What Is a Vestibular Migraine?
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 trusted Source 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.
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How is it diagnosed?
Vestibular migraines can be tricky to diagnose because there’s not a clear-cut test for them. 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
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Treatment, prevention, and management
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.
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Outlook
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 the treatment and prevention of those conditions, as well as any other concerns you may have.