ConditionBrain & nerves
Migraine-Associated Vertigo
Migraine-associated vertigo, now usually called vestibular migraine, is a form of migraine that causes episodes of vertigo (spinning or swaying) or dizziness lasting from 5 minutes to 72 hours. Headache may come with it, before or after, or not at all. Light and sound sensitivity, nausea and motion sensitivity are common. It is one of the most common causes of recurrent vertigo, especially in women. Avoiding triggers, rescue treatment for attacks and migraine-preventing medicines usually control it.
Also called: Vestibular migraine, migrainous vertigo, migraine-related dizziness, MAV
At a glance
- What it is
- Migraine that causes episodes of vertigo or dizziness, with or without headache.
- Episode length
- 5 minutes to 72 hours; seconds-long head-motion dizziness is common too.
- Who gets it
- People with a history of migraine; more common in women, often starting in their 30s to 40s.
- Other symptoms
- Light and sound sensitivity, nausea, imbalance, motion sickness, visual aura.
- Diagnosis
- Clinical criteria after ruling out other causes; hearing and balance tests, sometimes MRI.
- Treatment
- Trigger management, anti-nausea and migraine rescue medicines, daily preventive medicines, vestibular therapy.
When to get help
Call 911 or go to the ER
- Sudden vertigo with slurred speech, double vision, facial droop, limb weakness or numbness, or inability to walk (possible stroke)
- The worst headache of your life, or vertigo with a sudden severe headache and neck pain
- Vertigo with loss of consciousness or a seizure
See a doctor within a day or two
- A first-ever episode of severe vertigo lasting hours, especially over age 50 or with vascular risk factors
- Vertigo with sudden hearing loss in one ear
- Vomiting so severe you cannot keep fluids down
Book a routine appointment
- Repeated episodes of dizziness or spinning in someone with migraine
- Dizziness with headaches, light sensitivity or motion sickness that interferes with daily life
- Episodes becoming more frequent or longer
Usually safe to manage at home
- A known pattern of vestibular migraine attacks that respond to your usual rescue plan
What is migraine-associated vertigo?
Migraine is a brain disorder, not just a headache. In vestibular migraine, the migraine process affects the brain's balance and spatial orientation centers and the inner ear connections, causing vertigo. It is recognized by the International Classification of Headache Disorders as vestibular migraine. See also vestibular migraine.
It affects an estimated 1 percent of the population and up to 10 percent of people seen in dizziness clinics.
Symptoms
Vestibular symptoms
- spontaneous vertigo: a sense of spinning or the room moving
- positional vertigo when changing head position
- dizziness triggered by moving visual scenes, such as busy stores, traffic or scrolling screens
- head motion-induced dizziness with nausea
- imbalance and unsteadiness
Migraine features
- headache, often one-sided and throbbing, before, during, after or absent
- sensitivity to light and sound
- visual aura such as zigzag lines
- nausea and vomiting
- ear fullness or ringing, usually mild
Between episodes, many people feel normal, though some have ongoing mild motion sensitivity.
Diagnostic criteria
Vestibular migraine is diagnosed when:
- there have been at least 5 episodes of moderate or severe vestibular symptoms lasting 5 minutes to 72 hours
- there is a current or past history of migraine
- at least half of the episodes come with at least one migraine feature: migraine-type headache, light and sound sensitivity, or visual aura
- the symptoms are not better explained by another condition
"Probable vestibular migraine" is used when only some criteria are met.
Triggers
- stress and anxiety
- lack of sleep or irregular sleep
- skipped meals and dehydration
- hormonal changes around periods and menopause
- bright or flickering lights, busy visual environments
- strong smells, weather changes
- certain foods and drinks for some people: alcohol (especially red wine), aged cheese, caffeine excess or withdrawal, processed meats
Vestibular migraine vs other causes of vertigo
| Condition | Episode length | Key features |
|---|---|---|
| Vestibular migraine | 5 minutes to 72 hours | Migraine history, light and sound sensitivity, little hearing loss |
| BPPV | Seconds | Triggered by rolling over or looking up |
| Ménière's disease | 20 minutes to 12 hours | Fluctuating hearing loss, ringing, ear fullness in one ear |
| Vestibular neuritis | Days of continuous vertigo | Single episode, often after a viral illness |
| Stroke or TIA | Sudden | Other neurological signs, often older with vascular risk factors |
Vestibular migraine and Ménière's disease can overlap and occur together.
Diagnosis
A doctor will take a detailed history of the episodes and headaches, examine eye movements, balance and hearing, and perform positional tests. Tests may include:
- hearing tests (audiometry)
- vestibular function tests (videonystagmography, caloric testing, video head impulse test)
- MRI of the brain if there are unusual features or to rule out other causes
A headache and symptom diary helps link episodes to triggers.
Treatment
Lifestyle and trigger management
- regular sleep, meals and hydration
- limit caffeine and alcohol
- regular aerobic exercise
- stress management, relaxation and CBT
- identify personal triggers with a diary
Treating attacks
- rest in a quiet, dark room
- anti-nausea and vestibular-suppressant medicines such as promethazine, meclizine or ondansetron for short-term use
- migraine rescue medicines such as NSAIDs or triptans, taken early, especially when headache is present
Preventive medicines
When attacks are frequent or disabling, daily preventive medicines used for migraine are often effective, including:
- beta-blockers (propranolol, metoprolol)
- calcium channel blockers (verapamil, flunarizine where available)
- tricyclic antidepressants (amitriptyline, nortriptyline)
- SNRIs (venlafaxine)
- anti-seizure medicines (topiramate)
- CGRP-targeting medicines, which are being studied and used for vestibular migraine
Vestibular rehabilitation
A physical therapist trained in balance disorders can reduce motion sensitivity and improve balance with targeted exercises.
Outlook
Vestibular migraine is a chronic but manageable condition. Most people achieve good control with lifestyle changes and medicine. Attacks often become less frequent after menopause or with age, though they can persist.
Frequently asked questions
Can migraine cause vertigo without a headache?
Yes. Many people with vestibular migraine have vertigo episodes without any headache, or with only mild head pressure. A past history of migraine and features such as light sensitivity help make the diagnosis.
How long does migraine-associated vertigo last?
Episodes last from 5 minutes to 72 hours, but some people have brief seconds-long dizziness with head movement, or feel off-balance for days after an attack.
How is vestibular migraine treated?
Treatment includes avoiding triggers, regular sleep and meals, anti-nausea and migraine rescue medicines during attacks, and daily preventive medicines such as propranolol, amitriptyline, venlafaxine or topiramate for frequent episodes. Vestibular therapy helps motion sensitivity.
Is vestibular migraine dangerous?
It is not dangerous in itself, but it can be disabling. Because sudden vertigo can also be a sign of stroke, any new vertigo with weakness, speech or vision problems, or severe headache, needs emergency assessment.
Sources
This guide was written from current patient and clinical guidance, including:
- International Headache Society and Bárány Society: Vestibular migraine diagnostic criteria (ICHD-3)
- American Academy of Otolaryngology-Head and Neck Surgery: Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (differential diagnosis)
- American Migraine Foundation: Vestibular Migraine
- Vestibular Disorders Association: Vestibular Migraine
- National Institute on Deafness and Other Communication Disorders: Balance Disorders