Migraine-Associated Vertigo

Overview

Migraine-associated vertigo, often called vestibular migraine, is a condition in which people who have migraine experience repeated episodes of vertigo, a false sense of spinning or movement, or other forms of dizziness and imbalance. These episodes are linked to the same brain processes that cause migraine.

What makes the condition confusing is that the dizziness does not always come with a headache. Some people have classic migraine headaches at other times, while their vertigo episodes occur on their own. Migraine-associated vertigo is one of the most common causes of recurring vertigo, and although it can be disruptive, it is not dangerous, and symptoms can usually be reduced with the right approach.

Symptoms

Episodes can last from minutes to hours, and sometimes longer. Symptoms include:

• Vertigo: A spinning or rocking sensation, or a feeling that you or your surroundings are moving.
• Dizziness or unsteadiness and trouble with balance.
• Sensitivity to motion, including worsening with head movement.
• Nausea or vomiting.
• Sensitivity to light, sound, or smells, as in typical migraine.
• Headache, which may or may not be present.

Some people also notice visual disturbances or an aura. Hearing loss is not usually a feature, which helps distinguish it from some inner ear conditions.

Causes

The exact cause is not fully understood, but migraine-associated vertigo is believed to involve the same changes in brain activity and signaling that cause migraine. These changes appear to affect the brain regions and pathways that process balance and motion, leading to vertigo.

Episodes are often set off by the same triggers that bring on migraine headaches, such as stress, lack of sleep, dehydration, certain foods or drinks, bright lights, and hormonal changes. It tends to run in families, reflecting the inherited tendency toward migraine.

Risk Factors

• A personal history of migraine
• A family history of migraine
• Female sex, in which it is more common
• Hormonal changes, such as around menstruation
• Exposure to common migraine triggers like stress and poor sleep

Diagnosis

There is no single test for migraine-associated vertigo. Diagnosis is based on the pattern of symptoms and ruling out other causes of vertigo.

• Medical history: A history of migraine plus recurring vertigo episodes is central to the diagnosis.
• Physical and neurological exam: Including tests of balance, eye movements, and the inner ear.
• Hearing and balance tests: To distinguish it from inner ear disorders such as Meniere disease or benign paroxysmal positional vertigo.
• Imaging: Occasionally an MRI is done to exclude other neurological causes.

Treatment

Treatment is similar to managing migraine and is tailored to how often and how severely episodes occur.

• Trigger management: Identifying and avoiding personal triggers and keeping regular sleep, meals, and hydration.
• Medication for episodes: Anti-nausea medicines and some migraine treatments may help during an attack.
• Preventive medication: For frequent episodes, daily medicines used to prevent migraine may reduce attacks.
• Vestibular rehabilitation: Balance exercises with a trained therapist can help with lingering unsteadiness.

Treatment is often a process of trial and adjustment, since what works varies from person to person. Keeping a diary of episodes, possible triggers, and how treatments are helping can guide decisions over time. Many people improve significantly with a combination of trigger control, steady daily habits, and medication when needed, and episodes may become less frequent as the condition is managed.

Prevention

• Keep a regular sleep schedule and avoid sleep deprivation
• Stay hydrated and avoid skipping meals
• Identify and limit personal food and drink triggers
• Manage stress with relaxation techniques or regular exercise
• Take preventive migraine medication as advised if episodes are frequent

When to See a Doctor

See a doctor if you have recurring vertigo or dizziness, especially with a history of migraine, so the cause can be identified. Seek emergency care right away if vertigo or dizziness comes with stroke-like warning signs, such as:

• Sudden severe headache unlike any before
• Weakness or numbness of the face, arm, or leg, especially on one side
• Trouble speaking, confusion, or sudden vision loss
• Sudden severe imbalance or inability to walk
• New hearing loss with vertigo

Related Topics

Frequently Asked Questions

References

1. American Migraine Foundation. Vestibular Migraine.
2. National Institute on Deafness and Other Communication Disorders (NIDCD).
3. MedlinePlus, U.S. National Library of Medicine. Vertigo-associated disorders.
4. Mayo Clinic. Vestibular migraine.