Many people who experience migraine also have feelings of dizziness or vertigo. When this happens repeatedly, it is known as vestibular migraine.
The condition is also referred to as migraine-associated dizziness or vertigo, migrainous vertigo, or migraine-related vestibulopathy.
The causes of vestibular migraine are not always clear but relate to the inner ear, nerves, and blood vessels.
We explain what can trigger an episode of vestibular migraine, and the lifestyle changes and medication that can help to manage the condition.
Migraine is not just a moderate or severe headache, but a disease of the nervous system. It can have a number of other symptoms, and often a significant impact on someone’s daily life.
Nerves, blood vessels, and chemicals in the brain are temporarily affected, often prompted by a trigger, such as stress or environmental factors, causing a migraine.
The most common symptom of migraine is a throbbing pain on one side of the head, but people are also likely to experience some or all of the following:
- sensitivity to light, sound, or touch
- nausea or vomiting
- a numb or tingling feeling
- problems with vision
There may be warning signs that a migraine is about to happen, such as seeing flashing lights or other visual disturbances, often referred to as an aura.
Migraine is very common, affecting approximately 29.5 million people in the United States.
What is a vestibular migraine?
The vestibular system of the inner ear and brain controls balance and how people understand the space they are in. When this is affected, someone may experience feelings of vertigo, unsteadiness, or dizziness, which can be triggered by movement.
Vestibular migraine is diagnosed when the vestibular system is repeatedly affected, in episodes lasting for minutes or hours, in someone who has a history of migraine.
The sensation may be experienced alongside other migraine symptoms, such as an intense headache or nausea, or on its own.
Around 40 percent of people who suffer from migraine also have vestibular symptoms.
Vestibular migraine affects balance. It can cause a feeling that the ground is moving, a sensation of falling, or problems coordinating movement.
It can also impact the senses and distort hearing or affect vision.
Key symptoms of vestibular migraine are dizziness, vertigo, and difficulties with balance, but symptoms can also include the following:
- neck pain
- discomfort turning, bending down, or looking up
- feeling of pressure in the head or the ear
- ringing in the ears known as tinnitus
- partial or complete loss of vision
- visual disturbances, such as flashing lights, spots, or blurring
These symptoms can vary in severity. They may appear alongside a headache but can also appear on their own.
The causes of migraine are not completely understood. They are likely to relate to an unusual electrical charge in the neurons that sets off the brain’s pain receptors.
Migraine may be hereditary. Around 4 out of 5 people who experience migraine report a family history of the condition, according to the National Headache Foundation.
There are many triggers for the condition, and these vary from person to person. Keeping a record of factors leading up to a vestibular migraine, such as a bad night’s sleep, can aid a diagnosis and help someone to avoid the triggers that could lead to an episode.
Common triggers include:
- stress and anxiety
- food or drink, such as caffeine, alcohol, or dairy products
- lack of sleep or too much sleep
- environmental factors, such as bright artificial lights
- hormonal changes, such as during menstruation
Vestibular migraine should be diagnosed by a doctor, or a medical professional called a neurologist who has specialist knowledge of the nervous system.
A doctor will ask about someone’s medical history, conduct a physical examination, and seek more information on symptoms and how often they occur.
The causes of vestibular migraine are not always clear, but there is a clear set of guidelines for diagnosing the condition. The International Headache Society guidelines are:
- current or a history of migraine
- moderate or severe vestibular symptoms, lasting from 5 minutes to 72 hours
- 50 percent of episodes happen with a migraine headache, visual disturbances, or discomfort with sound or light
- at least five episodes of either vestibular symptoms alone, or alongside a migraine
Once diagnosed, a person should be prescribed medication if needed. They can also be offered guidance on understanding their triggers and advised on managing the condition.
Medication is available to help if vestibular migraine is severe and happens regularly enough to interfere with a person’s life. Some triggers, such as hormonal changes or stress, are not avoidable so that medication can offer support.
Preventive medication is taken every day regardless of whether someone is having a migraine. Also, medication to relieve pain or nausea can help when an episode happens.
Lifestyle changes and avoiding triggers can contribute to reducing the number of vestibular migraine episodes for many people. Steps that can help include the following:
- eating a healthful diet
- getting the same amount of sleep each night
- trying to reduce stress
- exercising regularly
- avoiding any food or drink that can be a trigger
Vestibular rehabilitation may help if the condition is severe as well as with regular or particularly bad episodes. This treatment can include exercises to stabilize the gaze and improve the ability of the eyes to track movement. It can also incorporate tasks to improve balance and hand-eye coordination.
Lifestyle changes and preventive medication should help to reduce the frequency of migraine episodes.
It is helpful to pinpoint personal triggers, such as alcohol or lack of sleep, and try to avoid these. Making a note of every migraine episode can help someone to find any common factors that could be triggers.
During a migraine episode, many people will find that lying down in a dark room or sleeping can help.
Taking over-the-counter pain or nausea-relief medication at the first sign of migraine may reduce the severity of the episode.
Vestibular migraine is a serious, disorientating condition that can make people feel too unwell to complete basic tasks, such as sleeping, walking, or driving.
Getting to know personal triggers, consulting a doctor about medication and self-care, and making lifestyle changes can reduce the episodes of vestibular migraine and ensure a good recovery.