Vestibular Migraine

What is Vestibular Migraine and what are the symptoms?

Migraine is typically characterised by onset of one-sided severe head pain (usually throbbing or pounding) accompanied by photophobia (sensitivity to light), phonophobia (sensitivity to sound), nausea and/or vomiting. Vestibular Migraine is a variant of migraine in which vertigo (a sensation of spinning) or dizziness is the most prominent feature rather than headache. Approximately 30% of Migraine sufferers will also suffer from attacks of Vertigo or dizziness that may or may not also be accompanied by typical migraine headache (1). 

Symptoms of Vestibular Migraine may include, but are not limited to:

  • Severe one-sided head and/or neck pain (throbbing or pounding)

  • Vertigo and/or dizziness

  • Impaired balance

  • Nausea and/or vomiting

  • Motion sensitivity

  • Blurred vision or visual ‘aura’ (spots/shadows in vision)

  • Photophobia (sensitivity to light)

  • Phonophobia (sensitivity to sound)

  • Perceived hearing loss and/or tinnitus (ringing in the ears)

  • Anxiety/Panic

These symptoms may behave in attacks lasting a few minutes to 72 hours and may resolve completely between episodes and are usually preceded by ‘warning signs’ that a migraine is about to commence. Other sufferers may feel a constant level of motion sensitivity, impaired balance and visual symptoms which impair their day-to-day function. 

What causes it?

The exact mechanisms of Vestibular migraine are not completely understood, however there are a number of theories on the subject. It is believed Migraine is a complex process caused by both neurological and vascular (blood flow) issues whereby for one reason or another neural signals are spread across the brain followed by an activation of pain receptors in the brain stem, which is near the area of the brain that triggers vertigo. The release of neurotransmitters causes a dilatation of blood vessels near the scalp which in turn causes the pain experienced (2). 

How is it diagnosed?

A diagnosis of Vestibular Migraine is usually based largely on a thorough history of symptoms, along with a number of tests to rule out other conditions which have a similar presentation. These tests may include (if necessary) a CT or MRI of the brain, and Vestibular Function tests, such as the head impulse test – which test the function of the inner ear. Usually, these tests will be completely normal, and therefore vestibular migraine is usually ruled in as a cause for the symptoms. 

How is it treated? 

Vestibular Migraine is treated using a combination of factors which may include:

  • Dietary trigger control

  • Vestibular Physiotherapy

  • Medication

 If you have any further questions with regards to Vestibular Migraine or its treatment, please contact Laura at The Vertigo Co via phone on 0467392414 or via email on laura@thevertigoco.com.au. 


References:

1. Savundra PA, Carroll JD, Davies RA, Luxon LM. Migraine-associated vertigo. Cephalalgia. 1997;17(4):505-10; discussion 487.
2. Baloh RW. Vestibular Migraine I: Mechanisms, Diagnosis, and Clinical Features. Semin Neurol. 2020;40(1):76-82.