A vestibular migraine refers to an episode of vertigo in someone who has a history of migraines. People with vertigo feel like they, or objects around them, are moving when they’re actually not. “Vestibular” refers to the system in your inner ear that controls your body’s balance.
Migraines are often associated with painful headaches, but vestibular migraines are different because the episodes commonly involve no headache at all. Many people who get classic or basilar migraines (with auras) also experience vestibular migraines, but not all people.
Vestibular migraines may last only a few seconds or minutes, but sometimes they persist for days. Rarely do they last longer than 72 hours. In most cases, symptoms last for a few minutes to several hours. In addition to vertigo, you may feel off-balance, dizzy, and light-headed. Moving your head may cause those symptoms to worsen.
A vestibular migraine occurs in about 1 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.
The main symptom of a vestibular migraine is an episode of vertigo. Usually it happens spontaneously. You may also experience symptoms including:
- feeling imbalanced
- motion sickness caused by moving your head
- dizziness from looking at moving objects such as cars or people walking
- feeling like you’re rocking on a boat
- nausea and vomiting as a result of the other symptoms
Doctors aren’t certain what causes vestibular migraines, but some believe that the abnormal release of chemicals in the brain plays a role.
Some of the same factors that triggers other kinds of migraines can trigger a vestibular migraine, including:
- lack of sleep
- weather changes, or changes in barometric pressure
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 for getting vestibular migraines. Doctors suspect that vestibular migraines run in families, but studies have not yet proven that link.
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:
- 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?
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
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.
If you frequently experience episodes, your doctor may prescribe the same drugs that help prevent other kinds of migraines. Those drugs include:
- beta blockers
- triptans such as sumatriptan (Imitrex)
- anti-seizure drugs, such as lamotrigine (Lamictal)
- calcium channel blockers
- CGRP antagonists, such as erenumab (Aimovig)
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.
There is no cure for migraines. A German study from 2012 looked at people with vestibular migraines over a period of almost 10 years. The researchers found that over time, the frequency of vertigo lessened in 56 percent of cases, increased in 29 percent, and was about the same in 16 percent.
People who get vestibular migraines are also more likely to get motion sickness and are at a greater risk for ischemic strokes. Talk to your doctor about treatment and prevention of those conditions, as well as any other concerns you may have.