What is vestibular migraine?

Vestibular migraine is a type of migraine during which people experience spinning or swaying sensations (vertigo), dizziness or balance problems. These sensations usually happen alongside other migraine symptoms. Vestibular migraine was previously known as migrainous vertigo, migraine-associated vertigo (MAV) or migraine-associated dizziness.

Symptoms of vestibular migraine

Everyone experiences migraine differently, and your symptoms may not completely fit one type of migraine. Migraine can have a range of symptoms alongside headache, including:

• feeling sick (nausea) or being sick (vomiting)
• sensitivity to light (photophobia)
• sensitivity to sound (phonophobia)
• sensitivity to movement (for some people, exercise can make their headache worse).

People with vestibular migraine also experience one or more of the following vestibular symptoms, alongside the symptoms listed above:

• spinning or swaying sensations (vertigo)
• dizziness
• unsteadiness.

The length of these vertigo attacks or “dizzy spells” can vary. For many people they can last hours, but for others they last seconds, minutes or even days. It is possible for people to have vertigo attacks without a headache. However, to meet the diagnosis criteria for vestibular migraine you must have experienced migraine headache at some point in your life, alongside vertigo, dizziness or unsteadiness. As migraine symptoms can change between attacks, you might occasionally experience vestibular migraine symptoms even if you are diagnosed with another type of migraine.

Usually, people with vestibular migraine experience similar stages of a migraine attack to people with other types of migraine. These include a prodrome or “warning” stage, an aura stage (not experienced by everyone), a main attack stage and a postdrome or “recovery” stage. It can take up to a few days or longer to feel back to your normal self after a migraine attack.

Diagnosis of vestibular migraine

Anyone with the symptoms of vestibular migraine should visit their doctor. They will be able to discuss your symptoms as well as other health conditions and your family history. The doctor may be able to diagnose and treat your symptoms themselves, but sometimes they will need to refer you to a specialist, who may be:

• a neurologist or headache specialist
• an ear, nose and throat (ENT) specialist
• an expert in dizziness and balance disorders (audiovestibular physician or neuro-otologist).

You are more likely to be referred to an ENT specialist, audiovestibular physician or neuro-otologist if you have vertigo symptoms without any headache.

The International Classification of Headache Disorders (ICHD-3) and Bárány Society criteria for vestibular migraine diagnosis are:

• current or past migraine attacks
• at least five episodes of vertigo or dizziness lasting between five minutes and 72 hours
• experiencing migraine-like headache, sensitivity to light or sound, or visual aura in at least half of the vertigo/dizziness episodes.

To diagnose vestibular migraine, your doctor or specialist may need to rule out other conditions. You might have tests to assess the inner ear balance organs to check if they are working properly. For people with suspected vestibular migraine, the tests should show that their function is largely within normal limits. If the tests show something significantly different from this, you may have a different condition.

Treatment options for vestibular migraine

Treatment of vestibular migraine is like the treatment for other types of migraine. It might include preventive or acute (rescue) medicines, lifestyle changes, supplements, migraine devices, vestibular rehabilitation therapy or psychological support.

Medication

Healthcare professionals are likely to prescribe preventive medicines for vestibular migraine, which aim to reduce how bad your attacks are and how often they happen. These might include amitriptyline, propranolol, candesartan, topiramate, Calcitonin Gene-Related Peptide monoclonal antibodies (CGRP mAbs), gepants, Botox or flunarizine. CGRP mAbs, gepants, Botox and flunarizine are not available through your GP but can often be prescribed by a headache specialist. Greater Occipital Nerve blocks may also be offered by a specialist.

If you get a headache as part of vestibular migraine, the recommended acute medicines are the same as those usually recommended for other types of migraine. It’s best to take these as soon as the headache starts, when the pain is still mild. Acute medicines might include painkillers, such as ibuprofen, aspirin and paracetamol, or migraine-specific medicines, such as triptans and gepants. Painkillers containing opioids, such as codeine, should be avoided where possible. This is because they can increase nausea and be addictive.

Medicines such as paracetamol, ibuprofen, triptans and opioids can cause medication overuse headache when used on more than 10–15 days per month. If you are regularly taking painkillers for your migraine and still experiencing daily headaches, it’s important to discuss this with your doctor.

For vertigo and dizziness symptoms, prochlorperazine or cinnarizine may be prescribed. These can help with dizzy or spinning feelings, as well as sickness. However, they should only be used for short periods of time (e.g. a few days) during severe attacks. Regular or long-term use should be avoided, as they may affect the brain’s natural ability to compensate and adapt to balance problems. Anti-sickness (anti-emetic) medicines like metoclopramide may also be prescribed.

Other treatment options

There are alternative treatment options that can be effective at improving vestibular migraine symptoms when used alongside medicines, or if you are unable or prefer not to take medicines.

Lifestyle habits such as stress management, getting regular sleep, eating well and being physically active can help the symptoms of vestibular migraine and reduce the frequency of attacks. Keeping a migraine diary may also help with identifying triggers. Some people find that simple heating or cooling products, such as head wraps and pads, can provide symptom relief during an attack. We also have separate information about supplements, acupuncture and migraine devices.

About our information

This information has been written by The Migraine Trust Information and Support Services team. It has been reviewed by our panel of expert health professionals and people affected by migraine.

Our information has been awarded the PIF TICK quality mark for trustworthy health information.

If you have feedback on our information, please get in touch at: feedback@migrainetrust.org

Last reviewed: September 2026 | Next review due: September 2029