Vestibular Migraine

At PMC Physiotherapy Dunboyne, Lee Chambers is our specialised physiotherapist treating patients with dizziness, vertigo and balance disorders.

The association of migraine and vertigo has been recognised for a long time, but the nature of the relationship is uncertain. This is because there are no reliable findings on tests like scans, blood tests etc that can be used to diagnose a vestibular migraine. However, it has been consistently found that patients with migraine are significantly more likely to have vertigo compared to patients with tension type headaches (1) and those without headaches (2).

There is no concrete evidence regarding the cause of vestibular migraine but it is thought that genetics may play a role. It also seems to be associated with other vestibular disorders such as Meniere’s syndrome and BPPV. It is not known if a Meniere’s attack or BPPV episode triggers a vestibular migraine or not. Episodes can also be associated with women’s menstrual cycles.

Vestibular migraine is more commonly seen in women than in men. The ratio is thought to be 5:1 with the average age of onset being 37 years of age for women and 42 years of age for men. Patients will usually have suffered from migraine before they get their vestibular symptoms.

30% of those diagnosed with vestibular migraines may present without a history of headache (3). A patient will usually describe acute episodes of vertigo lasting seconds to days, dizziness, imbalance and spatial disorientation. Other symptoms may include light-headedness, a swimming sensation, excessive motion sickness susceptibility. Some patients may also get hearing symptoms such as transient fluctuating hearing loss, aural fullness and tinnitus.

Vertigo and headache do not usually present together and there does not seem to be a consistent pattern of vestibular symptoms during headache presentation (3,4,5).

One study showed that nearly 30% of vestibular migraine patients experienced increased frequency of attacks over a 9-year observation period, although 50% experienced a reduced frequency of attacks. Nearly 90% of patients still report vertiginous attacks after 9 years. Symptoms such as aural fullness, tinnitus and hearing loss during vertigo spells seem to become more common as time progresses (6).

Diagnosis is mainly based on a thorough history. Imaging and testing such as caloric tests are not used to diagnose vestibular migraine as there is no signs with either that are consistent with vestibular migraine.

Current recommendations for vestibular migraine prevention are similar to migraine prevention. These include lifestyle changes such as avoidance of dietary, behavioural or sleep hygiene triggers (7). For acute vestibular migraine attacks, antiemetic and antivertigo medications may be recommended to help control symptoms. For some, once the initial symptoms resolve, they can get on with their lives without any after effects.

For those who continue to get symptoms of imbalance, physiotherapy in the form of vestibular rehabilitation has been shown to improve symptoms (8, 9, 10). Your physiotherapist will use the information gained in your examination to put together an exercise programme to help improve the function of your balance system and reduce your symptoms.

If you are experiencing symptoms of vestibular migraine attacks, contact one of our specialist physios at PMC Physiotherapy Dunboyne to your diagnosis appointment.

1. O’Connell Ferster AP, Priesol AJ, Isildak H. The clinical manifestations of vestibular migraine: A review. Auris Nasus Larynx. 2017 Jun;44(3):249-252.
2. Luzeiro I, Luís L, Gonçalves F, Pavão Martins I. Vestibular Migraine: Clinical Challenges and Opportunities for Multidisciplinarity. Behav Neurol. 2016;2016:6179805.
3. Sargent EW. The challenge of vestibular migraine. Curr Opin Otolaryngol Head Neck Surg. 2013 Oct;21(5):473-9.
4. Lee H, Jen JC, Wang H, Chen Z, Mamsa H, Sabatti C, Baloh RW, Nelson SF. A genome-wide linkage scan of familial benign recurrent vertigo: linkage to 22q12 with evidence of heterogeneity. Hum Mol Genet. 2006 Jan 15;15(2):251-8.
5. Furman JM, Marcus DA, Balaban CD. Vestibular migraine: clinical aspects and pathophysiology. Lancet Neurol. 2013 Jul;12(7):706-15.
6. Radtke A, von Brevern M, Neuhauser H, Hottenrott T, Lempert T. Vestibular migraine: long-term follow-up of clinical symptoms and vestibulo-cochlear findings. Neurology. 2012 Oct 09;79(15):1607-14.
7. Neuhauser H, Radtke A, von Brevern M, Lempert T. Zolmitriptan for treatment of migrainous vertigo: a pilot randomized placebo-controlled trial. Neurology. 2003 Mar 11;60(5):882-3.
8. Whitney SL, Wrisley DM, Brown KE, Furman JM. Physical therapy for migraine-related vestibulopathy and vestibular dysfunction with history of migraine. Laryngoscope. 2000 Sep;110(9):1528-34.
9. Wrisley D.M., Whitney S.L., Furman J.M. (2002) Vestibular rehabilitation outcomes in patients with a history of migraine. Otol Neurotol 23: 483–487
10. Furman J.M., Marcus D.A., Balaban C.D. (2003) Migrainous vertigo: Development of a pathogenetic model and structured diagnostic interview. Curr Opin Neurol 16: 5–13