Vestibular migraine is the internationally accepted term for a type of migraine that affects the balance system.
What are the symptoms of vestibular migraine?
The symptoms of vestibular migraine include:
- episodes of dizziness, vertigo or unsteadiness
- headaches (but not always at the same time as the dizziness)
- sensitivity to light or sound
- nausea or vomiting
Symptoms mostly occur without headache, although in around half of patients are followed by or occur with a headache or visual changes.
Other symptoms can include: sweating, flushing, and visual changes such as blurring, flashing lights and difficulty focusing. Patients also report difficulty concentrating, finding bright lights and loud sounds uncomfortable and, most commonly, feel extreme tiredness and fatigue, needing to sleep.
How long do vestibular migraine symptoms last?
The duration of attacks are very variable, from seconds in some patients to days in others, but usually last minutes to hours.
How is vestibular migraine diagnosed?
Vestibular migraine is diagnosed on the basis of patient’s history, including a history of migraine headaches or migraine-like symptoms; recurrent episodes of vertigo/dizziness with migraine features; and excluding other causes such as BPPV or Ménière's.
The commonest (benign) neurological condition to mimic BPPV is a form of migraine. The presence of concurrent symptoms not expected in Ménière’s disease such as visual symptoms during attacks is often the key to the diagnosis. This may include blurred vision or sensitivity to light. Patients also often complain of extreme fatigue immediately following an attack. Incidentally, vestibular migraine can cause attacks which are not unlike those of Ménière’s and which are often misdiagnosed as such without expertise!
Vestibular migraine used to be called migrainous vertigo, migraine-associated dizziness, migraine-related vestibulopathy, or recurrent vertigo, however the internationally accepted term from the Barany Society and International Headache Society is vestibular migraine.
Is migraine the same as headache?
Migraine does not mean headache. In fact, there are many types of migraine that involve no headache at all, it just so happens that the two most common types of migraine in the population are the headache varieties; common migraine and classical migraine. Migraine is actually a condition of altered sensation and can happen at any age and in any part of the body. Young babies may present with migraine in the form of cyclical vomiting. Children present with abdominal migraine having tummy pains and diarrhoea. Those with vestibular migraine can also have prominent motion sickness
Who is affected by vestibular migraine?
Vestibular migraine often starts in people with a history of migraine headaches. It is the most common cause of recurrent spontaneous vertigo and the second most common vestibular disorder after benign paroxysmal positional vertigo (BPPV).
Vestibular migraine may start at any age and has a female preponderance of about 3:1. Familial occurrence is common, pointing to a genetic origin of the disorder.
There is a strong association with Ménière’s disease, with approximately half of people with Ménière’s experiencing at least one migraine symptom during a Ménière’s attack. The two conditions can coincide in 40% of patients with Ménière’s disease. Vestibular migraine must always be considered in any patient with Ménière’s whose symptoms recur unexpectedly and before any destructive Ménière’s treatment is contemplated.
Benign paroxysmal vertigo of childhood is thought to be a variant of vestibular migraine that starts at pre-school age with brief attacks of isolated vertigo which tend to be replaced by typical headache migraine after a few years.
What are the triggers of vestibular migraine?
The top 5 most common triggers for vestibular migraine are:
- Stress and anxiety.
- Poor sleep – both too little, and too much!
- Hunger and dehydration – missing meals and not taking enough water.
- Dietary triggers – many common foods, especially caffeine.
- Hormonal changes – i.e. menstruation, menopause and in teenagers.
Other external triggers can include certain forms of lighting and ventilation, weather changes, smoking and strong odours.
How is vestibular migraine treated?
With the right treatment plan, most people find their condition/symptoms improve significantly. Early intervention can make a big difference. Most patients have one or more specific triggers and treatment, therefore, centres on identifying and managing these triggers in individual patients. Ongoing management and adjustments may be needed as symptoms may change over time.
Treatment options include:
- Initial treatment is education, with the systematic identification of trigger factors with a symptom diary.
- Regulation of lifestyle is often the key and the good news is simple lifestyle and dietary changes have been shown to help in 80-90% of patients!
- Ensure regular meals and hydration
- Have good sleep
- Use stress management - such as yoga or mindfulness
- Medication - if symptoms are not managed by the other lifestyle options
- Vestibular rehabilitation - exercises to retrain the balance system. It is important to note that vestibular rehabilitation is not suitable for everyone with vestibular migraine. If attacks of dizziness or headache are very frequent, medication may need to be initiated first, so that the exercises used in vestibular rehabilitation are not excessively stimulating or do not exacerbate symptoms.
Where can I get further information and support for vestibular migraine?
- Please contact us to request a FREE vestibular migraine information pack - email us: info@meandve.org.uk or give us a ring: 01306 876883 to chat with a member of our team
- See your GP for advice if you have any question or concerns about your symptoms. They may refer to a specialist if neccessary
- Become a member to receive regular information, resources and updates
- Donate to support our work and help us continue supporting people affected by vestibular migraine and other vestibular conditions
Please note, Ménière's & Vestibular UK can provide general information, but is unable to provide specific medical advice. You should always check with your medical professional for information and advice relating to your symptoms/condition.