What Is Vestibular Migraine?
A vestibular migraine is a nervous system problem that causes repeated dizziness (or vertigo) in people with a history of migraine symptoms. Unlike traditional migraines, you may not always have a headache. Along with dizziness, you may have symptoms such as loss of balance and nausea, with or without head pain.
“Vestibular” refers to the inner ear, which plays a key role in both hearing and balance. There are many names for vestibular migraine. Your doctor may also call it:
- Migraine-associated vertigo
- Migrainous vertigo
- Migraine-related vestibulopathy
- Migrаine-associated ԁizzinеѕs
Vestibular Migraine Symptoms
The main symptoms are dizziness, vertigo, trouble with balance, and headache, which may come and go. You might have a vestibular migraine attack without a headache.
Vertigo and migraines
People with vestibular migraine might have intense episodes of vertigo. Vertigo is the sensation of moving, falling, or spinning even when you're still. Some people with vertigo have an unusual symptom called “Alice in Wonderland” syndrome, where objects seem bigger or smaller than they are.
Studies show vestibular migraine is one of the most common reasons why people have vertigo. Vertigo usually lasts minutes to hours, but sometimes goes on for days. The most common symptoms include:
- Feeling like you're moving when you aren't
- Unsteadiness or loss of balance
- The feeling that everything around you is spinning or shifting
- Dizziness when you watch big things move, like traffic or a train
- You feel dizzy or sick when you move your head
Migraine symptoms
In addition to vertigo, vestibular migraine can have other symptoms such as:
- Nausea and vomiting
- Sensitivity to light, sounds, or smells
- Visual issues, such as blurriness, seeing spots, or flashing lights
- Hearing problems such as ringing in your ears (tinnitus) or a feeling of fullness in one or both ears
- Sweating
- Flushing
- Trouble focusing
- Extreme tiredness and fatigue
- Brain “fog” (trouble thinking clearly)
- Scalp tenderness
- Excessive yawning
- A tingling feeling
- Dry mouth
How long do vestibular migraines last?
A vestibular migraine episode can last anywhere from seconds to days. To get a diagnosis of vestibular migraine, your symptoms must last at least five minutes. About 30% of people have attacks that last a few minutes, another 30% endure episodes for hours, and the rest 30% deal with symptoms for several days. Episodes may occur daily or just once or twice a month.
These symptoms of vestibular migraine can disrupt your daily life. You might avoid driving, traveling, bright lights, strong smells, and movement.
Vestibular Migraine Causes
There are many theories about what causes vestibular migraine. But doctors don't fully understand how and why they occur. Some believe they're due to misfires between nerve cells in your brain.
We do know that vestibular migraine tends to run in families.
Vestibular migraine triggers
The same things that can trigger other types of migraine attacks can also set off an episode of vestibular migraine. They may include: :
- Weather changes
- Lack of sleep
- Stress
- Hormonal changes (puberty, menstrual cycle, menopause)
- Bright or flashing lights
- Skipping meals
- Certain foods, such as caffeine, chocolate, alcohol, cheese, or fermented products
Shin Beh, MD, director of UT Southwestern Medical Center’s Vestibular Neurology & Neuro-Visual Disorders Clinic, says triggers are unique to each person and can be tough to identify. But keeping track of them can help you and your doctor find the best treatment and ways to manage symptoms.
Who Gets Vestibular Migraines?
It's hard to tell how many people have this condition, as its symptoms mimic those of many other diseases. Researchers think they affect about 1% of the population. But that number could be higher.
Vestibular migraines are more likely to affect:
- Women, or those assigned as female at birth. it's five times more common in women than men.
- People with a personal or family history of migraines
- Those with a history of motion sickness
it may affect children more often than adults. In adults, the average age of the first attack is 40.
Vestibular Migraine Diagnosis
There’s no one test to diagnose vestibular migraine. If your doctor thinks you may have it, they'll ask you questions about your symptoms and health history. They may also do tests to rule out other conditions.
Diagnosing vestibular migraine can be challenging because symptoms differ from person to person. To make things more complicated, many symptoms overlap with other inner ear disorders, making it harder for doctors to confirm a diagnosis.
Vestibular migraine diagnostic criteria
You could have vestibular migraine if:
- You have migraine or have had it in the past.
- You have at least five episodes of vertigo that make you feel like you're spinning or moving. This isn't the same as motion sickness or feeling faint.
- These feelings last between 5 minutes and 72 hours.
- Your symptoms are moderate to severe. That means they stop you from doing everyday tasks or they're so bad that you can't do anything at all.
To be diagnosed with vestibular migraine, at least half of your episodes should include:
- A headache that has two of these characteristics: one-sided, pulsing, moderate to severe, or worsens with activity
- Sensitivity to light or sound
- Seeing shimmering or flashing lights or having other sensory disturbances (migraine aura)
How Does My Doctor Rule Out Something Else?
To help rule out other causes of your symptoms, your doctor may do:
- A neurological exam
- Imaging tests such as MRIs or CT scans
- A hearing test
- Electronystagmography (EMG) or videonystagmography (VMG) to measure your eye movements
Some conditions that can cause similar symptoms include:
Ménière's disease
Vestibular migraine and Ménière's disease both cause dizziness, but they're different. Vestibular migraine usually causes vertigo without hearing loss, while Ménière's disease typically includes hearing problems.
When you have Ménière's, one ear may feel full, stuffy, or painful before the dizziness starts. During an attack, you might hear ringing or lose hearing in one or both ears. This doesn't usually happen with a vestibular migraine.
Migraine with brain stem aura
A vestibular migraine could also be confused with migraine with brain stem aura. With this rare type of migraine, attacks start in the brain stem, the lower part of the brain. Along with feeling dizzy, you may speak slowly or have slurred speech, see double, lose some of your hearing, or hear ringing in your ears. You might also lose coordination or some level of awareness.
Brain stem stroke
A brain stem stroke is a very serious condition that happens when blood flow to the base of your brain stops. This can affect important body functions such as your heart rate, breathing, and blood pressure. There are two main types: ischemic (the most common) and hemorrhagic.
If you feel dizzy along with numbness, weakness, trouble speaking, or other stroke symptoms, or if you have sudden, unexplained dizziness, get help right away.
Vestibular Migraine Treatment
There’s isn't a medication specifically for treating vestibular migraine. Your treatment may include medications to prevent attacks or stop symptoms once an attack has begun.
Abortive therapy
Abortive or acute treatments aim to stop or reduce symptoms of a migraine attack after it starts.
Nonsteroidal anti-inflammatory drugs (NSAIDs). Examples include acetaminophen, aspirin, and naproxen, and they are taken to ease migraine headaches.
Triptans. Take these migraine meds at the first sign of headache symptoms.
Vestibular suppressants. They can ease your dizziness and motion sensitivity. This type of drug works on the balance center in your inner ear. Your doctor might prescribe benzodiazepines such as lorazepam (Ativan), anti-nausea drugs such as promethazine (Phenergan, Prorex, Provigan, Zipan), and antihistamines such as meclizine.
Preventive therapy
If you have frequent or disabling vestibular migraines, your doctor may try preventive medications. You take them daily or weekly to help prevent attacks. They include:
Antiseizure drugs. These include gabapentin (Gralise, Horizant, Neurontin), topiramate (Topamax, Topamax Sprinkle, Trokendi XR, Qudexy XR), or valproate (Depakote, Depakene, Stavzor)
Blood pressure medicines. They include:
- Beta-blockers: Atenolol (Tenormin), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), propranolol (Hemangeol, Inderal LA, Inderal XL, and InnoPran XL)
- Calcium channel blockers: Verapamil (Isoptin)
Tricyclic antidepressants. Examples include amitriptyline, nortriptyline (Aventyl, Pamelor).
Selective serotonin reuptake inhibitors (SSRIs). These antidepressants include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Rapiflux, Sarafem, Selfemra), paroxetine (Paxil, Pexeva), and sertraline (Zoloft).
Serotonin and norepinephrine reuptake inhibitors (SNRIs). This is a different type of antidepressant that includes duloxetine (Cymbalta, Irenka) and venlafaxine (Effexor).
Devices for vestibular migraine
It's possible to get relief by using some devices. Those reviewed by the FDA include:
- Cefaly is a small headband device that sends electrical pulses through the forehead to stimulate a nerve linked to migraines.
- SpringTMS or eNeura sTMS is a device that can be held at the back of your head, and it emits a magnetic pulse to stimulate part of the brain at the first sign of a headache.
- GammaCore is a handheld portable device. It is a noninvasive vagus nerve stimulator (nVNS). When placed over the vagus nerve in the neck, it releases a mild electrical stimulation to the nerve's fibers to relieve pain.
- A remote electrical neuromodulation called Nerivio is also available. Unlike the other three, it's approved only for acute treatment and not for prevention.
Natural remedies for vestibular migraines
We need more studies, but there's some scientific evidence that these supplements might help with symptoms:
- Magnesium
- Riboflavin (Vitamin B2)
- Coenzyme Q10 (CoQ10)
- Ginger
Always talk to your doctor before starting any supplement, as they can interact with other medications.
Living With Vestibular Migraine
One of the most important ways to manage vestibular migraine is to figure out what triggers your attacks and avoid those things. Try keeping a journal to track your symptoms and patterns, and share it with your doctor.
Some lifestyle changes that may help include:
- Eat and sleep on a regular schedule.
- Exercise regularly.
- Get at least seven hours of sleep a night.
- Find ways to manage stress, such as meditation, yoga, or breathing exercises.
Vestibular migraine diet
There's no specific diet for vestibular migraine. But knowing your triggers may help you ward off migraine-related vertigo and other symptoms. Foods that trigger migraine attacks for some people include:
- Chocolate,
- Aged cheese
- Alcohol
- Red wine
- Processed meat
- Foods with the preservative monosodium glutamate (MSG)
It can't hurt to cut them from your diet to see if your symptoms ease up a bit.
Tracking your diet can help you tell whether your vertigo symptoms are really due to food. Triggers differ for everyone, and not all migraine attacks are caused by triggers, so it's not always easy to figure out what they might be.
Takeaways
Vestibular Migraine FAQs
What is the main cause of vestibular migraines?
Vestibular migraines, like other migraines, tend to run in families. Scientists are still studying the condition, as there isn't a single cause. Women and those assigned female at birth are more likely to have this condition.
How do you fix a vestibular migraine?
Medications and lifestyle changes may help prevent or stop migraine attacks. It helps to identify and avoid any triggers you may have, such as certain foods, stress, sleep loss, or bright lights.
What are the 4 stages of vestibular migraine?
Migraines often go through four stages: prodrome, aura, headache, and postdrome. Prodrome involves early warning signs such as mood changes or cravings. Aura can include visual or sensory issues. The headache phase brings intense pain. And the postdrome may leave you feeling drained or confused.
Is vestibular migraine a brain disorder?
Vestibular migraine is a disorder of the brain and nervous system that affects how your brain controls balance and your sense of position. This leads to symptoms like vertigo and dizziness.
