Vestibular Migraine

What is a vestibular migraine?

A vestibular migraine (VM) is a neurological disease that causes vertigo. Vertigo makes you feel dizzy and off balance. Studies show vestibular migraine is the second most common reason why people have vertigo. Other names for a vestibular migraine include migraine-associated vertigo (MAV), migraine-related vestibulopathy and migrainous vertigo.

Researchers haven’t decided if vestibular migraines are a form of migraine or a separate but related condition. But they agree the condition affects people’s quality of life. Healthcare providers may recommend lifestyle changes and medication to treat vestibular migraines.

Are they common?

Vestibular migraines cause dizziness, a common issue, but the migraines themselves aren’t common. One analysis found 2.7% of people in the United States had vestibular migraine symptoms. Other research shows that a significant percentage of people seeking treatment for dizziness and balance issues have vestibular migraines.

What are the symptoms of a vestibular migraine?

The most noticeable symptoms are vertigo symptoms — having balance issues, dizziness and feeling light-headed. Vertigo symptoms may come and go within minutes or last for days. They can be quite severe, affecting daily life. Other symptoms may include:

• Nausea and vomiting.
• Sensitivity to sound, light and odors.
• Headache.

What causes vestibular migraines?

Experts are researching the specific cause or causes. But they do know risk factors, including:

• Having a history of migraines, including childhood migraines.
• Stress.
• Fatigue.
• Serotonin imbalance.
• Hormonal changes from menopause or periods.
• Changes in barometric pressure (weather changes).
• Certain foods and liquids.

How is a vestibular migraine diagnosed?

Healthcare providers first ask questions about your symptoms, including how long you’ve been dealing with dizziness and balance issues. They do that because conditions like Ménière’s disease and benign paroxysmal positional vertigo (BPPV) also cause dizziness or a spinning sensation. Providers will rule out other potential causes before focusing on vestibular migraine as a diagnosis.

In general, you may receive a vestibular migraine diagnosis if you have:

• Sudden attacks of vertigo that make you vomit or feel nauseous.
• At least five episodes of vertigo, with half of those causing other migraine symptoms, like headache or increased sensitivity to light, sound or touch.
• Vertigo that lasts for five minutes up to 72 hours.
• Vertigo that’s so severe that it affects your ability to work or manage everyday activities.
• Migraine aura.

If your provider suspects you have a vestibular migraine, they may do the following tests:

• Neurological examination.
• Videonstagmography or electronystagmography.
• Imaging tests like computed tomography (CT) scans or brain magnetic resonance imaging (MRI) scans.
• Hearing loss test.

What is the treatment for vestibular migraines?

Healthcare providers may recommend medications, lifestyle changes or vestibular rehabilitation therapy.

Medications

Healthcare providers may recommend daily or weekly medications that reduce the chance you’ll have a vestibular migraine. Or they may recommend medication that eases migraine symptoms when you have one.

Medications that may prevent vestibular migraine include:

• Tricyclic antidepressants.
• Calcium channel blockers.
• Antiseizure medications.
• Beta-blockers.

Medications to reduce symptoms include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs).
• Motion-sickness medications.
• Antipsychotic medication.

Lifestyle changes

Your provider may recommend that you:

• Get more rest than usual.
• Schedule regular meals and snacks.
• Avoid certain foods and beverages. There’s a long list of food and beverages that trigger migraines. If you have vestibular migraines, your provider will explain what you should avoid.
• Get some exercise.
• Find ways to reduce stress.

What can I expect if I have vestibular migraines?

That depends on your situation. Some people may need ongoing treatment to cope with the condition. Other people may benefit by changing their diets, or by getting more exercise and more rest.

When should I see my healthcare provider?

Talk to a healthcare provider if you have several dizzy spells or balance issues that affect your daily life, particularly if you have migraines. If you know you have vestibular migraines, contact your provider if you have increasing or more severe bouts of dizziness, more sensitivity to light and sound, and more painful headaches.

What questions should I ask my healthcare provider?

Vestibular migraines aren’t common. You may want to ask the following questions:

• Why do I have this condition?
• Will my symptoms get worse?
• What treatments do you recommend?
• Will I always need medication?
• Apart from watching what I eat and getting enough rest, are there other ways I can manage vestibular migraine symptoms?

A note from Cleveland Clinic

If you have migraines, you’re probably familiar with its symptoms: seeing streaks of light just before you’re hit with a painful, throbbing headache. You may have blamed your migraines for bouts of dizziness and feeling like you’ve lost your sense of balance. But regular severe dizzy spells (with or without throbbing headache) may be a sign that you have vestibular migraines.

Fortunately, healthcare providers have treatments that can keep the condition from happening or ease its symptoms. And there are steps you can take, like getting more sleep, avoiding certain foods and drinks, and reducing stress. If you have migraines and frequent dizzy spells, talk to a healthcare provider. They’ll do tests to confirm vestibular migraines. More importantly, they’ll provide information, medication and other treatments that may prevent or ease vestibular migraine attacks.