Vestibular Migraines: Why This Dizzying Type of Migraine Is a Little Strange

What you need to know about diagnosis and treatment
Vestibular Migraines: Why This Dizzying Type of Migraine Is a Little Strange

When you think “migraine” you probably think “headache.” But if you have a history of migraine headaches and start having dizzy spells, you may have vestibular migraines — and they’re a bit of an oddity; they may not involve headaches at all.

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A history of migraines and dizziness are clues to this condition, but diagnosing vestibular migraines isn’t as straightforward as that, says neurologist Neil Cherian, MD.

“It’s like saying that if a car is fast and red it must be a Ferrari,” he says.

What is a vestibular migraine? 

Doctors look for at least a five- to eight-year history of migraine symptoms and developing dizziness to identify vestibular migraines (also known as migraine-associated vertigo, migraine-related vestibulopathy and migrainous vertigo). The term “vestibular” refers to the inner ear and your sense of balance.

“The vestibular symptoms are quite variable,” Dr. Cherian says. “They could include a spinning feeling, a sensation of movement and the perception that things are moving out of proportion to the environment.”

Symptoms can last for minutes or days. And, they can knock you off your feet.

“Vestibular migraines can be quite debilitating,” he says. “Even though there is not always a headache, the dizziness, light and sound sensitivity, and/or the nausea are sometimes quite incapacitating.”

It’s difficult to say how common vestibular migraines are. One study suggests that 1.7 percent of the general population may have them.

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”The research on this is still evolving,“ Dr. Cherian says. “In my 18 years of practice, I have not seen many cases.”

How do vestibular migraines differ from classic migraines?

A migraine headache causes moderate to severe pain and tends to recur. The pain often begins on one side of the head and throbs or pulses. You may notice sensitivity to light, sound and odors. You may experience nausea and vomiting.

Some people notice a warning signal or aura (visual cues such as bright flashing lights, for example) before a migraine.

They tend to run in families, but there are other triggers — emotional stress, sensitivity to chemicals and preservatives in food, caffeine, and sleep deprivation.

Vestibular migraines mirror many of these symptoms along with dizziness (with or without a headache). Dr. Cherian says he looks for the absence of signs of an inner ear problem or other possible sources of dizziness to help make a diagnosis.

How does dizziness factor in?

Dizziness by itself is a common ailment. About 15 percent of the general population experiences dizziness each year, and the rate is higher among older adults.

“It’s one of the top five presenting symptoms to a primary doctor,” Dr. Cherian says.

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It causes falls and faintness in some cases, but with vestibular migraines you’ll have vertigo or a sense of spinning.

Dizziness is generally not serious, and may relate to medications or heart problems as well as inner ear problems (with vestibular migraines), he says.

How do doctors treat vestibular migraines?

“Typically, we treat migraines and vestibular migraines the same,” Dr. Cherian says.

He suggests three common approaches:

  1. Determine and avoid your triggers — stress, certain foods or not enough sleep.
  2. Take supplements, such as riboflavin or magnesium.
  3. Take over-the-counter or prescription drugs to reduce pain or prevent headaches.

Your doctor also may prescribe vestibular rehabilitation, a type of physical therapy that can help improve balance and manage your dizziness.

The rehabilitation team will tailor an exercise plan for your specific problems, including exercises for neck stretching and vision stability, for example.

Bottom line? Don’t try to diagnose yourself. Explain your headache history and symptoms and let your doctor determine whether you’re having vestibular migraines.

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