Migraine is one of the most debilitating chronic disorders. It is almost as prevalent as hypertension (high blood pressure) and is more common than asthma and diabetes mellitus. More importantly, migraine strikes people during what are expected to be their most productive years: between ages 20 and 40 for most women, with a slightly higher age range for men. Here are 11 facts about migraine.
A vestibular migraine is a nervous system problem that causes repeated dizziness (or vertigo) in people who have a history of migraine symptoms. Unlike traditional migraines, you may not always have a headache.
A vestibular migraine occurs in about one percent of the population. It’s the most common cause of spontaneous vertigo episodes. Children may also experience episodes similar to vestibular migraines. In children, it’s known as “benign paroxysmal vertigo of childhood.” Those children are more likely than others to experience migraines later in life. Learn more about migraine in children here.
- 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% of people who suffer from migraines also have vestibular symptoms.
There are many names for this type of problem. Your doctor might also call it:
- Migraine-associated vertigo
- Migrainous vertigo
- Migraine-related vestibulopathy
You can learn more about different types of migraine, their causes, symptoms and treatments here.
Symptoms of a Vestibular Migraine
The main symptom is dizziness that comes and goes. Vestibular refers to the inner ear, which controls your hearing and balance.
You could get dizzy and have balance problems without having a migraine at all. Other times, the vertigo symptoms happen before, during, or after the headache. Sometimes, you might have migraines for years before the vertigo symptoms begin. It can cause a feeling that the ground is moving, a sensation of falling, or problems coordinating movement.
A vestibular migraine may cause pain or discomfort in the neck and ears, as well as visual disturbances.
These symptoms can vary in severity. They may appear alongside a headache but can also appear on their own. Symptoms can include:
- Dizziness that lasts more than a few minutes
- Neck pain
- Nausea and vomiting
- Discomfort turning, bending down, or looking up
- Balance problems
- Feeling of pressure in the head or the ear
- Extreme motion sensitivity, feeling sick or dizzy when you move your head, eyes or body
- Ringing in the ears known as Tinnitus
- Feeling disoriented or confused
- Partial or complete loss of vision
- Feeling unsteady, like you´re in a rocking boat
- Visual disturbances, such as flashing lights, spots, or blurring
- Sensitivity to sound
- feeling imbalanced
- motion sickness caused by moving your head
- dizziness from looking at moving objects such as cars or people walking
Vestibular Migraines Triggers
There are no "universal" triggers for those with migraines, but certain factors do seem to affect patients more than others. This generally holds true for those with specific migraine types too, including vestibular migraine, whose distinguishing feature is dizziness and vertigo. And there are some unique complications as well that must be taken into account. The top triggers of vestibular migraine, according to research, include:
Stress always floats to the top of any "migraine triggers" list, and it is no different for those with vestibular migraine. Even with the variable characteristics of migraine attacks, estimates still suggest that nearly half of those with migraine-related vertigo is induced by increasing stress. And of course we know that those with any type of migraine are at a greater risk for stressful reactions and other emotional symptoms.
One of the more subjective triggers revolves around changes in the weather, however, it still is reported by a significant percentage of those with migrainous vertigo. In a 2019 analysis, incoming storm systems were the most frequent weather-related issue to cause vestibular attacks, although changes in season are also thought to contribute to this process.
Lack of Sleep
Sleep disturbances can bring on vestibular attacks in more than 25% of migraine patients, particularly first thing in the morning or in the middle of the night. Researchers do not know exactly why this occurs, but they believe that there are several migraine pathways that are activated when sleep is disrupted.
We have extensive knowledge of the negative role that light plays in migraine, which makes it unsurprising that is included as a leading trigger here. Light sensitivity or photophobia is already a diagnostic signal for vestibular migraine, and exposure to high-intensity lighting has also been connected to general dizziness symptoms, regardless of condition. Learn how to counter light sensitivity when you have migraine.
Visual and Motion Triggers
The eye-to-brain system is highly sensitive for people with migraines (as evidenced by the high proportion of those with photophobia), and this is especially true for people with a vestibular component. For example, vestibular migraine attacks can be triggered by the following stimuli:
- External motion such as moving vehicles, movies or computer screens
- Visually "busy" or "cluttered" environments, including shopping malls and grocery stores
- High-contrast patterns like flashing lights or even striped images
And all of these have been shown to be the biggest factors in the development of vestibular-specific symptoms, which include dizziness, vertigo, and lightheadedness, among others.
Excessive Head Motion
Another unique stimulant for vestibular episodes has to do with head motion, which might affect more than 80% of individuals with the condition. This can be as simple as turning one’s head too quickly or shifting it from one view to another repeatedly.
