If you experience frequent migraine attacks, you know that dizziness, unsteadiness, and a general experience of vertigo are all common symptoms. But when does vertigo become a different disorder altogether?

A 2014 review of studies identified people with migraine episodes who reported less frequent headache attacks and more frequent episodes of vertigo as they grew older. In these cases, vertigo seemed to replace other migraine symptoms.

Researchers have named this experience epigone migraine vertigo (EMV), but it is not a widely accepted term or diagnosis yet.

The International Headache Society recognizes vestibular migraine (VM) in the International Classification of Headache Disorders. However, it’s still unclear whether or not EMV is related to VM or if the two are actually the same thing.

If you previously had a history of migraine and are now finding that vertigo is your primary complaint, it’s possible you have a form of migraine-related vertigo. Here’s what we know so far about epigone migraine vertigo.

The word “epigone” means follower, disciple, or imitator. EMV gets its name because experts have suggested it’s actually a form of vertigo that occurs in people who previously experienced migraine attacks.

This type of vertigo follows migraine episodes. People report first experiencing regular episodes of migraine attacks and then primarily only episodes of vertigo.

Age seems to play a role too. The three people highlighted in the 2014 review of studies mentioned earlier were all in their 40s. They all also reported a history of migraine for several decades before their vertigo symptoms began as well as motion sickness that started in childhood.

Previous symptomsCurrent symptoms
intense headachevertigo
throbbing pain in the head, neck, or bothdizziness
light and sound sensitivity nausea
seeing aurasimbalance

A history of migraine does seem to play an important role in the development of vertigo disorders.

A 2020 study found that 86 out of 172 people experiencing both migraine and vertigo had their migraine symptoms develop first. Meanwhile, 35 people had vertigo symptoms first, and 52 people had symptoms of both migraine and vertigo appear at the same time.

Currently, it’s unclear if epigone migraine is different from vestibular migraine.

Vestibular migraine (VM) is a type of migraine that causes vertigo. According to the American Migraine Foundation (AMF), its symptoms usually include:

  • dizziness
  • a sense of imbalance
  • light and sound sensitivity
  • ear pressure or ringing

VM also may or may not include headache symptoms.

If EMV were to be established as a separate condition, it would differ from VM since it would be seen as a type of vertigo brought on by a history of migraine episodes.

The difference is minor but important. EMV would be considered a vestibular disorder, while VM would be a migraine disorder. But there is a lot of crossover between symptoms.

Another 2020 study found that 30 percent of VM attacks do not involve a headache. This potentially makes it difficult to determine whether someone has EMV or headache-free VM.

VM is not a well-understood variation of migraine disorders, and even less is known about EMV. Vertigo might be related to migraine episodes since they share some of the same neurological pathways.

Migraine attacks occur when pain receptors in the brain are triggered or inflamed, so it makes sense that any overlapping receptors controlling parts of your vestibular system may also be affected.

A migraine that includes symptoms of vertigo will often feel similar to a traditional migraine. You could have:

  • intense, throbbing pain
  • increased pain with movement
  • nausea
  • extreme sensitivity to light, sound, and smell

Not all people experience head pain during migraine with vertigo episodes, so you may only have vertigo symptoms. You could also have nausea, which could be related to either migraine or vertigo.

With or without these traditional symptoms, you would have vertigo symptoms. The AMF describes vertigo symptoms as feeling like you are “moving, falling, or spinning” when you’re actually fixed in one position.

This is what many people mean when they say they feel dizzy or off-balance. In general, vertigo symptoms can last anywhere from a few minutes to a few days and can even be chronic, depending on the cause.

Since they often stem from vestibular migraine episodes, the maximum length is usually not more than 72 hours.

What’s the difference between vertigo and dizziness?

Despite the fact that most people use the word “dizziness” to describe what vertigo feels like, the two are actually different:

  • Dizziness is more associated with a lightheaded feeling or an off-balance center of gravity.
  • Vertigo makes you feel like everything around you is spinning or that youare spinning. In reality, you and your environment are stationary.

When should you worry about vertigo?

Vertigo is not a serious symptom in itself, but it can point to something more serious or cause injury if it happens at the wrong time. According to the Moffitt Cancer Center, you should see your doctor if your vertigo interferes with your daily life because it’s:

  • severe or produces anxiety
  • happening frequently
  • happening over a long period of time
  • happening without a known cause

You should also seek urgent medical care if your vertigo occurs after an injury or alongside other symptoms, such as:

In the three case studies presented in the 2014 review of studies, there were no clear triggers for the episodes of epigone migraine that occurred. Since EMV does not have a diagnostic profile, no one knows what the triggers are for certain.

But experts do know what the triggers of VM are. They’re usually the same triggers for traditional migraine attacks, like:

The treatments for traditional migraine and vestibular migraine are mostly the same, just like their triggers and symptoms.

Many medications can be prescribed by a doctor to prevent VM episodes and relieve an episode once it starts, according to 2019 research. If your episodes are triggered by things in your lifestyle, like your diet or sleep habits, you can make adjustments to reduce the number of attacks.

Research from 2020 found that vestibular rehabilitation, which is like physical therapy for your vestibular system, can also be beneficial.

Migraine treatment at home

Most migraine episodes are treated at home. People usually only go to their doctor’s office or seek urgent care for migraine when their symptoms stop responding to their usual treatments or last for several days without change or improvement.

According to the AMF, you should seek medical care if you experience a severe headache that takes only seconds to develop or if your migraine symptoms include fever, weakness, or vision loss.

For the most part, basic care at home will be enough to get you through your migraine. This includes:

  • lying down to rest and taking a nap, preferably in a dark, quiet room
  • using a sleep mask or earplugs to ease sensory sensitivity
  • placing an ice pack or cool cloth wherever the site of the pain is
  • drinking water if your stomach can tolerate it
  • trying an over-the-counter migraine medication
  • taking any rescue medications a doctor has prescribed you for migraine, like NSAIDs, triptans, or anti-nausea medications

Emerging evidence also suggests that noninvasive vagus nerve stimulation is a beneficial treatment for vestibular migraine.

Epigone migraine vertigo is an emerging idea. It’s not an official diagnosis, but it has a lot in common with vestibular migraine. Experts still are unsure how EMV is related to vestibular migraine, whether they’re the same condition, or if EMV is a vestibular disorder versus a migraine disorder.

What we do know is that vertigo is a common symptom of migraine attacks and that many people with a history of migraine episodes end up reporting episodes of vertigo later in life.

If you have either vertigo or migraine symptoms that you have not addressed with a healthcare professional, it’s a good idea to bring them up and discuss treatment.