• Migraines

Vestibular Migraines: Symptoms, Causes, and Treatment

The term “migraine” is often associated with headache, but migraines are a far more complex neurological disorder. One of the lesser-known but significant forms of migraine is the vestibular migraine – which can cause dizziness, vertigo, and balance issues.

Approximately 55% of migraine patients experience vestibular symptoms at some point, making it essential to recognize and understand these symptoms for effective treatment and management.

What is a Vestibular Migraine?

A vestibular migraine is a type of migraine that primarily affects the vestibular system – the part of the inner ear and brain responsible for balance and spatial orientation. The vestibular system is made up of five organs that maintain balance. It does this by helping to detect rotation and movement, allowing us to sense a wide range of motions. This includes up-and-down, side-to-side, any type of rotational movement, or any combination of these. 

It’s closely connected with the eyes to help you move around without feeling dizzy. When you walk or turn your head, your eyes and inner ear work together to make sure everything you see stays steady, even if you're looking around or at something that's not moving. This helps you keep your balance and know where you are in space. 

This coordination of eye movements with head and body is known as vestibulo-ocular reflex – and is crucial for balance. Any dysfunction within this network can lead to sensations of dizziness, imbalance, and disorientation in space. That’s why those with vestibular migraine have a greater sensitivity to complex motion than those without.

Unlike typical migraines – which are mainly characterized by intense headaches – vestibular migraines often present with dizziness, vertigo, and a sense of imbalance. Sometimes a vestibular migraine can even present without the headache at all. In fact, about 50% of the time, people with vestibular migraines experience only symptoms of vertigo and balance issues, without any actual head pain.

Common Symptoms of Vestibular Migraines

Vestibular migraines are known for a range of symptoms, some of which may be unfamiliar or "weird" to those experiencing them. The most common symptoms of vestibular migraines include:

• Dizziness and vertigo: One of the hallmark symptoms, vertigo can feel like the room is spinning or like you are off-balance, even when standing still. This sensation of disorientation can be sudden and overwhelming.

• Nausea and vomiting: The dizziness often leads to nausea, which can sometimes result in vomiting, similar to what is experienced during a typical migraine attack.

• Sensitivity to light and sound: Many people with vestibular migraines experience heightened sensitivity to light (photophobia) and sound (phonophobia). Bright lights, loud noises, and even certain visual patterns can trigger or worsen symptoms.

• Tinnitus (ringing in the ears): Some may experience a ringing or buzzing sound in the ears during a vestibular migraine episode, which can further add to the sensation of imbalance.

• Headache (or absence of headache): While vestibular migraines can include headaches, they often don’t follow the traditional migraine pattern.

In addition to the common symptoms listed above, people with vestibular migraines may also experience what are often described as "weird symptoms." These can include:

• Visual disturbances: Some individuals notice visual disturbances like blurred vision, sensitivity to movement, or difficulty focusing – even if they don't experience a full-on migraine aura.

• Feelings of disorientation: A sense of confusion or being "in a fog" can accompany the dizziness, making it harder to concentrate or perform everyday activities.

• Unusual sensory sensitivities: Some people may develop heightened sensitivity to smells or certain textures, which can be particularly distressing during an episode.

• Motion sensitivity: Even the slightest movement – such as turning your head or looking at moving objects – can trigger or intensify symptoms.

These "weird symptoms" are often what set vestibular migraines apart from other types of migraines or vestibular disorders. Their unpredictable nature can make diagnosis more challenging, but awareness of these diverse symptoms is key to managing the condition effectively.

Causes of Vestibular Migraines

Vestibular migraines are complex, and their exact causes remain unclear. However, research suggests that a combination of genetic, hormonal, and environmental factors plays a significant role in triggering this condition. 

Vestibular migraines are believed to result from abnormalities within the vestibular system, the network in the inner ear and brain that regulates balance and spatial awareness. This dysfunction can create a mismatch between sensory signals from the vestibular system, eyes, and body, leading to symptoms like dizziness and vertigo.

While research into the exact mechanisms is limited, studies have linked vestibular migraines to:

• Genetics: A family history of migraines or vestibular disorders increases susceptibility.

• Hormonal changes: Hormones – especially in women – play a role. Migraines may worsen during menstruation, pregnancy, menopause, or puberty.

• Comorbid conditions: Vestibular migraines are often associated with conditions like Meniere’s disease or general vestibular disorders, which also affect balance and hearing.

Additionally, migraines, in general, have shown a strong connection to stress, anxiety, and depression, suggesting an emotional and neurological link to vestibular migraines.

Common triggers of vestibular migraines

Most people with vestibular migraines experience specific triggers that bring on episodes. The five most common triggers include:

1. Stress and anxiety: Emotional stress is one of the leading triggers.

2. Poor sleep: Both sleep deprivation and oversleeping can disrupt the body’s natural rhythms.

3. Hunger and dehydration: Skipping meals or not drinking enough water is a common trigger.

4. Dietary triggers: Certain foods and drinks, particularly caffeine, aged cheeses, or alcohol, can provoke symptoms.

5. Hormonal changes: Fluctuations during menstruation, menopause, or adolescence can intensify symptoms.

Other triggers include:

• External stimuli like bright lights, certain forms of ventilation, or strong odors

• Weather changes, particularly shifts in barometric pressure

• Lifestyle factors such as smoking

Managing triggers

Initial treatment focuses on education and systematic identification of trigger factors. Keeping a symptom diary can help patients pinpoint their specific triggers, enabling tailored lifestyle changes. Regulation of sleep, stress, hydration, and diet is often central to managing vestibular migraines. Research shows that 80–90% of patients see significant improvement with these simple adjustments.

Dealing with vestibular migraines often starts with identifying and managing your personal triggers. While it’s not always possible to avoid every flare-up, knowing what sets off your symptoms can make a big difference. The good news? With a few lifestyle tweaks, many people find significant relief.

Once you’ve pinpointed your triggers, the next step is making adjustments. It might feel overwhelming at first, but small, consistent changes often bring big results.

• Stay consistent: Regular routines – whether it’s for sleep, meals, or exercise – help keep your body in balance.

• Practice stress management: Stress might not be avoidable, but managing it can make a world of difference. Experiment with what helps you unwind and make it part of your routine.

• Fuel your body: Eating balanced meals and staying hydrated gives your body the support it needs to stay steady.

While these changes might not be a cure-all, many people find that these tweaks help reduce their symptoms. Over time, you’ll likely discover what works best for you.

Underlying vestibular system abnormalities

While triggers play a significant role in symptom management, the root cause of vestibular migraines typically lies in an underlying abnormality within the vestibular system. Whether the issue stems from an injury, genetic predisposition, or differences in brain processing, the specific cause can vary widely. Further research is needed to fully understand the mechanisms behind vestibular migraines, but identifying and managing triggers remains a cornerstone of treatment.

Diagnosing Vestibular Migraines

Diagnosing vestibular migraines can be a complex process because the symptoms often overlap with other conditions – such as Meniere’s disease, inner ear disorders, or general migraines. Unlike typical migraines, vestibular migraines may not always present with head pain, making them harder to identify without careful evaluation.

The diagnosis of vestibular migraines is primarily clinical, meaning it relies heavily on a detailed medical history and symptom description rather than a single definitive test. Physicians often face challenges due to the variability in symptoms, which can include dizziness, vertigo, sensitivity to motion, and imbalance.

To confirm a diagnosis, doctors use the following steps:

1. Comprehensive medical history: A detailed history of migraine episodes, triggers, and associated vestibular symptoms like vertigo or dizziness. Patients are often asked about family history, lifestyle factors, and other health conditions that could contribute.

2. Symptom tracking: Keeping a symptom diary that logs the timing, frequency, and intensity of symptoms can help differentiate vestibular migraines from other disorders.

While no single test can diagnose vestibular migraines, several diagnostic tools are used to rule out other conditions:

• MRI (magnetic resonance imaging): Used to check for structural abnormalities in the brain or inner ear and rule out other neurological conditions.

• Blood tests: These can identify underlying conditions like thyroid imbalances or vitamin deficiencies that may contribute to symptoms.

• Vestibular testing: Tests such as videonystagmography (VNG) or rotary chair testing assess inner ear function and how it interacts with the brain.

Because vestibular migraines often occur without headache, they are sometimes misdiagnosed as other vestibular disorders or dismissed altogether. Additionally, symptoms like vertigo and dizziness can be episodic, making it difficult to capture them during a single medical evaluation. Collaborative care with neurologists and otolaryngologists is often necessary to reach an accurate diagnosis.

Treatment for Vestibular Migraines

Treating vestibular migraines can be challenging due to the limited research on the specific causes and effective treatments for this condition. The complexity lies in the fact that vestibular migraines may be triggered by an imbalance between the ears, a problem in the brain, or a combination of both. The symptoms, causes, and triggers of vestibular migraines vary greatly from person to person – making a one-size-fits-all treatment approach difficult to achieve.

Medical treatment options

The treatment for vestibular migraines typically includes both medication and lifestyle changes. Medications may focus on relieving symptoms during an episode or preventing future attacks:

• Acute treatment: Medications like anti-nausea drugs, vestibular suppressants (such as meclizine), or triptans (used for typical migraines) can help manage dizziness and vertigo during an attack.

• Preventative treatment: Daily medications, including beta-blockers, anticonvulsants, or certain antidepressants, may be prescribed to reduce the frequency and severity of episodes.

• Pain management: For those with headaches accompanying the vertigo, pain relievers like NSAIDs or prescribed migraine medications might be used.

Vestibular rehabilitation therapy (VRT)

Vestibular rehabilitation therapy plays an important role in treating vestibular migraines, especially when vertigo and balance issues are prominent. VRT is a form of physical therapy that helps individuals retrain their brains to compensate for balance disturbances caused by vestibular dysfunction. This therapy includes exercises designed to improve balance, reduce dizziness, and help the brain adjust to changes in vestibular input.

Since the underlying causes of vestibular migraines can vary greatly – whether the issue is with one ear, both, or the brain – treatment plans must be tailored to the individual. A detailed evaluation by a healthcare provider is essential to determine the best approach, which could involve a combination of medications, lifestyle adjustments, and therapies like VRT.

Where Can I Learn More About Vestibular Migraines and Related Concerns?

If you're looking for help in the management of migraines, reach out to LifeMD for expert care from the comfort of your home.

A team of healthcare providers can provide guidance on managing your migraines and prescribe medication if medically appropriate. 

Schedule an online appointment with a licensed healthcare provider today.

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