Overview
What are vestibular migraines?
Vestibular migraines are a neurological condition that involves dizzy spells that might occur alongside typical migraine symptoms, for example, an intense, and often one-sided headache. Vestibular migraines can last from between a few minutes to several days which can leave the individual feeling tired and drained.1
Are vestibular migraines common?
It is thought that about 1% of the general population experiences vestibular migraines, with people assigned female at birth being more likely to have them than people assigned male at birth (pamb).1 Amongst those who have vestibular migraines, it is almost always the case that they have a history of motion sickness and have previously experienced typical migraine symptoms.2
Symptoms of vestibular migraines
Vestibular migraines can be distinguished from other migraines by assessing whether there are so-called ‘vestibular symptoms’ present. These tend to be experienced before the onset of typical migraine symptoms.
Vestibular symptoms
- Early indicators of a vestibular migraine include: Vertigo loss of balance
- Motion sickness or sensitivity
Typical migraine symptoms
Vestibular symptoms may or may not be present in combination with these typical migraine symptoms:2
- Headache, usually one sided, pulsating with moderate to severe intensity
- Sensitivity to light and sound
Nausea and vomiting since vestibular migraines do not always have typical migraine symptoms, it can be difficult to differentiate them from an episode of vertigo. This can be problematic, as vestibular migraines are a distinct diagnosis, whereas vertigo is a symptom of vestibular migraines and other conditions, for example benign paroxysmal positional vertigo.
Causes of vestibular migraine
There is no known specific cause of vestibular migraine but like their counterpart, vestibular migraines tend to run in families, which suggests some level of genetic influence.2 Additionally, alterations in the vestibular system within the brain are thought to be involved. These, alongside the presence of different triggers, are likely to cause the onset of a vestibular migraine.
Triggers
There are a wide range of migraine triggers, with each individual being sensitive to different things. Therefore, it is key to understand your own triggers to prevent the onset of a vestibular migraine.
Examples of some triggers are:3
- Stress
- Flashing lights
- Hormonal changes, e.g., menstrual cycle
- Caffeine
- Certain foods, e.g., cheese, chocolate, citrus fruits
Mechanisms of vestibular migraines
Scientists are not yet certain on how vestibular migraines happen. There are a few existing theories on what occurs after a trigger, including temporary changes in blood flow and signalling in the brain.
Some mechanisms that are responsible for the symptoms in regular migraines have been suggested as causes for vestibular migraines, due to the similarities between the conditions.
Vestibular system
The vestibular system is a complex network of structures located in the brain and inner ear. Through fluids in the ear canals, we are able to detect changes in movement and body position to recognise the orientation of our head. After syncing our eyes with these changes, we can stabilise our balance and posture.3
Problems with the vestibular system can lead to the symptoms seen in vestibular migraines, such as vertigo or dizziness and loss of balance.
Trigeminal nerve
The headache is often described as one of the most debilitating symptoms of a vestibular migraine. It is thought that this pain is brought about by overactivation of the trigeminal nerve.
The trigeminal nerves are one of the 12 pairs of cranial nerves, with the main role being to carry sensory information like touch, temperature and pain from the face to the brain. Sometimes, triggers like those mentioned above can activate the pain pathways within the trigeminal nerve, which brings about an intense headache.4
Lifestyle changes
Everyone has different triggers that cause migraine so there is no one specific lifestyle change that will reduce the frequency and intensity of vestibular migraines. However, by understanding your specific triggers, it may be possible to improve the management of the condition.
Keeping a diary of vestibular migraines may help to narrow down the root cause of an episode. For example, noting down the types of food you ate during the lead up to a migraine, or reflecting on the quality of your sleep the night before you experienced an attack.By maintaining an up to date record, you can highlight and eliminate certain aspects of your daily life that trigger the onset of a vestibular migraine, and continue with those that don’t have an effect.
Some broad suggestions of lifestyle changes that might improve the condition are:
- Maintaining a regular sleep pattern
- Regular exercise
- Consuming a balanced diet
FAQs
What are the stages of a vestibular migraine?
Like regular migraines, vestibular migraines tend to have 4 stages: prodromal, aura, headache and postdrome. The prodromal stage alerts you to an oncoming migraine, which can include symptoms like fatigue and irritability. The aura stage is usually where vestibular symptoms begin, such as dizziness and loss of balance. This may be followed by a headache, often described as pulsating, intense and one-sided. The final stage is the postdrome stage, with common symptoms including fatigue and difficulty concentrating.
How long do vestibular migraines last?
Vestibular migraines vary in length between people. On average, they can last anywhere from 5 minutes to 3 days.
What is the difference between regular migraines and vestibular migraines?
Regular migraines affect around 10% of the population, with typical symptoms being an intense, one-sided headache alongside sensitivity to light. Vestibular migraines are much less common, with around 1% of the population experiencing them. A distinct difference between these being the presence of dizziness and loss of balance in vestibular migraines, in combination with regular migraine symptoms.
Are vestibular migraines dangerous?
Whilst vestibular migraines can greatly impact quality of life, they are not considered to be dangerous. However, it is important to rest whilst experiencing a vestibular migraine to prevent accidents from happening when symptoms like vertigo and loss of balance are severe.
What age do vestibular migraines occur?
Vestibular migraines can affect people of any age but the average age of onset of dizziness in migraines is around 40 years old.
Summary
Vestibular migraines can be identified by dizziness and loss of balance, which are often present alongside the signs of a typical migraine. No matter the duration, vestibular migraines can seriously impact an individual’s quality of life. By identifying the physical, dietary and environmental triggers unique to the individual and implementing lifestyle changes, vestibular migraines can be managed.
References
- Sohn J-H. Recent Advances in the Understanding of Vestibular Migraine. Behav Neurol 2016;2016:1801845. https://doi.org/10.1155/2016/1801845.
- Mei C, Dong H, Nisenbaum E, Thielhelm T, Nourbakhsh A, Yan D, et al. Genetics and the Individualised Therapy of Vestibular Disorders. Front Neurol 2021;12:633207. https://doi.org/10.3389/fneur.2021.633207.
- Casale J, Browne T, Murray IV, Gupta G. Physiology, Vestibular System. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 May 3]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK532978/
- Ashina M, Hansen JM, Do TP, Melo-Carrillo A, Burstein R, Moskowitz MA. Migraine and the trigeminovascular system—40 years and counting. Lancet Neurol 2019;18:795–804. https://doi.org/10.1016/S1474-4422(19)30185-1