Migraine and Dizziness/Vertigo

Around 30-50% of migraine patients will sometimes experience dizziness, a sense of spinning, or feeling off balance with their headaches. Migraine specialists now call this vestibular migraine.

A frequent additional symptom is head motion intolerance, ie imbalance, and a sense of motion, often with nausea, aggravated or triggered by head movements.

Vertigo provoked by moving scenes such as traffic or movies, ie visually induced vertigo, can be another prominent feature of vestibular migraine.

Vertigo can precede headache, may begin with headache or may appear late in the headache phase. Many patients experience attacks both with and without headache. In some patients vertigo and headache never occur together, and this can make the diagnosis of vestibular migraine at times challenging.

Along with the vertigo, patients may experience light and noise sensitivity and or visual or other auras, and this can help the migraine specialist establish the link to migraines. Triggers for vestibular migraine attacks can also be similar to those seen in more typical migraine, for example, menstruation, lack of sleep, stress, specific foods, bright lights, strong smells or noise.

There are warning signs or red flags that vertigo is not part of a migraine, including new and sudden onset, sudden hearing loss, ear fullness, loss of balance alone, +/-weakness, and these suggest urgent evaluation for a non migraine disorder.

Otherwise, if a diagnosis of vestibular migraine has been established by a migraine specialist, standard migraine prevention and attack treatment strategies are typically prescribed, and these are frequently effective.

 Note:Information on this site is not a substitute for professional medical advice.

References:

Vestibular Migraine, Lempert MD et al, Seminars in Neurology 2013;33:212-218

Migraine associated Vertigo, Tepper MD, Headache 2015, American Headache Society