Vestibular migraine is a migraine-related condition in which episodes of dizziness or vertigo can occur with or without a typical headache. People may experience motion sensitivity, nausea, imbalance or discomfort in visually busy environments. Symptoms overlap with inner-ear and neurological conditions, so a person should not assume that dizziness is migraine without considering the history and examination. New severe symptoms may require urgent assessment.
How episodes can feel
Episodes may last minutes to hours and sometimes longer. Some people have a history of migraine or sensitivity to light and sound, while others have prominent dizziness with little head pain. Movement, poor sleep, stress, dehydration or particular sensory environments may be triggers for some people, but triggers are individual. A diary can help identify patterns without replacing medical evaluation.
How it is assessed
There is no single simple test that confirms vestibular migraine in every case. The clinician reviews the episode pattern, migraine history, hearing symptoms, medicines and neurological features, and may examine eye movements, gait and balance. Hearing tests or imaging may be considered if another condition needs exclusion. Sudden hearing loss, a new neurological sign or an inability to walk normally should not be attributed to migraine without urgent assessment.
Management and prevention
Management may include identifying personal triggers, maintaining regular sleep and meals, hydration, appropriate acute migraine treatment and, for frequent disabling episodes, preventive treatment prescribed by a clinician. Vestibular rehabilitation can help selected patients, particularly when imbalance persists, but it is not suitable as a substitute for diagnosis during a new episode. Treatment should be individualised to other medical conditions and medicines.
When to seek urgent care
Seek emergency assessment for sudden severe headache, weakness, facial droop, difficulty speaking, double vision, new inability to walk, fainting or persistent severe vertigo with concerning features. Arrange a planned review for recurrent episodes, falls, worsening symptoms or uncertainty about the diagnosis.
Frequently asked questions
Can vestibular migraine happen without headache? Yes. Dizziness or vertigo may occur without a typical headache, but diagnosis depends on the overall pattern.
Is it the same as BPPV? No. The episode pattern and underlying mechanisms differ, and treatment can differ.
Should I exercise through severe dizziness? Do not force activity during severe or unexplained dizziness. Seek advice and keep yourself safe from falls.
Explore our ENT consultation page for more information about this care option. A clinician can advise based on the individual history and examination findings.
Related reading
- Vertigo and BPPV: Causes, Treatment and Warning Signs
- Sinus Headache or Migraine? Understanding the Difference
- Vestibular Rehabilitation: Exercises for Certain Balance Disorders