Food and drink consumption is another common migraine trigger that equally impacts those with migraine-associated vertigo—perhaps even as many as half of the patients. More specifically, skipping meals, drinking alcohol or red wine, and caffeine intake are among the most likely behaviors to initiate attacks, according to research. You can learn more about migraine and diet here.
Much like light sensitivity and visual disorientation, sound can play a prominent role in the onset of vestibular migraines. Scientists have repeatedly connected the migrainous process with sensory processing, and many with the headache disorder report comparable levels of sensitivity to both light and noise. Although light may be a bigger threat to vestibular attacks, rarely do they exist in isolation.
Given the high percentage of women who are affected by migraine and other headache disorders, biological changes involving the menstrual cycle can have a major impact on attacks. In fact, anywhere from 20-40% of patients with vestibular migraine have acknowledged that these hormonal fluctuations have triggered at least some of their symptoms.
Although less prominent than others, exercise can still cause problems for people with this subtype of migraine. Although there does not appear to be an additional risk, we have to remember that exercising often incorporates head, neck and other sensitive movements for those with vestibular migraine.
Certain foods and drinks can also trigger a vestibular migraine:
- red wine
- aged cheeses
- monosodium glutamate (MSG)
- processed meats
- sodas with caffeine
Women are at a greater risk of getting vestibular migraines. Doctors suspect that vestibular migraines run in families, but studies have not yet proven that link.
It's important to remember this is just a shortlist of the leading triggers associated with vestibular migraine, and in fact there may be countless more that affect patients just as prominently: fatigue, strong odors or airline travel, to name a few. We encourage you to work with your neurologist or headache specialist to identify those factors that are causing trouble for you.
How are Vestibular Migraines Diagnosed?
Vestibular migraine should be diagnosed by a doctor, or 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.
There’s no blood or imaging test that can tell for sure. But the International Headache Society and other organizations recently set up the first criteria to help your doctor diagnose the disorder.
Vestibular migraines can be tricky to diagnose because there’s not a clear-cut test for it. Instead, your doctor will discuss your symptoms and history and consider factors laid out by guidelines in the International Classification of Headache Disorders and from the International Headache Society:
- Have you had at least five moderate or severe vertigo episodes lasting 5 minutes to 72 hours?
- Have you previously or do you still get migraines with or without an aura?
- At least 50 percent of the vertigo episodes also involved at least one of the following:
a. painful sensitivity to light, known as photophobia, or to sound, known as phonophobia
b. a visual aura
c. a headache involving at least two of these characteristics:
i. It’s centered on one side of your head.
ii. It feels like it’s pulsating.
iii. The intensity is moderate or severe.
iv. The headache worsens with routine physical activity.
- Is there another condition that better explains your symptoms?
- Current or a history of migraine
- You have at least 5 episodes of vertigo that make you feel like you are spinning or moving. This isn’t the same as motion sickness or feeling faint.
- At least five episodes of either vestibular symptoms alone, or alongside a migraine
- Your symptoms are moderate to severe. That means they stop you from doing everyday tasks or they’re so bad you can't do anything at all.
In order to treat you best, your doctor will want to rule out these other conditions that could be causing the symptoms:
- nerve irritation or fluid leaks in your inner ear
- transient ischemic attacks (TIAs), also called ministrokes
- Meniere´s disease (an inner ear disorder)
- Benign positional vertigo (BPV), which causes brief periods of mild or intense dizziness
Once diagnosed, a person should be prescribed medication if needed. They can also be offered guidance on understanding their triggers and advise on managing the condition.
The same drugs used for vertigo can provide relief from vestibular migraine episodes. These drugs help treat dizziness, motion sickness, nausea and vomiting, and other symptoms.
A regular sleep pattern may help to treat vestibular migraines or prevent them from occurring.
Medication is available to help if a 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.
Lifestyle changes and avoiding triggers can contribute to reducing the number of vestibular migraine episodes for many people.
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.
Here are some migraine home remedies that could be useful to you.
Living with Vestibular Migraine
You can reduce the chance that you will get a migraine by avoiding the foods and drinks that may trigger them. Pay attention to what you’ve eaten; you may notice a pattern. Keeping a food diary can help you identify something that upsets your body and leads to an episode.
Lifestyle changes can also help:
- Make sure you’re getting enough sleep and rest.
- Exercise regularly.
- Drink plenty of water.
- Take up stress-reducing activities like meditation and gardening.
- If menstruation is a cause of your migraines, it may help to take a water pill and avoid eating salty foods.
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.
Migraine associated vertigo afflicts a large percent of the population and continues to be a challenge to healthcare professionals. Technologies for measurement continue to expand and new medications continue to be manufactured for this affliction. Effective management of vestibular migraines requires a comprehensive effort and active participation of the patient, the treating physician, and the rehabilitation professionals. Proper identification, objective diagnostic measurements, and an optimized treatment approach will get the best results.
Compiled using information from the following sources: