Migraine and Vertigo

For many, the word "migraine" is synonymous with a severe headache. But for a significant number of people, the experience is much more complex, involving a dizzying and disorienting symptom: vertigo. If you’ve ever felt like you, or the world around you, is spinning, tilting, or swaying, you know how frightening and disabling it can be. When this sensation is linked to migraine, it’s often part of a condition called vestibular migraine. It’s a challenge that goes beyond pain, affecting your very sense of balance and stability. This guide is here to offer a compassionate and clear explanation of the connection between migraine and vertigo, and to explore how this condition is diagnosed and managed.

Understanding Vestibular Migraine

Vestibular migraine is a type of migraine where the primary symptoms are related to the vestibular system, which is the part of your inner ear and brain that controls balance and spatial orientation. The hallmark symptom is vertigo, but it can also include dizziness, unsteadiness, and motion sensitivity.

One of the most confusing aspects of vestibular migraine is that the vertigo does not always happen at the same time as a headache. In fact, about 50% of attacks occur without any head pain at all. The vertigo itself is the migraine event. This can make diagnosis tricky, as people may see different specialists for their "dizziness" and their "headaches," not realizing the two are connected.

What Does Vestibular Migraine Feel Like?

The experience can vary greatly from person to person, but common symptoms include:

Spontaneous Vertigo: A sudden feeling of spinning or movement that can last from a few minutes to several hours.
Positional Vertigo: Vertigo that is triggered by changing your head position.
Constant Dizziness or Unsteadiness: A persistent feeling of being off-balance or "woozy."
Motion Sensitivity: Feeling sick or dizzy when watching moving objects, scrolling on a phone, or being in a crowded, busy environment.
Other Migraine Symptoms: The vertigo is often accompanied by other typical migraine symptoms like sensitivity to light and sound, nausea, and fatigue, even if there is no headache.

A Patient's Story: Sarah's Unsteady World

"For years, I had these 'dizzy spells' that no one could explain," says Sarah, 42. "The world would just start to tilt, and I'd have to grab onto something to stay upright. It was terrifying. I saw an ear, nose, and throat doctor who couldn't find anything wrong with my ears. It wasn't until I mentioned my history of migraine with aura to a new neurologist that everything clicked. He explained that the dizziness was actually a form of migraine. Just having a name for it—vestibular migraine—was a huge relief. It meant I wasn't crazy, and there were treatments we could try."

Getting a Diagnosis: A Process of Elimination

There is no single test for vestibular migraine. A diagnosis is made based on your symptoms, your personal and family history of migraine, and by ruling out other conditions that can cause vertigo, such as Meniere's disease or benign paroxysmal positional vertigo, which is often called BPPV.

Your doctor will likely ask detailed questions about the timing, duration, and triggers of your vertigo episodes and your headaches. They may also perform a neurological exam and may refer you for tests to check your inner ear function.

Managing Migraine and Vertigo

The treatment for vestibular migraine is similar to the treatment for other types of migraine, with a focus on prevention and a few specific strategies for the vertigo itself.

1. Preventive Medications and Supplements

The same preventive medications used for other forms of migraine are often effective for vestibular migraine. This can include certain blood pressure medications, antidepressants, or anti-seizure medications. Supplements like magnesium, CoQ10, and riboflavin (Vitamin B2) may also be recommended.

2. Lifestyle Adjustments

A consistent lifestyle is key. This includes regular sleep, stress management, staying hydrated, and eating regular meals. Identifying and avoiding personal triggers is also crucial. For vestibular migraine, this might include avoiding visually "busy" environments or being mindful of head movements.

3. Vestibular Rehabilitation Therapy

This is a specialized form of physical therapy that can be incredibly helpful. A vestibular therapist can guide you through a series of exercises designed to help your brain adapt to and compensate for the confusing signals it's receiving. This can help to reduce dizziness and improve your balance and stability over time.

Coping During an Attack

When the world is spinning, the most important thing is to keep yourself safe.

Sit or Lie Down: Find a safe position immediately to reduce the risk of falling.
Focus on a Fixed Point: Staring at a single, non-moving object can sometimes help your brain reorient itself.
Minimize Sensory Input: Just like with a typical migraine, resting in a quiet, dark room can be very helpful.
Use Acute Medication: Your doctor may prescribe a medication to take at the onset of an attack, such as a triptan or a medication specifically for dizziness, like meclizine.

A Final, Gentle Thought

Living with vestibular migraine can be profoundly disorienting and can make you feel untethered from the world. It’s a condition that can affect your ability to work, drive, and even just walk across a room. Please be extra compassionate with yourself. Learning to manage this condition is a process, and there will be good days and bad days. Celebrate the small victories and know that you are not alone on this journey.

Trusted Resources

For more detailed information, we encourage you to explore these reliable sources: