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Vestibular Migraines — An Overview

Medically reviewed by Amit M. Shelat, D.O.
Written by Brooke Dulka, Ph.D.
Posted on November 1, 2021

A vestibular migraine is a neurological condition in which a person experiences migraine-associated vertigo (a spinning sensation), imbalance, nausea, or vomiting, either with or without a headache. Vestibular migraine attacks are also known as migrainous vertigo, migraine-related dizziness, and migraine with prominent vertigo.

Vestibular migraine may affect as much as 1 percent of the population, and these migraine attacks are the most common cause of episodic vertigo. This type of migraine affects far more women than men, with a gender ratio of 5 to 1.

Symptoms of Vestibular Migraine

Symptoms of vestibular migraine include a combination of migraine-related symptoms and vestibular-related symptoms (symptoms related to your sense of balance and perception of your body). However, symptoms do not have to occur at the same time — migraine symptoms tend to appear earlier than vestibular symptoms when this condition first arises.

Symptoms of a migraine include:

  • Severe headache
  • Nausea
  • Vomiting
  • Sensitivity to light, smells, and noise

Vestibular migraine symptoms also include:

  • Vertigo
  • Dizziness
  • Loss of balance (unsteadiness)
  • Sensitivity to motion (motion sickness)

The biggest difference between vestibular migraine and other migraine types is that vestibular migraine does not always have the severe head pain that is so closely associated with regular migraine attacks.

What Causes Vestibular Migraine?

The causes of vestibular migraine attacks are largely unknown. However, vestibular migraine attacks (like other migraine types) do tend to run in families, which suggests that there is a strong genetic component. Because of possible heredity, it’s important to tell your doctor about any family history of migraine disorders.

How Is Vestibular Migraine Diagnosed?

A family doctor can be helpful in coming to a medical conclusion about conditions such as migraine, but an official diagnosis of vestibular migraine will typically come from a neurologist (a specialist in neurological symptoms).

It may be difficult to diagnose vestibular migraine because the migraine symptoms do not always occur alongside the vestibular symptoms. In fact, “vestibular migraine” was not always its own diagnosis. Now, the Bárány Society and the International Headache Society have settled on the following diagnostic criteria for vestibular migraine:

  • At least five episodes of vestibular symptoms (in moderate to severe intensity) that last from five minutes to 72 hours
  • A history of migraine with or without aura, defined according to the International Classification of Headache Disorders classification system
  • Symptoms not better explained by another diagnosis

A person must also experience one or more of the following migraine features with at least half of their vestibular episodes:

  • Headache with two or more of the following characteristics: one-sided location, pulsating quality, moderate or severe pain, or pain that worsens with physical activity
  • Photophobia (light sensitivity) or phonophobia (auditory sensitivity)
  • Visual aura, a temporary vision disturbance like a blind spot or shimmering light

A doctor usually looks at several years of headache and vestibular symptoms history before coming to a diagnosis.

Similar Conditions to Vestibular Migraine

There are other vestibular disorders that can present similarly to vestibular migraine. These include:

  • Benign paroxysmal positional vertigo: This is a disorder of the inner ear that causes symptoms such as vertigo when calcium crystals (otoconia) migrate from their normal location in the inner ear.
  • Ménière’s disease: This condition is a balance disorder caused by an abnormality in a part of the inner ear called the labyrinth.
  • Transient ischemic attack (mini stroke): A transient ischemic attack results when blood flow to the brain is interrupted. Compared to normal strokes, the effects of a mini stroke are only temporary.

It is also possible for these conditions to be comorbid (co-occurring) with vestibular migraine, which can further complicate getting a proper diagnosis.

Treating Vestibular Migraine

Vestibular migraine attacks are treated similarly to other migraine attacks, with pain-relieving or pain prevention medications. For instance, prescription medications called triptans — such as Imitrex (sumatriptan) and Maxalt (rizatriptan) — are often used to treat migraine because they block pain pathways in the brain. A newer drug, Reyvow (lasmiditan), has also been approved for the treatment of migraine with or without aura.

If episodes of vestibular migraine are frequent, the following treatments may also be suggested.

Beta Blockers

Beta blockers are used to help prevent migraine attacks. These drugs block beta-adrenergic activity, meaning they prevent the actions of epinephrine (adrenaline) and help relax blood vessels. Examples of beta blockers include Inderal (propranolol) and Blocadren (timolol).

Calcium Channel Blockers

Calcium channel blockers are also used to help prevent migraine attacks. These drugs prevent calcium from entering the cells of your heart and arteries, which prevents contraction of the muscle wall of the artery. An example of a calcium channel blocker is Norvasc (amlodipine).

Antidepressants

Antidepressants such as selective serotonin reuptake inhibitors or serotonin norepinephrine reuptake inhibitors may be used to help prevent migraine attacks. These medications are believed to work by changing serotonin levels in the brain, although their efficacy has been disputed. Tricyclic antidepressants may be more helpful. Examples of tricyclic antidepressants include Elavil (amitriptyline) and Pamelor (nortriptyline).

Anticonvulsants

Sometimes medications typically used for seizures, such as Topamax (topiramate), can also be used to prevent migraine attacks.

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Have you or a loved one been diagnosed with vestibular migraine? Comment below, or join the conversation at MyMigraineTeam.

Posted on November 1, 2021
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Amit M. Shelat, D.O. is a fellow of the American Academy of Neurology and the American College of Physicians. Review provided by VeriMed Healthcare Network. Learn more about him here.
Brooke Dulka, Ph.D. is a freelance science writer and editor. She received her doctoral training in biological psychology at the University of Tennessee. Learn more about her here.

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