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Vestibular Migraine

Reviewed by: HU Medical Review Board | Last reviewed: October 2020

Vertigo is a type of dizziness. People describe it as the feeling that their body or their surrounding environment is spinning or tilting, even though they know both are still. Vertigo and dizziness are common symptoms of migraine. When a migraine includes vertigo that lasts up to 3 days, it is diagnosed as a vestibular migraine.1

“Vestibular” refers to the inner ear. The inner ear is the part of the body that controls your sense of balance and ability to sense your body in relation to your surroundings. Older names for vestibular migraine include migraine-associated vertigo/dizziness, migraine-related vestibulopathy, and migrainous vertigo.1

Only 1 out of every 100 people have vestibular migraine.2

Symptoms of vestibular migraine

The symptoms of vestibular migraine include all the symptoms of migraine without aura, or migraine with aura, plus dizziness or vertigo that lasts from 5 minutes to 3 days. The types of vertigo possible include:1

  • Internal vertigo, the false feeling that your body is moving
  • External vertigo, the false feeling that your external environment is spinning or flowing
  • Vertigo that occurs after moving the head
  • Vertigo that is caused by seeing the movement of something complex or large
  • Dizziness with nausea caused by the inability to sense true body position or motion in relation to surroundings

This vertigo is called moderate when it interferes with but does not prevent daily activities. It is called severe when daily activities cannot be continued.

Roughly 1 out of every 3 people with vestibular migraine have vertigo that lasts a few minutes. Another 1 out of 3 have vertigo attacks that last hours, and the remaining ones have vertigo that lasts for days. A few will have vertigo that lasts for a few seconds only, mostly when they move their head. Rarely, someone will have vertigo that lasts a month.1

Diagnosing vestibular migraine

According to the International Headache Society, someone may have vestibular migraine if they have migraine with or without aura, plus vertigo attacks at least 5 times a month that last longer than a regular migraine.1

Typical migraine symptoms include:1

Treating vestibular migraine

Vestibular migraine is treated with many of the same lifestyle changes, and preventive and acute drugs used for other types of migraine. Magnesium, certain blood pressure medicine, antiseizure drugs, and certain antidepressants may also work but more study is needed into this type of migraine.2

Things to consider

Vestibular migraine may be confused with other conditions that cause vertigo. For example, migraine with brainstem aura often causes vertigo but is a different type of migraine.

Ménière’s disease

Vestibular migraine and Ménière’s disease also share a common set of symptoms that include vertigo, headache, sensitivity to light, sensitivity to sound, hearing loss, and ringing in the ears.

The key difference between the 2 conditions is that hearing loss related to vestibular migraine is temporary, while the hearing loss of Ménière’s disease is permanent. Also, migraine is more common in people with Ménière’s disease, so a person can be diagnosed with both conditions. It can be especially hard for your doctor to tell which condition you have, or if you have both, during the first year after symptoms begin.1

Benign paroxysmal vertigo

In children, a syndrome called benign paroxysmal vertigo (which means recurring brief attacks of vertigo) may be an indication that migraine will develop later in life.1

There are some signs that mean vertigo is not caused by a migraine. First, an ear infection may cause vertigo and hearing loss, especially if there is pain or drainage. Second, if vertigo comes on suddenly, especially if there is also a loss of balance and weakness or numbness on one side of the body, may be caused by a stroke. Both of these conditions should be treated by a doctor right away.2

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