Vestibular Migraine, also called Migraine Associated Vertigo or Migrainous Vertigo, is a type of migraine where you get dizzy spells as one of the more prominent complaints during an migraine attack rather than a severe headache.
Vestibular Migraine can include a range of debilitating symptoms affecting the ears, vision, and balance. It is the most common cause of recurrent attacks of vertigo.
Other diagnoses that look very similar to Vestibular Migraine include migraine with Benign Paroxysmal Positional Vertigo (BPPV) and Meniere’s disease.
During a Vestibular Migraine attack, alongside symptoms of vertigo, imbalance and dizziness, some people may also:
• Find head movement involved in turning, bending down, or looking up, is intolerable
• Experience motion sickness or nausea
• Feel a pressure within their head and/or ear
• Have neck pain
• Find it hard to hear low sounds, or develop tinnitus (a ringing or other sound in the ear)
What’s different about Vestibular Migraine?
The main difference of Vestibular Migraine is that the dizziness and other balance problems can be much more bothersome than the headache of other more typical migraine symptoms.
Vestibular Migraine without significant headache can precede or follow other more typical migraine presentations throughout life. It is quite common for children who have not yet been diagnosed with migraine to have dizzy spells or get car sick quite often. Similarly,
later in life, people who have had migraine attacks for many years may find their headache and other typical migraine symptoms become more manageable, but they start getting spells of vertigo instead.
There is rarely any mechanical reason for vertigo in Vestibular Migraine patients, that is, there isn’t anything wrong with your inner ears or that would be found on a vestibular function test. But the dizziness, loss of balance, and other symptoms are very real and may be challenging to diagnose and manage.
Good to know!
Approximately 40% of migraine patients have some accompanying vestibular symptoms involving disruption in their balance and/or dizziness at one time or another. This may be before, during, after, or totally independent of their migraine attacks.
Treating Vestibular Migraine
Accurate diagnosis of Vestibular Migraine is important as your treatment plan may be different from other migraine types. It is common for Vestibular Migraine symptoms to be experienced in or in combination with other vestibular conditions like Benign Paroxysmal Positional Vertigo (BPPV), Meniere’s disease (MD) and Persistent PosturalPerceptual Dizziness (PPPD), which makes the diagnosis and treatment more challenging.
You will probably try several migraine prophylactic medications and acute symptom medications. Interestingly, some of the pain medications do not resolve the dizziness, and medications for the dizziness often do not resolve the pain, so you may be told to try
combinations of acute medications.
There are neurologists or ear/nose/throat (ENT) surgeons who specialise in treating dizzy and balance disorders (termed neurootologists), so ask your GP to refer you to one of these three groups of specialists depending on local availability of expertise. Specialist vestibular physiotherapists also form an important part of the Vestibular Migraine care team.
While many people with Vestibular Migraine get headaches, it is possible for Vestibular Migraine patients to get dizzy but not have a headache during their migraine attacks.