Understanding Vestibular Migraine: What You Need to Know
Vestibular migraine is a type of migraine that primarily causes episodes of vertigo or dizziness rather than just headache. It involves a false sensation of motion, such as spinning, swaying, or rocking, and can lead to significant disorientation.
- Definition: Vertigo is the false sensation of motion when there is none, such as feeling like you or your environment is spinning, swaying, or moving.
- Difference from Dizziness: Dizziness is a non-specific term for disorientation or feeling lightheaded, without the sensation of motion.
Can You Have Both Typical and Vestibular Migraine?
Yes, individuals can experience both the more common types of migraine (with or without aura) and vestibular migraine. These conditions can overlap, with patients experiencing headaches along with vertigo or dizziness.
Does Vestibular Migraine Always Come with Head Pain?
No, vestibular migraine does not always present with head pain. Diagnostic criteria include having vertigo or dizziness with at least one migraine feature, such as:
- Headache
- Light or noise sensitivity
- Visual aura
While some episodes may come with headaches, they are not mandatory for a diagnosis.
Diagnosis of Vestibular Migraine
To diagnose vestibular migraine, patients must meet the following criteria:
- At least five attacks of vertigo or dizziness.
- At least half of these attacks must be accompanied by one or more migraine features (headache, light/noise sensitivity, or visual aura).
Treatment Options for Vestibular Migraine
Vestibular migraine can be managed with similar treatments used for other migraine types:
Preventive Treatments:
- Medications: Anti-epilepsy drugs, beta-blockers, antidepressants, and CGRP blockers.
- Neurostimulation: Devices like gammaCore that help manage migraine symptoms.
Rescue Treatments:
- Medications: Triptans, non-steroidal anti-inflammatory drugs (NSAIDs), and newer CGRP blockers.
Common Triggers of Vestibular Migraine
Similar to other types of migraine, vestibular migraine can be triggered by:
- Stress
- Lack of sleep or sleep changes
- Hormonal fluctuations (e.g., menstrual cycle)
- Weather changes
- Diet
Who Can Diagnose and Treat Vestibular Migraine?
- Specialists to Consult: Neurologists or ENT (ear, nose, and throat) doctors can diagnose vestibular migraine. ENT doctors often see patients with vertigo and can differentiate between inner ear disorders and vestibular migraine.
- Tests and Diagnosis: Vestibular testing, hearing tests, and thorough examinations help rule out other conditions like Meniere’s disease or benign paroxysmal positional vertigo (BPPV).
Conditions Commonly Misdiagnosed as Vestibular Migraine
- Meniere’s Disease: Causes asymmetric hearing loss and is more likely if there is low-frequency hearing loss on one side. Meniere’s disease can coexist with vestibular migraine.
- Benign Paroxysmal Positional Vertigo (BPPV): Often confused with vestibular migraine, but BPPV causes brief episodes of vertigo related to head movement and is treated with specific maneuvers, not migraine medications.
When To Talk With a Healthcare Provider
You should consult a healthcare provider if you experience:
- Frequent or severe episodes of vertigo or dizziness, especially if they disrupt daily activities.
- Vertigo or dizziness accompanied by other migraine features, such as headache, light or noise sensitivity, or visual aura.
- Symptoms that worsen over time or do not respond to typical migraine treatments.
- Unusual or concerning symptoms, such as hearing loss, persistent ear ringing, or any changes in vision or balance.
Seeing a neurologist or ENT specialist can help diagnose vestibular migraine accurately and differentiate it from other conditions.
Vestibular migraine is a treatable condition, and with the right diagnosis and management, people can significantly improve their quality of life. If you experience recurring vertigo or dizziness with migraine-like symptoms, consult a healthcare provider to explore your treatment options.
This resource is based on HeadWise Episode 180, Dizziness, Vertigo, Lightheadedness? Maybe Vestibular Migraine with Shin Beh, MD
Published, 04/12/2024
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Learn More Through Personal Stories
Kelly’s story is one of resilience, determination, and the power of finding the right support system when living with a chronic headache disorder.
As a young child, she vividly remembers the debilitating pain and sensitivity to light that would leave her curled up in her room, comforted by her mother.
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