Yes – and it is one of the most commonly missed causes of chronic dizziness.
“I don’t get migraines… so why am I dizzy?”
This is one of the most common statements we hear every week at The Vertigo Co.
Patients arrive convinced that Vestibular Migraine cannot possibly explain their symptoms because they don’t experience severe headaches.
Instead, they describe:
- Feeling like they’re on a boat
- Walking on marshmallows
- Rocking and swaying
- Feeling disconnected from their surroundings
- Brain fog
- Motion sickness
- Dizziness in supermarkets
- Feeling overwhelmed by bright lights
- Feeling unsteady when walking
Many have already undergone extensive investigations. They may have had an MRI Brain, CT scan, hearing tests, blood tests and even Vestibular Function Testing, all of which are reported as normal.
Some have been told they are anxious.
Others have been told nothing is wrong.
Many start questioning themselves.
The reality is that Vestibular Migraine is one of the most common causes of persistent dizziness seen by Vestibular Physiotherapists, Neurologists and Neuro-otologists, and a significant proportion of people experience very little or no headache at all.
Understanding this can be life-changing.
What is Vestibular Migraine?
Vestibular Migraine is a neurological condition that affects the way the brain processes balance information.
Rather than simply causing pain, migraine changes the excitability of multiple parts of the brain responsible for:
- Balance
- Vision
- Motion perception
- Spatial awareness
- Sensory processing
For some people this results in severe headaches.
For others, the dominant symptom is dizziness.
In fact, many patients experience dizziness months or years before they ever develop significant headaches.
Some never develop headaches at all.
So can Vestibular Migraine happen without headache?
Absolutely.
The International Classification of Headache Disorders recognises Vestibular Migraine as a distinct diagnosis where vestibular symptoms may be the predominant feature.
Many patients experience:
- dizziness
- vertigo
- imbalance
- rocking sensations
- motion sensitivity
- visual sensitivity
without significant head pain.
Instead of saying
“I’ve got a migraine.”
patients often say
“Something just feels wrong.”
What does Vestibular Migraine feel like?
One of the biggest reasons Vestibular Migraine is underdiagnosed is that symptoms vary enormously.
No two patients describe it exactly the same way.
Common descriptions include:
“I feel drunk.”
“The ground feels soft.”
“My eyes can’t keep up.”
“Everything feels like it’s moving.”
“My brain feels foggy.”
“I feel like I’m floating.”
“Supermarkets make me feel awful.”
“I feel like I’m going to fall over.”
These symptoms may last:
- seconds
- minutes
- hours
- days
- weeks
or even become persistent.
Symptoms of Vestibular Migraine
Patients may experience:
Dizziness
Usually described as:
- floating
- rocking
- swaying
- bobbing
- internal spinning
- lightheadedness
- feeling pulled sideways
rather than classic room spinning.
Motion sensitivity
Many people notice symptoms when:
- travelling in cars
- trains
- trams
- aeroplanes
- ferries
or after getting off transport.
Some become unable to tolerate escalators or elevators.
Visual motion sensitivity
Visual information becomes overwhelming.
Patients commonly struggle with:
- supermarkets
- shopping centres
- airports
- hardware stores
- scrolling on phones
- computer screens
- fluorescent lighting
They often describe feeling as though their brain cannot process movement around them.
Balance problems
Many patients report:
- veering when walking
- feeling unstable with eyes closed
- difficulty walking in crowds
- needing to hold onto trolleys
- feeling worse in the dark
yet neurological examination and MRI imaging are completely normal.
Brain fog
Perhaps the most frustrating symptom.
Patients describe:
- poor concentration
- forgetting words
- difficulty multitasking
- feeling detached
- slowed thinking
Many worry they are developing dementia.
Fortunately, this cognitive fog is extremely common in Vestibular Migraine.
Why don’t I get headaches?
Migraine is much more than pain.
It is a disorder of sensory processing.
Different people express migraine differently.
Some primarily experience:
- headache
Others experience:
- dizziness
- visual aura
- nausea
- balance problems
- extreme sensitivity to light or sound
The location within the brain that becomes activated determines which symptoms become dominant.
This is why two members of the same family may both have migraine but present completely differently.
Common Vestibular Migraine triggers
Many patients spend years trying to identify patterns.
The most common triggers include:
Stress
One of the biggest triggers.
Work deadlines.
Relationship difficulties.
Poor sleep.
Illness.
Travel.
Life changes.
All increase nervous system sensitivity.
Hormonal changes
Many women notice worsening symptoms:
- before menstruation
- during perimenopause
- during menopause
- with hormonal contraception
Hormones influence migraine thresholds and vestibular processing.
Poor sleep
Even one disrupted night can trigger symptoms.
Many patients notice dizziness the morning after:
- late nights
- shift work
- jet lag
- fragmented sleep
Bright lights
Patients frequently report:
- supermarkets
- shopping centres
- fluorescent lights
- LED lighting
- sunlight reflecting off cars
as major triggers.
Busy visual environments
Walking through shopping centres requires the brain to process hundreds of moving visual objects simultaneously.
For a sensitive vestibular system this can quickly overwhelm processing capacity, resulting in:
- rocking
- swaying
- nausea
- imbalance
- anxiety
Dehydration
Many patients notice worsening symptoms when:
- exercising
- travelling
- fasting
- drinking alcohol
Hydration is a simple but often overlooked migraine strategy.
Low blood sugar
Skipping meals is a very common Vestibular Migraine trigger.
Patients often notice symptoms:
- late morning
- late afternoon
- after prolonged fasting
Regular meals and stable blood glucose can significantly reduce attacks.
Can Vestibular Migraine become constant?
Yes.
Many people initially experience occasional attacks.
Over time attacks become more frequent until symptoms are present almost every day.
Common daily symptoms include:
- brain fog
- rocking
- floating
- visual sensitivity
- fatigue
- mild headaches
- motion intolerance
At this stage many patients also develop Persistent Postural Perceptual Dizziness (PPPD).
PPPD occurs when the brain becomes hypervigilant after repeated vestibular episodes.
The result is persistent dizziness that is worse:
- when upright
- in supermarkets
- in crowds
- with visual motion
- during stress
Vestibular Migraine and PPPD frequently occur together and require management of both conditions rather than one alone.
One of the most reassuring things patients hear in clinic is:
A normal MRI does not exclude Vestibular Migraine.
Vestibular Migraine is a disorder of function rather than structure.
The brain is processing sensory information differently, but there is no tumour, bleed or structural lesion causing symptoms.
This explains why patients often undergo multiple normal investigations while continuing to experience significant disability.
How is Vestibular Migraine treated?
Treatment is multifactorial.
It may include:
- Vestibular Rehabilitation
- Migraine education
- Sleep optimisation
- Hydration
- Regular meals
- Magnesium Glycinate or Theronate supplementation
- Vitamin B2
- Stress management
- Exercise
- Vestibular Psychology
- Migraine Medication prescribed by a Neurologist or Neuro-Otologist
Recovery is rarely immediate.
Instead, most patients gradually notice:
- fewer bad days
- reduced symptom intensity
- improved confidence
- better balance
- increased activity tolerance
which accumulate over time.
The most important message
If you experience vertigo, dizziness, rocking, floating, brain fog or motion sensitivity without headaches, Vestibular Migraine remains a very real possibility.
You do not need severe pain to have migraine.
Many patients spend years searching for answers because they believe migraine must involve a pounding headache.
Understanding that migraine can primarily affect the balance system is often the first step towards effective treatment, recovery and returning to the activities you enjoy.
