Migraine

What You Need to Know About Migraine and Vertigo

Vertigo and sometimes even dizziness that consistently occur with migraine may be signs of what’s known as vestibular migraine.

Becky Upham
By
Jessica Baity, MD
by
woman kaleidoscope effect photo spinning
Vertigo, or a feeling that the world is spinning around you, can happen during any phase of a migraine attack.Chelsea Victoria/Stocksy

If your migraine attacks sometimes come with a sensation that you’re standing in a rocking boat, or you feel as though the world is spinning around you, you are experiencing vertigo, and you may have what’s known as vestibular migraine.

The term “vestibular disorder” generally refers to a disorder affecting the inner ear that leads to dizziness, vertigo, and balance problems.

When vertigo occurs as part of a migraine attack, it can happen in any of the phases — that is, the prodrome, aura, headache, or postdrome phase — of migraine, according to the American Migraine Foundation.

“Vertigo is the feeling that you’re moving or spinning even though you are sitting still,” says Loretta Mueller, DO, a headache specialist at Cooper University Health Care in Cherry Hill, New Jersey.

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Does Migraine Cause Vertigo?

Vertigo can occur spontaneously, with no warning, or it can be triggered by moving your head or placing your head in a certain position, according to the American Migraine Foundation.

Because people with vestibular migraine are often more sensitive to sensory input, a headache or vertigo can be triggered by visual stimulation, such as specific patterns or moving objects.

“For example, when you are driving and the sun is setting, the light going through the trees could set off a headache or vestibular symptoms,” says Dr. Mueller. “A 3D movie can be bothersome as well.”

Vertigo, Dizziness, and Light-Headedness: What’s the Difference?

In true vertigo, there is a feeling that the world is moving around you when in fact there is no motion.

Dizziness is often used as a general term to include vertigo and other sensations, such as disequilibrium, in which you feel unstable on your feet or light-headed, according to University of Michigan Health.

Light-headedness is when you feel as though you might faint or pass out. You can be dizzy when you’re lightheaded, but you don’t usually feel like the world is spinning around you. People can also feel nauseous or vomit when they are light-headed.

The language is important because describing your symptoms as specifically as possible will help your doctor make an accurate diagnosis.

RELATED: What Tests Will My Doctor Use to Diagnose Vertigo?

What Does a Vestibular Migraine Feel Like? 

People’s experiences of vertigo vary, says Mueller. “They can report feeling like they are walking on air, light-headedness, spinning, or feeling off-balance, like they are pulling to the right or the left,” she says.

Some people with vestibular migraine can experience vertigo as a “to-and-fro” sensation, according to one review.

The vertigo may or may not come with a headache — often a vestibular migraine attack doesn’t include head pain, according to the American Migraine Foundation.

People with vestibular migraine do report common migraine symptoms, such as sensitivity to light (photophobia), sensitivity to sound (phonophobia), and nausea.

Less common symptoms include brain fog, fatigue, dry mouth, sweating, diarrhea, excessive yawning, tingling, scalp tenderness, and visual blurring.

How Is Vestibular Migraine Diagnosed?

Understanding and diagnosing vestibular migraine has been challenging — even more so than with other types of headaches — in part because there are so many different types of vertigo, says Mueller.

According to the diagnostic criteria from the International Classification of Headache Disorders, symptoms that indicate a diagnosis of vestibular migraine include various types of vertigo (spontaneous, positional, visually induced, and head-motion-induced), as well as head-motion-induced dizziness with nausea. The symptoms must be of moderate or severe intensity, and the duration of acute episodes is limited to a window of between 5 minutes and 72 hours.

“You don’t have to have a migraine headache with every dizziness episode. By the definition, when you do have episodes of dizziness, at least half of them should have some migraine features,” says Mueller. And those symptoms don’t need to include headache pain — it could be aura, light sensitivity, sound sensitivity, or nausea, she says.

People with vestibular migraine often have a history of motion sickness that started in childhood, according to the American Migraine Foundation.

What Other Conditions Can Have Vertigo as a Symptom?

