Many people who experience migraine headaches may also have feelings of dizziness or vertigo. When a person experiences this repeatedly, they may have vestibular migraine.
Other names for vestibular migraine are migraine-associated dizziness or vertigo, migrainous vertigo, or migraine-related vestibulopathy.
Medical professionals have not found clear causes of vestibular migraine, but believe they may relate to a person’s inner ear, nerves, or blood vessels.
This article explains what may trigger vestibular migraine, and the lifestyle changes and medication that can help a person manage the condition.
Migraine headaches are very common, affecting approximately 29.5 million people in the United States. The condition may be debilitating for some people. About 9 out of 10 people who have migraine are not able to function normally when symptoms strike, and 3 in 10 may need bed rest.
People who get migraine headaches tend to be between the ages of 15 to 55, and they are three times more likely to be females.
Migraine is not always just a moderate or severe headache, but can affect the nervous system.
What is a vestibular migraine?
Migraine can affect the vestibular system of the inner ear, which impacts the way the brain controls balance and the way a person experiences the space around them. When this system does not work properly, a person may experience feelings of vertigo, unsteadiness, or dizziness that can be triggered by movement.
A doctor may think a person has vestibular migraine when the person experiences these kinds of symptoms for minutes or hours.
A person with vestibular migraine may also have a history of migraine headaches. About 40% of people who suffer from migraine headaches also have vestibular symptoms. However, a person can also experience vestibular migraine without headaches.
Vestibular migraine can cause a feeling that the ground is moving or falling, or cause problems coordinating movement. It can also impact the senses and distort hearing.
Other than a headache, symptoms can include:
- sensitivity to light, sound, or smell
- nausea or vomiting
- a numb or tingling feeling
- problems with vision
- 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. There may be warning signs that vestibular symptoms are about to happen. A person may see flashing lights or other visual disturbances, a phenomenon also known as an aura.
Researchers do not fully know what causes migraine. One theory suggests migraine relates to an unusual electrical charge in the neurons that sets off the brain’s pain receptors. Another theory suggests that migraine may be related to changes in serotonin in the brain.
Migraine may also be hereditary. About 80% of people who experience migraine report a family history of the condition.
Common triggers may 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
Triggers for the condition likely vary from person to person. Keeping a record of factors leading up to vestibular migraine symptoms, such as a bad night’s sleep, can aid in getting a diagnosis. It can also help a person know to avoid the triggers.
A general practitioner or a neurologist specializing in the nervous system should diagnose vestibular migraine.
The doctor will ask about the person’s medical history, conduct a physical examination, and seek more information on symptoms and how often they occur.
Though the are no definitive causes for vestibular migraine, there is a clear set of guidelines for diagnosing the condition. They include:
- current or history of migraine
- moderate or severe vestibular symptoms lasting from 5 minutes to 72 hours
- half of the episodes happening with a migraine headache, visual disturbances, or discomfort with sound or light
- at least five episodes of either vestibular symptoms happening alone, or alongside a migraine headache
Once diagnosed, a person may be prescribed medication if needed. They can also get guidance determining their triggers and advice on managing the condition.
Medication is available to help if vestibular migraine symptoms are severe and happen regularly enough to interfere with a person’s life. Medication may especially be able to help less unavoidable triggers, such as hormonal changes or stress.
Possible medications that treat a variety of conditions may also help treat vestibular migraine. These may include:
- beta-blocker medications
- tricyclic antidepressants
- selective serotonin reuptake inhibitor (SSRIs) or serotonin or serotonin/norepinephrine reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors (SNRIs)
- anticonvulsant medications
- calcitonin gene-related peptide medications
- onabotulinum toxin A
A person taking preventive medication should take it every day regardless of whether they are having migraine symptoms. Rescue medications may relieve pain or nausea when symptoms happen.
One kind of rescue medication to consider is triptans. Researchers designed these to be taken once migraine symptoms start to restore the balance of serotonin in the brain.
Making lifestyle changes and avoiding triggers can help reduce the symptoms of vestibular migraine. Steps that can help include:
- eating a healthy diet
- getting enough sleep every night
- trying to reduce stress
- exercising regularly
- avoiding any food or drink that may be a trigger, such as alcohol
Vestibular rehabilitation therapy (VRT) may help in general if the condition is severe, as well as with regular or particularly bad symptoms. 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.
Many people may find that lying down in a dark room or sleeping can help reduce migraine symptoms.
Taking over-the-counter pain or nausea-relief medication at the first sign of symptoms may also reduce the severity of the symptoms.
People who have vestibular migraine may experience periods in life with fewer occurrences, and other periods when there are more.
When symptoms happen with high frequency, it can impact a person’s ability to live their day-to-day life. This may include a negative impact on a person’s career, education, and relationships with family and friends.
Living with the condition can be isolating and discouraging. In addition to exploring treatments, looking for support from peers with the condition may also help.
Vestibular migraine can be serious and disorientating. It 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 frequency of vestibular migraine symptoms and ensure a good recovery.