Most patients have a personal history of migraine headache and/or motion sickness, as well as a family history of migraine or similar episodic vertigo or dizziness.

Dr. Beh describes his typical patient with vestibular migraine as a woman in her late 30s or 40s with a history of migraine and motion sickness. While migraine may improve with age, vestibular symptoms often increase. These symptoms can affect a patient’s daily life, including their ability to drive, work and travel.

There isn’t a cure for vestibular migraine. But with the help of an experienced headache specialist, many patients learn to manage their triggers. That can help them live a normal life.

What are treatment options and ways to lessen the impact of symptoms of vestibular migraine?

If you are affected by vestibular migraine, it’s important to notice your triggers. In other words, know what experiences or situations seem to come before an attack. “Most of them are very similar to migraine—weather changes, not enough sleep, stress, menstrual cycle, bright light, flashing lights, missing meals, food-type triggers like caffeine, chocolate or alcohol,” says Dr. Beh. Your triggers can be very unique and sometimes difficult to pinpoint, so it is important to keep track of them.

Consider what happens before, during, and after a migraine attack. How do you feel? Is there something, in particular, that seems to come along with your migraine symptoms?  Keeping a headache journal is a good way to identify patterns—and to share this information with your doctor. Note specific examples of all your symptoms, such as dizzy spells or visual disturbances. Tracking your symptoms, noting possible triggers, and discussing treatment options with a doctor can help prevent and relieve vestibular migraine attacks.

Not all attacks have a trigger, so it’s also important to consult your doctor and discuss treatment options. “A lot of the treatments I use for migraine also can work really well in patients who have vestibular migraine,” says Dr. Beh. “The key is to find what works for you.” He often recommends options such as Vitamin B2, magnesium and Coenzyme Q10. Other treatments include prescription medications such as triptans as well as neuromodulation devices like the vagus nerve stimulator or external trigeminal nerve stimulator.

What should I do if I think I have vestibular migraine?

If you think you may have vestibular migraine, a headache specialist will be able to diagnose your condition and discuss your options for treatment and prevention. Use the American Migraine Foundation’s Find a Doctor tool to locate a healthcare provider near you who has experience working with other patients with headache, migraine and vestibular migraine. Schedule an appointment and be sure to bring your headache journal.

The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.