What are the signs of vestibular migraines?

April 9, 2025

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What are the signs of vestibular migraines?

Vestibular migraines (also known as migraine-associated vertigo) are a migraine condition characterized by vestibular (balance-related) symptoms alongside the typical headache manifestations of migraines. Symptoms and signs may vary from individual to individual, but some of the most common are:

1. Dizziness and Vertigo
Vertigo: A spinning or off-balance sensation that is severe enough to affect everyday activities. It may last for a few minutes or several hours.

Dizziness: Dizziness or unsteadiness without actual spinning of vertigo.

2. Headaches
Migraine-like headaches: The majority of individuals with vestibular migraines will experience the typical symptoms of a migraine, such as a pulsating or throbbing headache, typically on one side of the head.

Light and sound sensitivity: Headaches may be accompanied by light sensitivity (photophobia), sensitivity to sound (phonophobia), or sensitivity to smell (osmophobia).

Nausea and vomiting: Nausea and vomiting may also be present in the headache attack, especially if dizziness and vertigo are poor.

3. Balance Problems
Unsteadiness: Difficulty with balance or like you could fall, especially while moving your head quickly or shifting positions.

Difficulty walking: Some people with vestibular migraines may have difficulty walking a straight line or develop loss of coordination due to dizziness and imbalance.

4. Nausea
Gastrointestinal manifestations: Nausea is common, as in the other types of migraines. This ranges from mild queasiness to violent vomiting, especially if dizziness and vertigo are also present.

5. Sensory Sensitivities
Heightened sensitivity to motion: Abnormal head movement or visual stimuli (such as scrolling on a phone or watching quickly moving images) can trigger or worsen the symptoms.

Motion sickness: People may be more prone to motion sickness in spite of activities like driving, reading in a car, or watching moving objects on a TV screen.

6. Visual Disturbances
Visual aura: Certain people exhibit visual disturbances in advance of or during a bout of vestibular migraine that is similar to the aura of typical migraines. These may include:

Flashing lights

Zigzag lines or blind spots

Transitory loss of vision

Double vision: Vision problems also occur during the migrainous phase, hence concentration becomes impaired.

7. Frequency of Attacks
Frequency of attacks: Vestibular migraine attacks tend to recur, which may be anything from a few minutes to days. Attacks are with or without headache.

Triggers: Similar to other types of migraines, there may be some triggers that contribute to vestibular migraine attacks, such as stress, sleep deprivation, hormonal change, or certain foods (e.g., chocolate, cheese, alcohol).

8. Absence of Typical Migraine Features
No headache: There is vertigo and balance disturbance in some vestibular migraine patients without a headache, making diagnosis more difficult. It is also referred to as a “migraine without headache” or “silent migraine.”

9. Other Associated Symptoms
Tinnitus (ringing in the ears): Ringing or buzzing in the ears, typically occurring with dizziness.

Hyperacusis: Heightened sensitivity to sound, typically worsened by the migraine.

Cognitive changes: Difficulty concentrating, being “foggy,” or experiencing mental fatigue during or after an attack.

Diagnosis:
Vestibular migraines are troublesome to diagnose since the symptoms and signs manifest in other conditions, such as BPPV, Meniere’s disease, or other vestibular disturbances. A thorough evaluation from a provider would most likely include an appropriate medical history, physical exam, and possibly an imaging test or vestibular test.

Treatment:
Some of the treatment for vestibular migraines can include some of the medication that is used to prevent or reverse migraine, such as:

Preventive treatment: Some drugs like beta-blockers, antidepressants, or anticonvulsants.

Acute treatments: Triptans, anti-nausea medication, or NSAIDs for symptom relief.

Vestibular rehabilitation therapy: Physical therapy to improve balance and reduce dizziness.

Lifestyle changes, such as stress management, improving sleep, and avoidance of known precipitating stimuli, can also reduce frequency and severity of episodes.

If you are experiencing any of these symptoms, it’s important to visit a healthcare provider for accurate diagnosis and treatment plan.
Vestibular migraines, a type of migraine involving dizziness or vertigo as well as typical migraine symptoms (such as headache, nausea, and photophobia), can be challenging to treat due to the combination of neurological and vestibular (balance) symptoms. The treatment regimen generally involves a combination of lifestyle modifications, medications, and vestibular rehabilitation therapy (VRT). The following is an overview of potential treatments:

1. Acute Migraine Treatments (For Attacks):
Triptans (e.g., sumatriptan): These are most commonly used in the acute episode of a migraine, including vestibular migraines. They are effective in eliminating both headache as well as other associated symptoms of dizziness and nausea.

NSAIDs (e.g., ibuprofen, naproxen): Non-steroidal anti-inflammatory medications can help alleviate pain and inflammation in an acute attack.

Anti-nausea drugs (e.g., metoclopramide or prochlorperazine): These may be prescribed to control nausea or vomiting that can occur during a vestibular migraine.

