What are the symptoms of vestibular migraines?

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Vestibular migraines (also known as migraine-associated vertigo) are a type of migraine that includes vestibular (balance-related) symptoms, such as dizziness and vertigo. They can occur with or without the typical headache pain of a classic migraine. The symptoms of vestibular migraines can vary from person to person, but common symptoms include:

1. Vertigo or Dizziness

Vertigo (a spinning sensation) is a hallmark symptom of vestibular migraines. This sensation may be triggered by head movements and can last from a few seconds to several minutes, or sometimes longer.
Some individuals may experience dizziness or a sense of imbalance rather than true vertigo.

2. Headache

Not all individuals with vestibular migraines experience a headache, but many do. When present, the headache is typically:
- Throbbing or pulsating
- One-sided (affecting one side of the head, though it can sometimes be bilateral)
- Moderate to severe in intensity
- Worsened by physical activity, light, or sound
The headache often occurs before, during, or after the vestibular symptoms.

3. Sensitivity to Light and Sound (Photophobia and Phonophobia)

People with vestibular migraines may experience heightened sensitivity to light (photophobia) or sound (phonophobia) during an episode.
Bright lights and loud sounds can worsen the symptoms of dizziness and vertigo.

4. Nausea and Vomiting

Nausea is common with vestibular migraines and can be severe, sometimes leading to vomiting.
The nausea is often linked to the dizziness or vertigo, similar to the nausea experienced during a typical migraine headache.

5. Aura

Some individuals experience an aura, which is a series of visual disturbances that occur before or during a migraine attack. These may include:
- Flashes of light
- Zigzag lines or blind spots
- Temporary vision loss (scotoma)
Not everyone with vestibular migraines will have an aura, and it is more commonly seen in individuals with traditional migraines.

6. Unsteadiness or Imbalance

People with vestibular migraines often report feeling unsteady, lightheaded, or like they are about to lose their balance, even when not experiencing full vertigo.
This sense of imbalance may be constant or may come and go during the migraine episode.

7. Motion Sensitivity

Motion, such as walking, driving, or moving the head, may worsen the symptoms of dizziness or vertigo. Some individuals may also have a heightened sensitivity to visual motion, such as watching moving objects or scrolling on screens.

8. Tinnitus (Ringing in the Ears)

Some individuals with vestibular migraines experience tinnitus (ringing in the ears) during or after an episode.

9. Fatigue and Irritability

Many people with vestibular migraines report feeling fatigued or irritable both during and after an episode. These symptoms may persist for hours to days after the main symptoms subside.

10. Cognitive Symptoms

Some people may experience difficulty concentrating or “brain fog” during an episode of vestibular migraine.
This can include trouble with memory, thinking clearly, or focusing on tasks.

Duration and Frequency:

Duration: The duration of vestibular migraine symptoms can vary. The vertigo and dizziness episodes can last from seconds to hours, and in some cases, up to several days. However, the headache component, if present, typically lasts less than 24 hours.
Frequency: Vestibular migraines can occur occasionally or several times per month, depending on the individual. Episodes can be triggered by certain factors, such as stress, sleep disturbances, hormonal changes, or certain foods.

Diagnosis:

Diagnosing vestibular migraines can be challenging because the symptoms overlap with other vestibular disorders, such as Meniere’s disease or vestibular neuritis. A thorough evaluation by a healthcare provider, including a detailed history of symptoms, may be needed.
Diagnostic criteria include:
- At least five episodes of vertigo lasting 5 minutes to 72 hours, with or without associated headaches.
- Headache features consistent with migraines (e.g., photophobia, phonophobia, nausea).
- The vertigo and dizziness are not attributed to other vestibular or neurological conditions.

When to Seek Medical Attention:

If you experience dizziness, vertigo, or other symptoms that interfere with your daily life, it is important to seek medical attention. A healthcare provider can help determine whether vestibular migraine is the cause and recommend an appropriate treatment plan.
If you experience new or worsening symptoms, such as sudden severe headaches, visual disturbances, or neurological symptoms (e.g., weakness, speech difficulty), immediate medical attention may be needed to rule out other conditions.

Treatment:

Treatment for vestibular migraines often includes a combination of acute treatments to relieve symptoms during an episode and preventive treatments to reduce the frequency of episodes. Options include:

Migraine medications (e.g., triptans, NSAIDs) for acute attacks.
Antiemetics for nausea.
Vestibular rehabilitation therapy (VRT) for balance issues.
Preventive medications (e.g., beta-blockers, anticonvulsants, or antidepressants) for frequent or severe attacks.
Lifestyle changes, such as managing triggers, avoiding known migraine foods, and improving sleep hygiene.

If you think you might have vestibular migraines, consulting with a healthcare provider, especially a neurologist or an ear, nose, and throat (ENT) specialist, is important for proper diagnosis and treatment.

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