Published by PMR of NY & CT
Some migraines don't announce themselves with a pounding headache. Instead, the room seems to tilt, a busy store leaves you feeling off balance, or turning your head brings on a wave of dizziness. If that sounds familiar, you may be dealing with vestibular migraine, one of the most common causes of recurring vertigo.
Vestibular migraine is a form of migraine with dizziness or vertigo as a main symptom. Headache may come with an episode, before it, after it or not at all, which is one reason it often goes unrecognized for years. Once it is diagnosed, there is a lot you and your care team can do.
What vestibular migraine feels like
People describe vestibular migraine symptoms in different ways. Common ones include:
- Spinning vertigo, or a sense that you or the room are moving
- Unsteadiness, rocking or a "swimming" feeling in your head
- Dizziness set off by head movement, scrolling screens or busy visual scenes
- Sensitivity to light and sound during an episode
- Nausea, and sometimes ear pressure or ringing
Episodes can last from a few minutes to several hours, and occasionally up to three days. Between attacks, some people feel completely normal, while others notice lingering motion sensitivity or less confidence on their feet.
Common triggers to track
This type of migraine shares triggers with other migraines. Keeping a simple log of episodes can help you spot your own pattern. Frequent culprits include:
- Short or irregular sleep
- Stress, or the letdown after a stressful stretch
- Skipped meals and dehydration
- Hormonal changes, such as around a menstrual period
- Bright, flickering or fast-moving visual input
- Certain foods or drinks for some people, such as alcohol or aged cheese
Not every trigger causes an attack every time. Triggers often add up, so a short night plus a skipped lunch plus a long screen session may be enough when one alone is not.
How it is diagnosed
There is no single test for this condition. A physician, often a neurologist or an ear, nose and throat specialist, makes the diagnosis from your history: repeated episodes of vertigo, a personal history of migraine, and migraine features, such as headache, light and sound sensitivity or visual aura, during at least half of the episodes.
Your doctor will also look for other causes of dizziness, including inner ear conditions such as benign paroxysmal positional vertigo (BPPV) and Ménière's disease, and will check for anything that needs urgent care. Hearing tests, balance testing or imaging are sometimes part of that workup.
Where vestibular rehabilitation fits
Vestibular migraine treatment usually has several parts. Your physician may recommend medicine to stop or prevent attacks, along with the sleep, hydration and trigger habits covered on our headaches and migraines page. When dizziness, motion sensitivity or unsteadiness lingers, rehabilitation may help.
Vestibular rehabilitation is a form of physical therapy that retrains how your brain uses information from your inner ears, eyes and body. A program may include:
- Gaze stabilization exercises that help your eyes stay steady while your head moves
- Habituation exercises that gently and repeatedly expose you to the movements or visual scenes that bother you, so your brain learns to tolerate them
- Balance training to rebuild steadiness when standing, walking and turning
Small studies suggest vestibular rehab may ease dizziness and its effect on daily life in people with vestibular migraine. Larger, well-designed trials are still needed, and rehab hasn't been shown to prevent attacks, so it works alongside your physician's migraine care rather than replacing it. Exercises are paced to stay below the level that sets off an attack, then built up over time.
When to get medical care right away
Dizziness is usually not an emergency, but some combinations are. Call 911 if dizziness comes with:
- Sudden weakness or numbness in the face, an arm or a leg
- Slurred speech, confusion or trouble understanding speech
- Double vision, loss of vision or a drooping face
- Trouble walking or a sudden loss of coordination
- A sudden, severe headache unlike any you have had
- Chest pain, a racing heartbeat, trouble breathing or fainting
Get medical care right away for sudden hearing loss in one ear or dizziness after a head injury, and see your doctor soon if attacks are becoming more frequent or more severe.
Frequently asked questions
Can you have vestibular migraine without a headache?
Yes. Many people have episodes of vertigo or imbalance with little or no head pain. Light or sound sensitivity, visual aura, or a history of migraine headaches at other times in life are clues that point to migraine as the cause. A physician can sort out whether your dizziness fits that pattern.
How long does vestibular rehabilitation take?
It varies with how often you have symptoms and how sensitive you are to motion. Many programs run for several weeks, with a short set of exercises to do at home most days between visits. Your therapist adjusts the plan as your tolerance improves rather than following a fixed schedule.
Will the exercises make my dizziness worse?
They may cause mild, short-lived dizziness, because they gently provoke your symptoms on purpose. A good program keeps that within a tolerable range and stops short of triggering a full attack. Tell your therapist how you feel during and after each session so they can adjust the intensity.
Request an appointment at PMR
If dizziness is limiting your work, driving or daily routine, the team at Physical Medicine & Rehabilitation of NY & CT (PMR) can evaluate your symptoms and coordinate with your physician. Read more about our vertigo and dizziness care, or request an appointment and our team will contact you to schedule your visit.
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