Corticosteroids: In some cases, an acute course of steroids may be prescribed for severe attacks to reduce inflammation and vestibular symptoms.

Anti-vertigo medications (e.g., meclizine or dimenhydrinate): These will sometimes relieve dizziness and vertigo with a migraine attack. Use these medications with caution overall since they will often mask symptoms rather than cure the root problem.

2. Preventive Medications:
For individuals with frequent or debilitating vestibular migraines, preventive treatment might be recommended. Such drugs prevent attacks from occurring as often, being as intense to lesser extents, and lasting as long.

Beta-blockers (e.g., propranolol): Used most commonly for the overall prevention of migraines, they can also relieve dizziness and vertigo associated with vestibular migraines.

Antidepressants (e.g., amitriptyline or venlafaxine): Tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors (SNRIs) can be beneficial in preventing headache and vestibular symptoms.

Anticonvulsants (e.g., topiramate or valproate): These medications are commonly prescribed for migraine prevention and can also relieve vestibular symptoms.

Calcium channel blockers (e.g., verapamil): These can be beneficial for migraine prevention, including vestibular migraines.

CGRP inhibitors (e.g., erenumab, fremanezumab): Calcitonin gene-related peptide (CGRP) inhibitors are new migraine-specific drugs that are helpful in prevention of headache as well as vestibular symptoms.

3. Vestibular Rehabilitation Therapy (VRT):
VRT: A form of specialized physical therapy that aims to improve balance and reduce dizziness. It includes exercises to help the brain compensate for vestibular disruptions and can help manage vertigo symptoms.

Training usually incorporates head movement, balance training, and eye stabilization exercises. These exercises could help the brain re-tune its balance systems and reduce the severity of vestibular symptoms.

Physical therapy can also consist of exercises that reinforce the neck muscles as well as posture, which will avoid triggering vestibular migraine attacks.

4. Lifestyle Changes:
Dietary changes: Certain foods or food additives, such as caffeine, chocolate, alcohol, and foods with high tyramine content (e.g., aged cheese, cured meats), may trigger vestibular migraines. Evading known triggers will prevent the frequency of attacks.

Sleep hygiene: Normal sleep habits and adequate sleep can ward off migraines. Too little sleep as well as too much sleep are triggers.

Stress management: Stress is a very common migraine trigger. Stress reduction techniques like meditation, deep breathing, yoga, and biofeedback can help reduce stress and ward off vestibular migraines.

Hydration and dehydration: Adequate fluid intake is essential because dehydration can trigger vestibular migraines as well as other kinds of migraines.

5. Dietary Supplements:
Others derive benefit from supplements that can reduce frequency and severity of migraines, albeit evidence is mixed. These are:

Magnesium: Magnesium supplementation might prevent migraines in some studies.

Coenzyme Q10 (CoQ10): This anti-oxidant reduces frequency of migraines in some patients.

Riboflavin (Vitamin B2): Riboflavin prevents migraines, including vestibular migraines, in some studies.

Feverfew and Butterbur: Dietary supplements may prove helpful in migraine prevention but have to be administered under the direction of a medical doctor due to the possibility of side effects as well as interactions with medications.

6. Biofeedback and Cognitive Behavioral Therapy (CBT):
Biofeedback: This technique helps patients learn the regulation of physiological functions, such as heart rate and muscle tension, to reduce the intensity of migraines. It might be particularly beneficial in managing stress-related etiologies of vestibular migraines.

Cognitive Behavioral Therapy (CBT): CBT can help patients cope with the emotional tension that tends to accompany chronic vestibular migraines and offer methods for coping with anxiety, depression, and other concomitant issues.

7. Botulinum Toxin (Botox) Injections:
For some treatment-resistant patients with chronic vestibular migraines, Botox injections may be used as a preventive treatment. Botox is commonly used to treat chronic headache migraines and may potentially relieve vestibular symptoms in some cases.

8. Complementary Therapies:
Others experience symptomatic improvement with complementary treatments such as acupuncture, chiropractic adjustment, or herbal remedies. While there is limited scientific evidence to back these treatments, some may benefit from their use, albeit in conjunction with other treatments.
Treatment of vestibular migraines is usually a multi-modal approach, including drugs, lifestyle changes, and physical therapy. Close consultation with a health practitioner, preferably a neurologist or vestibular disorders specialist, is recommended to develop an individualized treatment plan. Treatment of both the headache and the vestibular symptoms is important in order to effectively treat the condition and improve the quality of life.


The Stop Snoring And Sleep Apnea Program™ a well-researched program created to help stop snoring and sleep apnea so that you can have a good night sleep. The techniques that you will learn from this program works immediately. It will only take you 3-7 minutes to perform these simple exercises that the author has recommended but the results that you will get will help you have a good night sleep as soon as tonight. Within a week, snoring will be a thing of the past.