Vertigo can sometimes be a symptom of other conditions, and so doctors try to rule those things out before diagnosing vestibular migraine, says Mueller. It’s worth noting that having one condition that causes vertigo doesn’t necessarily exclude the others — it’s possible for a person to have both vestibular migraine and Ménière’s disease, for example, according to John Hopkins Medicine.

Other conditions that cause vertigo include the following:

Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is a problem with the inner ear, and it’s the most common inner ear disorder, according to Johns Hopkins Medicine. It can happen when the little crystals in the semicircles of the ear, called otoconia, become dislodged.

“This can bring on the symptoms of vertigo. When people have BPPV, it’s positional vertigo — the spinning feeling happens when you move your head or turn over in bed,” says Mueller.

Ménière’s Disease

Vertigo is a common symptom of Ménière’s disease, a condition that results from fluid buildup in the inner ear. Such a buildup can be caused by many things, including infection, head injury, and migraine, according to John Hopkins Medicine.

People with Ménière’s disease can also experience ringing in their ears (tinnitus) and may develop a progressive type of hearing loss, Mueller adds.

Persistent Perceptual Postural Dizziness (PPPD)

PPPD is common and can occur with migraine, says Mueller. It’s a chronic dysfunction of the vestibular system that makes people feel dizzy or unsteady all the time, according to one review.

“People may have a vertigo episode or a vestibular migraine attack, and then something happens that makes them feel that perception of dizziness all the time — it never really goes away. It’s mild, but it’s always there,” says Mueller.

Transient Ischemic Attack (TIA) or Mini-Stroke

A TIA can have many of the same symptoms as a stroke, but TIA symptoms are passing — they can last a few minutes or up to 24 hours. In addition to dizziness and balance problems, symptoms of a stroke or mini-stroke can include weakness or numbness on one side of the face or body, trouble speaking or understanding, and vision problems, according to the Centers for Disease Control and Prevention.

A TIA may be a warning sign that a stroke is about to occur. You should seek urgent medical attention right away if you think you or someone else is having a stroke or mini-stroke.

What Is the Treatment for Migraine With Vertigo?

Because the diagnostic criteria for vestibular migraine were released fairly recently, there’s a lack of information from placebo-controlled trials on how to best treat it, says Mueller.

There is limited evidence to support the use of triptans to treat dizziness in vestibular migraine, based on data from two initial trials, noted one research review. The acute therapies that are typically most effective for vestibular migraine episodes consist of vestibular suppressants (drugs that reduce the intensity of vertigo and related symptoms) and antiemetics (drugs that suppress nausea and vomiting).

In some cases, triptans may be effective when used in conjunction with vestibular suppressants or antiemetics if you have used triptans for acute migraine treatment in the past and if your headaches are frequently accompanied by vestibular symptoms.

If a person is experiencing frequent vestibular migraine attacks, the same kinds of preventive medications used for other types of migraine may reduce the number or severity of attacks, says Mueller.

The preventive medications that may be prescribed for vestibular migraine include the following:

How Long Can Migraine Vertigo Last?

By definition, a vestibular migraine can last between five minutes and 72 hours.

For some people, the episodes of dizziness or vertigo that come with the migraine may last just a few seconds but can happen repeatedly throughout the day, says Mueller.

“For others, the episode of dizziness could last hours or days. It’s variable,” she says.

What Lifestyle Changes or Therapies Can Help With Vestibular Migraine?

You may be able to reduce the number and intensity of your vestibular migraine attacks by keeping a consistent sleep routine, eating on a regular schedule (no skipping meals), managing stress, and getting enough exercise, according to Johns Hopkins Medicine.

While it’s important to recognize migraine triggers, you don’t want to avoid everything as a coping mechanism, says Mueller. “Cognitive behavioral therapy (CBT) can help people learn to manage stress and live with migraine and vertigo,” she says.

Some people may benefit from vestibular rehabilitation (VR), which is like physical therapy for people who have issues with vertigo and dizziness, says Mueller. VR is an exercise-based program that is designed to help train the nervous system to compensate for vestibular problems, according to the Vestibular Disorders Association.

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