What Is Vestibular Migraine?
A vestibular migraine is a nervous system problem that causes repeated dizziness (or vertigo) in people who have a history of migraine symptoms. Unlike traditional migraines, you may not always have a headache.
There are many names for this type of problem. Your doctor might also call it:
- Migraine-associated vertigo
- Migrainous vertigo
- Migraine-related vestibulopathy
Vestibular Migraine Symptoms
The main symptoms are headache and dizziness that come and go – though you may not have a headache. “Vestibular” refers to the inner ear, which controls your hearing and balance. Vertigo refers to problems in the inner ear that might cause:
- Dizziness that lasts more than a few minutes
- Nausea and vomiting
- Balance problems
- Extreme motion sensitivity – feeling sick or dizzy when you move your head, eyes, or body
- A feeling of disorientation or confusion
- An unsteady feeling, like you’re in a rocking boat
- Sensitivity to sound
You could get dizzy and have balance problems without having a migraine at all. Other times, the vertigo symptoms happen before, during, or after the headache. Sometimes, you might have migraines for years before the vertigo symptoms begin.
Vestibular Migraine Causes
Doctors aren't sure. Like migraines, there are a lot of theories. But how it really happens is poorly understood. They credit it to misfires between nerve cells in your brain.
Who Gets Vestibular Migraines?
It's hard to tell how many people are living with this condition. The symptoms mimic a lot of other diseases. Researchers think they affect about 1% of the population. But that number could be higher.
Like traditional migraines, they’re more common in women than men. Vertigo symptoms tend to first strike around age 40. But the condition doesn't just affect adults. Kids can get it, too.
How Are Vestibular Migraines Diagnosed?
There’s no blood or imaging test that can tell for sure. But the International Headache Society and other organizations recently set up the first criteria to help your doctor diagnose the disorder.
You could be having a vestibular migraine if:
- You have migraines or had them in the past.
- You have at least five episodes of vertigo that make you feel like you are spinning or moving. This isn’t the same as motion sickness or feeling faint.
- These feelings last between 5 minutes and 72 hours.
- Your symptoms are moderate to severe. That means they stop you from doing everyday tasks or they’re so bad, you can't do anything at all.
- At least half of the episodes happen with one of the following migraine symptoms:
- A headache that has two of these characteristics: is one-sided, pulsing, moderate to severe, or gets worse with activity
- Sensitivity to light or sound
- Seeing shimmering or flashing lights in your vision (a migraine aura)
How Does My Doctor Rule Out Something Else?
They’ll likely order an MRI to check your brain and run hearing and balance tests to look for problems with your ears.
- Meniere's disease. Before you get dizzy, usually one of your ears feels full or stuffy, or hurts. During an attack, one or both ears may ring, or you might lose hearing. This doesn't usually happen with a vestibular migraine.
- Brainstem stroke. Along with vertigo, you may also have numbness, weakness, trouble speaking, and other stroke symptoms. If you have any of these symptoms, or if you have new vertigo that has not been diagnosed, get emergency help right away.
Vestibular Migraine Treatment
There’s no specific medication for vestibular migraines. Your doctor will prescribe different drugs to stop an attack when it happens. This is called abortive therapy.
- Triptans. Take these migraine meds at the first sign of headache symptoms.
- Vestibular suppressant. It can ease your dizziness and motion sensitivity. This type of drug works on the balance center in your inner ear. Your doctor might prescribe benzodiazepines like lorazepam (Ativan), anti-nausea drugs like promethazine, and antihistamines like meclizine.
- If you have frequent or disabling vestibular migraines, your doctor may try drugs similar to traditional migraine prevention meds. You take these regularly to make the headaches less severe or less frequent. These include seizure medicines, blood pressure medicines (like beta-blockers and calcium channel blockers), and some antidepressants. CGRP inhibitors are a new class of preventive medicine that your doctor may recommend if other medicines don’t help.
If you have frequent or disabling vestibular migraines, your doctor may try drugs similar to traditional migraine meds. They include:
- Antiseizure drugs like gabapentin (Gralise, Horizant, Neurontin), topiramate (Qudexy XR, Topamax, Topamax Sprinkle, Trokendi XR), or valproate (Depakote, Depakene, Stavzor).
- Blood pressure medicines:
- Beta-blockers: atenolol (Tenormin), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), propranolol (Hemangeol, Inderal LA, Inderal XL, and InnoPran XL)
- Calcium channel blockers: verapamil (Isoptin)
- Tricyclic antidepressants: amitriptyline, nortriptyline (Aventyl, Pamelor)
- SSRIs: citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Rapiflux, Sarafem, Selfemra), paroxetine (Paxil, Pexeva), and sertraline (Zoloft)
- SNRIs: duloxetine (Cymbalta, Irenka) and venlafaxine (Effexor)
It’s possible to get relief by using some devices.
- Cefaly, a small headband device that sends electrical pulses through the forehead to stimulate a nerve linked with migraines
- SpringTMS or eNeura sTMS, a device that can be held at the back of your head at the first sign of a headache, and it gives off a magnetic pulse that stimulates part of the brain.
- gammaCore is a hand-held portable device that is a noninvasive vagus nerve stimulator (nVS). When placed over the vagus nerve in the neck, it releases a mild electrical stimulation to the nerve's fibers to relieve pain.
- A remote electrical neuromodulation called Nerivio is also available, but unlike the other three, it is approved for treatment only and not for both prevention and treatment.
Vestibular Migraine Diet
Knowing your headache triggers may help you ward off migraine-related vertigo. Things like chocolate, cheese, alcohol, and foods with the preservative MSG are triggers for some people. If you have vestibular migraines, these things might trigger your symptoms, too. It can't hurt to cut them from your diet to see if your symptoms ease up a bit.
Tracking your diet is another good way to help tell if your vertigo symptoms are really due to food. For example, a high-salt diet can make vertigo symptoms worse if you have Meniere's disease. Keep a food diary and show it to your doctor. It can help improve your diagnosis and treatment.