What is vestibular migraine? Symptoms, causes and treatments

Vestibular migraine is one of many variants of migraine. “Vestibular” refers to the inner ear and its effect on your sense of balance.

The main feature of this variant is vestibular symptoms, including dizziness and lightheadedness, which occur with other migraine symptoms. However, a headache does not have to be present for a doctor to diagnose vestibular migraine.

Doctors don’t know exactly what causes vestibular migraine. Treatment is similar to other types of migraine, with lifestyle changes, medication to treat the symptoms of an episode, and preventive medication all forming a key component.

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

This guide examines the symptoms, causes, diagnosis, and treatments associated with vestibular migraine.

What is vestibular migraine?

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Vestibular migraine is a subtype of migraine. Characteristic of this form is the presence of vestibular symptoms, namely vertigo. Vertigo is the feeling that you are moving when you are still or the world is moving around you. In fact, according to the American Migraine Foundation, vestibular migraine is the second leading cause of vertigo in adults.

Like other forms of migraine, vestibular migraine tends to affect women more than men. Children can also suffer from vestibular migraine. Most people with vestibular migraine have a history of migraines or motion sickness.

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

What are the symptoms of vestibular migraine?

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

  • dizziness induced by movement of the head with nausea
  • vertigo induced by head movement
  • positional vertigo
  • spontaneous dizziness, either internal as if you are moving or external as if 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 so, some people feel dizzy after the headache goes away. Rarely, vertigo begins during the aura phase, which usually occurs about 5 to 60 minutes before the headache or immediately before the headache. However, vertigo is technically not part of the aura.

Some other possible vestibular symptoms of migraine include:

What causes vestibular migraine?

Scientists are not yet able to explain the exact cause of migraine in general. The same is true for vestibular migraine. However, researchers have a few 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 orientation of 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 one or all of these structures are overly sensitive to stimuli.

What are the risk factors for vestibular migraine?

Several factors increase the risk of developing a vestibular migraine, including:

  • be between 30 and 40 years old, although 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 dizziness or lightheadedness
  • be female, with the condition being five times more common in women than in men
  • have a personal history of migraines or motion sickness

Some vestibular migraine triggers may include:

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

How do doctors diagnose vestibular migraine?

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

Some questions your doctor might ask you about your medical history include:

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

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. The tests usually involve 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
      • thrilling quality
      • moderate to severe intensity
      • worsening with routine physical activity
    • sensitivity to light and sound
  • not explainable by another migraine diagnosis or vestibular diagnosis

How to prevent vestibular migraine?

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

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

That said, there isn’t always a trigger. For episodes that have no identifiable triggers, taking preventive medications can 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. It’s 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, treatment for vestibular migraine aims to relieve symptoms. It is important to rest and drink fluids to stay hydrated.

Certain medications can also help treat symptoms, including:

  • antihistamines, which can help relieve dizziness
  • antinausea drugs
  • benzodiazepines
  • pain relievers, including acetaminophen (Tylenol) and ibuprofen (Advil, Motrin)
  • triptans, such as rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig)

There is also evidence to suggest that vagus nerve stimulation can quickly relieve episodes of vertigo.

What are the potential complications of vestibular migraine?

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

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

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

The treatment of vestibular migraine is similar to the treatment of other forms of migraine. Prevention is a key part of disease management. Lifestyle changes, medication, and vestibular rehabilitation can all be part of a prevention plan.

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