Vestibular Migraine

This topic provides information about vestibular migraine.

What is vestibular migraine?

Vestibular migraine is a term used to describe a variant of a migraine in which the predominant symptom is dizziness instead of headache. Vestibular migraine describes a condition of migraine-related dizziness.

Migraine is thought to be a genetically based neurological disorder in which certain triggers cause an activation of pain receptors in the brainstem. The release of neurotransmitters then causes a dilation of blood vessels. It is thought to be a combination of changes in both vascular and neural processes.

About one-third of people who have migraine also report vertigo, and about three-quarters also report general dizziness and/or unsteadiness. Vertigo caused by migraine has been termed migrainous vertigo (MV) or migraine associated vertigo (MAV).

What causes vestibular migraine?

Migraines are a disorder in the pain pathways. The mechanism behind vestibular migraines are thought to be similar, but remain inconclusive. There appears to be an abnormality affecting the vestibular pathways of the brainstem, producing symptoms associated with the inner ear balance mechanisms.

There are several triggers of migraine. These may include:

  • Foods such as aged cheese, alcohol, caffeine, aspartame, or MSG
  • Going an extended time without eating
  • Stress
  • Hormone changes such as when menstruating, taking contraceptives, or during pregnancy
  • Heavy physical activity
  • Fatigue or change in sleep patterns
  • Certain sensory stimuli such as bright lights, sounds, or smells
  • Changes in weather or altitude

You have a greater chance of having vestibular migraines if you are a woman between the ages of 20 and 40 years old. Typically, migraine associated vertigo occurs later in life, and may replace the headache symptoms of the migraine during menopause.

What are the symptoms?

The typical symptoms of migraine include a pain or throbbing on one side of the head, sensitivity to light and/or sound, a visual aura, and nausea and/or vomiting.

The symptoms of vestibular migraine will vary from person to person. Some may experience an intense vertigo and others may just feel lightheaded or unsteady. Symptoms of vestibular migraine may also include motion sickness, disorientation, light or sound sensitivity, and diminished eye focus. The symptoms of dizziness can vary from seconds to days, and may or may not be accompanied by headache.

How is vestibular migraine diagnosed?

Since dizziness can be caused by many conditions, diagnosis of vestibular migraine can be difficult. A thorough history of symptoms is necessary for a correct diagnosis.

In most cases, people experience migraine headaches prior to developing vestibular migraines.

A hearing evaluation, vestibular testing, and imaging may be performed to verify the absence of any abnormalities related to other potential diagnoses.

It is likely that vestibular migraines have been misdiagnosed as Meniere’s disease or BPPV, in which symptoms can be similar. Vestibular evoked myogenic potential (VEMP) testing can be helpful in differentiating vestibular migraines from Meniere’s Disease or BPPV.

How is it treated?

Treatment for vestibular migraine is done mainly through migraine prevention. Migraine prevention includes avoiding known triggers and maintaining a healthy lifestyle and sleep habits.

Medications used to prevent the headaches associated with migraine may not prevent the dizzy symptoms of vestibular migraine, however calcium channel blockers, beta-blocking agents, antiepileptics, antidepressants, and other medications may be prescribed for chronic vestibular migraines.

For attacks of vertigo, anti-emetic (anti-vomiting) medications may be prescribed to provide nausea relief.

Vestibular rehabilitation may help to reduce symptoms.

Does vestibular migraine cause lasting problems?

Migraine is one of the most debilitating chronic conditions in the United States. Migraine symptoms can interfere with one’s daily activities and inability to perform daily tasks.

Lindsey Banks

Audiologist

Lindsey Banks is a graduate of the Doctor of Audiology (Au.D.) program at the University of Florida. She uses her diverse experience in hearing healthcare and her passion for helping people to provide credible information to those with hearing loss who visit Everyday Hearing.