Q&A: Vestibular migraine
By: Mags Robinson, Information and Support Services Advisor
In this blog, we answer common questions we get asked about vestibular migraine via The Migraine Trust helpline.
What is vestibular migraine?
Vestibular migraine is a specific type of migraine in which sensations of movement (vertigo or dizziness), or balance problems occur alongside other migraine symptoms.
Vertigo attacks may vary between individuals and between attacks. They may last for minutes (sometimes seconds), or they can build up over a few hours and sometimes last for days at a time. The symptoms can be very debilitating and can have a profound impact on someone’s quality of life.
What does a vestibular migraine attack feel like?
People with vestibular migraine may feel dizzy, unsteady on their feet, light-headed, spaced out, or as if they are wearing someone else’s varifocal glasses. They may experience this as the world moving around them (external vertigo), or as if they are the one who is moving (internal vertigo). They may find themselves holding onto furniture and describe feeling as if they are on a boat on a rough sea. Or they may feel as if they are on solid ground but have the sensation of being at sea.
Head pain and “non-headache” migraine associated symptoms, such as aura, nausea, vomiting and increased sensitivity to sensory information, such as light, sound and smell, may also occur alongside the vestibular symptoms.
What causes vestibular migraine?
People with vestibular migraine probably have an inherited tendency to be sensitive to migraine triggers, such as lifestyle, hormonal changes, stress, and environmental factors, like lighting or flashing lights. Being aware of your own triggers can be helpful, but not all triggers are preventable.
Sometimes vestibular sensations can be triggered by position and may feel worse when standing up or lying down. Sometimes they may be triggered by head movement, or by lighting or by visual disturbance, for example when looking at stripes or patterns (visually induced vertigo). They may also develop without any apparent trigger.
How is vestibular migraine diagnosed?
If your GP suspects vestibular migraine, they may refer you to a neurologist or headache specialist to confirm the diagnosis.
For vestibular migraine to be diagnosed there must have been at least five episodes of vestibular symptoms, lasting between five minutes and 72 hours, which are not caused by other conditions; a history of migraine or current migraine headache; or other “non-headache” associated symptoms (such as aura, nausea, vomiting and increased sensitivity to light, sound and smell), in at least half of the episodes.
It is possible for people with vestibular migraine to have vertigo attacks without any headache. However, for vestibular migraine to be diagnosed migraine headache should be present at some point.
Why have I been referred to an ear, nose and throat (ENT) specialist?
If headache is not a prominent symptom for you, you may be referred to an ENT specialist or to a neurologist who specialises in dizziness and balance disorders (a neuro-otologist).
They will carry out vestibular function tests to assess how well the balance organs in your inner ears are working. This helps rule out other balance disorders such as inner ear infections, inflammation of the vestibular nerve, or Meniere’s disease. If both sides are functioning normally, and you meet the diagnostic criteria above, the specialist is likely to confirm a diagnosis of vestibular migraine.
Is vestibular migraine treated differently from other types of migraine?
The key to managing vestibular migraine is to control the underlying migraine process and to reduce the frequency of attacks. For that reason, even if the condition isn’t chronic, there is an emphasis on standard migraine preventive treatments such as amitriptyline, propranolol, candesartan.
Headache clinics may offer other specialist preventive treatments such as flunarizine or Greater Occipital Nerve blocks.
It can also be helpful to have a rescue plan in place to treat the symptoms and to stop or shorten the attack.
In addition to the acute painkillers and anti-sickness medications that are usually recommended for migraine, a short course of a vestibular sedative such as prochlorperazine may be offered to help ease the vertigo attack.
Learn more about the symptoms and diagnosis of vestibular migraine here. Read Jenny’s story of living with vestibular migraine here.