What Is Vestibular Migraine?
Vestibular migraine is a neurological condition that causes episodes of vertigo, dizziness, and balance problems, often alongside or instead of a typical migraine headache. It is considered the second most common cause of vertigo and affects approximately 2.7% of the population. Women are significantly more likely to be affected than men, particularly between the ages of 20 and 40. Vestibular migraine can severely disrupt daily life and is frequently misdiagnosed because episodes of vertigo do not always occur with a headache.
What Are the Symptoms of Vestibular Migraine?
Vestibular migraine symptoms vary from person to person and can change between episodes. The most common symptoms include:
- Vertigo, a spinning sensation affecting you or the room around you
- Dizziness and imbalance, a persistent feeling of being off-balance or unsteady
- Nausea and vomiting
- Sensitivity to light, sound and motion
- Headache, throbbing head pain, though not always present
- Tinnitus, hearing loss or a feeling of fullness in the ear
- Visual disturbances or aura such as patterns, lines, or flashing lights
- Pins and needles or numbness in the face
- Fatigue and feeling drained after an episode
- Sweating or feelings of panic during an attack
Episodes can last from a few minutes to several days. Not all vestibular migraine episodes include a headache, which is one of the main reasons the condition is often missed or misdiagnosed.
Vestibular Migraine Without Headache
One of the most confusing aspects of vestibular migraine is that vertigo and dizziness can occur completely without head pain. According to NHS Lanarkshire vestibular physiotherapy guidelines, up to 40% of migraine sufferers experience spinning or balance problems as part of their migraine, and many of these episodes involve no headache at all. This makes diagnosis particularly challenging and often leads patients to be investigated for inner ear conditions before vestibular migraine is considered.
What Causes Vestibular Migraine?
The underlying cause of vestibular migraine is not fully established. According to the University of Utah Neurology Department, the condition appears to involve disruptions in the brain pathways that regulate inner ear balance, following a similar pattern to that seen in classic migraine. A genetic component has also been identified, as the condition is more likely to develop in people with a personal or family history of migraine.
Researchers have identified several factors that increase the likelihood of developing vestibular migraine:
- Personal or family history of migraines
- Hormonal fluctuations associated with menopause or the menstrual cycle
- Serotonin imbalance
- Chronic stress
- Poor sleep or persistent fatigue
- Shifts in barometric pressure or weather conditions
Vestibular Migraine Triggers
Understanding personal triggers is one of the most important steps in reducing the frequency of attacks. Common triggers include:
- Stress, emotional or physical
- Hormonal fluctuations
- Certain foods such as aged cheeses, caffeine, alcohol, chocolate and citrus fruits
- Skipped meals or low blood sugar
- Dehydration
- Bright or flickering lights
- Loud noises
- Screen use and travel
- Sleep deprivation or irregular sleep patterns
Triggers vary from person to person and can occur several hours before symptoms begin. Keeping a symptom and food diary is one of the most effective tools for identifying personal triggers. Our migraine treatment page also covers trigger management for related migraine conditions.
Vestibular Migraine vs Vertigo and BPPV
Vestibular migraine is frequently confused with other conditions that cause dizziness.
Benign Paroxysmal Positional Vertigo (BPPV) is caused by displaced crystals in the inner ear, typically triggered by specific head movements and usually resolves with repositioning maneuvers.
Ménière’s disease causes vertigo, hearing loss and tinnitus and is related to fluid pressure changes in the inner ear.
Vestibular migraine differs in that episodes are more varied in duration, are not always triggered by head movements, and are associated with a history of migraines. According to Cleveland Clinic, a vestibular migraine diagnosis typically requires at least five episodes of vertigo, with half causing other migraine symptoms such as headache or light sensitivity. A specialist evaluation is required to distinguish between these conditions. See our dizziness treatment page for more information on related vestibular conditions.
When to See a Specialist
If you experience recurring episodes of vertigo, dizziness, or balance problems, with or without headache, professional evaluation is strongly recommended. Early diagnosis leads to better management and fewer disruptions to daily life. At Moore MyoWorx in Guelph, our neuromuscular approach addresses the underlying patterns contributing to vestibular symptoms.
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