what are vestibular migraines?

Are you having dizzy episodes that last minutes, hours, or even days?

Do you have a personal history or family history of migraines?

Light or sounds sensitivity during episodes?

You may have vestibular migraines.

Migraine may affect about 15% of the general population (1). While they are typically thought of as a severe headache, they can also present very differently between individuals, as in the case of a vestibular migraine.

What happens during a vestibular migraine?

While pathophysiology of migraines is still not completely understood, it is thought that there is an electrical event leading to depolarization of cells in the brain, changes in the flow of neurotransmitters, vascular changes, and inflammation (2). These events can cause migraineurs to be hypersensitive to their environment, as the brain is unable to efficiently process information it receives. There is often light, sound, motion, and/or visual sensitivity.

What are the criteria for vestibular migraine diagnosis?

Here are criteria from Barany Society and the International Headache Society for vestibular migraines (4):

1. At least 5 episodes with vestibular symptoms of moderate or severe intensity, lasting 5 minutes to 72 hours

2. Current or previous history of migraine with or without aura according to the international Classification of Headache Disorders

3. One or more of the migraine features below with at least 50% of the vestibular episodes

   1. Headache with at least two of the following characteristics: one sided location, pulsating quality, moderate or severe pain intensity, aggravation by routine physical activity

   2. photophobia and phonophobia (light and sounds sensitivity)

   3. Visual aura

   4. Not better accounted for by another vestibular or ICHD diagnosis

There it is, the “technical” diagnostic criteria for vestibular migraine, but I would guide you more towards the “probable vestibular migraine” criteria as many people may not fit exactly into the criteria above. The only difference is a history of migraines “or” migraine characteristic with the episodes.

1. Probable Vestibular Migraine

1. At least 5 episodes with vestibular symptoms of moderate or severe intensity, lasting 5 min to 72 hours

2. Only one of the criteria; history of migraine OR one migraine characteristic during 50% of episodes is fulfilled. Migraine characteristic options being:

   1. one sided headache, severe in intensity, throbbing or pulsating in quality

   2. light or sound sensitivity

   3. visual aura

   4. or other sensory disturbance

3. Not better accounted for by another vestibular or ICHD diagnosis

What causes vestibular migraines?

Vestibular migraines can have many possible triggers.

• Lack of sleep

• Dehydration

• Stress

• Certain foods (often food that have tyramines)

• Menstrual cycle

• Weather changes

• Environmental factors such as strong scents or bright lights

• Gut dysfunction

Maybe you’re fine if you don’t sleep much one night, but if you combine more than one of the possible triggers it’s a recipe for a migraine.

Can migraines change?

Migraines can also change their presentation over your lifespan. Maybe they presented as a severe headache when you were younger but now present as dizziness like a vestibular migraine. This will depend on which are of the brain is being affected as it will determine what type of symptoms you will experience.

How are vestibular migraines treated?

Vestibular physical therapy can help reduce symptoms, improve balance, and improve quality of life (3). However, exercises during a vestibular migraine attack are not recommended as they will exacerbate symptoms. Vagal nerve stimulation can be used as a preventative and acute treatment to manage migraines for those patients that it is appropriate for (5). Depending on the individual, medications in conjunction with therapy may be the best approach.

Find a vestibular physical therapist near you to start recovering from vestibular migraines!

1.       GBD 2016 Headache Collaborators. Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018 Nov;17(11):954-976. doi: 10.1016/S1474-4422(18)30322-3. Erratum in: Lancet Neurol. 2021 Dec;20(12):e7. PMID: 30353868; PMCID: PMC6191530.

2.       Krishnan PS, Carey JP. Vestibular Migraine: Clinical Aspects and Pathophysiology. Otolaryngol Clin North Am. 2022 Jun;55(3):531-547. doi: 10.1016/j.otc.2022.02.003. Epub 2022 Apr 25. PMID: 35477842.

3.       Byun YJ, Levy DA, Nguyen SA, Brennan E, Rizk HG. Treatment of Vestibular Migraine: A Systematic Review and Meta-analysis. Laryngoscope. 2021 Jan;131(1):186-194. doi: 10.1002/lary.28546. Epub 2020 Feb 21. PMID: 32083732.

4. Lempert T, Olesen J, Furman J, Waterston J, Seemungal B, Carey J, Bisdorff A, Versino M, Evers S, Kheradmand A, Newman-Toker D. Vestibular migraine: Diagnostic criteria1. J Vestib Res. 2022;32(1):1-6. doi: 10.3233/VES-201644. PMID: 34719447; PMCID: PMC9249276.

5. Lai YH, Huang YC, Huang LT, Chen RM, Chen C. Cervical Noninvasive Vagus Nerve Stimulation for Migraine and Cluster Headache: A Systematic Review and Meta-Analysis. Neuromodulation. 2020 Aug;23(6):721-731. doi: 10.1111/ner.13122. Epub 2020 Mar 12. PMID: 32166843.