Vestibular migraine: symptoms, treatment, triggers and diagnosis

ENT UK says most people experience only some of the possible symptoms and that severity varies from person to person. NHS information on vertigo describes it as feeling that you or everything around you is spinning, enough to affect balance, and says attacks can last from a few seconds to hours.

• Dizziness or vertigo, which may be brought on by a sudden change in head position or by seeing a moving object, or may come on suddenly for no apparent reason.

• Moderate to severe headache, which daily activities can make worse, although not everyone has a headache with each attack.

• Sensitivity to light, noise and certain smells, before, during or after an attack.

• Changes in vision, numbness, unusual sensations or speech problems in some people.

• Nausea and vomiting during an attack.

• Hearing loss, tinnitus and a feeling that the ear is blocked.

ENT UK says treatment involves preventing an attack and treating an attack when it happens, and that prevention is by far the best way to control the condition. Prevention involves taking medication every day, even when you are not having any symptoms, and you should ask your doctor about the treatment options for you. You should take the treatment for an attack as soon as you feel symptoms starting, so it is best to keep your medicine somewhere convenient.

ENT UK describes vestibular migraine as a type of migraine. For migraine in general, the NHS says treatment for symptoms of an attack includes painkillers such as ibuprofen and paracetamol, medicines called triptans and gepants, and medicines that stop you feeling or being sick, and that preventing attacks may involve medicines such as beta blockers, antidepressants and medicines for epilepsy, acupuncture, relaxation techniques and cognitive behavioural therapy, or vitamin B2. Which of these suits you depends on your situation, and your doctor will advise.

The NHS migraine page advises trying not to take painkillers for more than 2 days a week, as this can cause more headaches and make migraine harder to treat. For the dizzy spells themselves, the NHS vertigo page suggests lying still in a quiet, dark room, moving your head carefully and slowly, sitting down straight away when you feel dizzy, and trying to relax because anxiety can make vertigo worse. It says antihistamines can sometimes help with vertigo symptoms and that exercises may be given to correct your balance.

Vestibular migraine is a form of migraine in which the main symptoms are dizziness, vertigo or unsteadiness. ENT UK explains that the balance organ of the inner ear tells the brain the position and direction of the head, and that in vestibular migraine the signals involved in balance, hearing and sensing pain become disordered in the brain. This can cause dizziness even when the inner ear itself is working normally.

The cause is complicated and not fully understood. ENT UK says it is thought that people with migraine are more sensitive to triggers such as light, noise or stress, and that migraine can run in families. Vertigo can also occur without migraine, which is one reason the diagnosis can be hard to make.

ENT UK says the cause is complicated and not fully understood. It is thought that migraine sufferers are more sensitive to triggers such as light, noise or stress, which leads to signals being sent in a disordered way. Migraine conditions may run in families, suggesting some people are more likely than others to develop the condition.

The NHS says it is not known what causes migraine in general, but it happens when there are changes to nerves and blood vessels in the brain, and that you are more likely to get it if a close family member has it. Women are also more likely to get migraine than men.

ENT UK does not give a standard length for attacks of vestibular migraine. The NHS vertigo page says a vertigo attack can last from a few seconds to hours, and that severe vertigo can last for many days or months. The NHS migraine page says migraine attacks usually last between 4 hours and 3 days, with early symptoms starting hours or up to 2 days before the head pain starts.

Vestibular migraine itself is a long-term pattern rather than a single episode. ENT UK says prevention with daily medicine is the best way to control it, and that staying fit and healthy helps reduce the frequency and severity of attacks. The NHS says most people find their migraine attacks slowly get better as they get older.

ENT UK recommends maintaining a healthy lifestyle, including a well-balanced diet, exercising regularly and getting enough sleep at night, because staying fit and healthy helps reduce the frequency and severity of attacks. It says attacks are often reported to be brought on by certain foods and activities and can be linked to the menstrual cycle, and that where possible you should try to avoid triggers.

The NHS lists general migraine triggers: having your period, anxiety and depression, stress and tiredness, skipping meals or not eating regularly, too much caffeine and not getting enough regular exercise. It suggests staying well hydrated, limiting caffeine and alcohol, eating meals at regular times and getting regular exercise and plenty of sleep. A symptom or migraine diary helps work out patterns.

There is no blood test or scan that confirms vestibular migraine. ENT UK says it is diagnosed from your account of the symptoms and an examination. A GP will ask about the length of episodes, what sets them off, whether there is a history of migraine and whether there are hearing symptoms. The NHS vertigo page notes that a GP may do a simple test that involves moving quickly from a sitting to a lying position to check your balance, and that you may be referred to a specialist for further tests.

Specialists in ENT, audiology or neurology may be involved where the diagnosis is unclear. The NHS lists common causes of vertigo as inner ear problems such as benign paroxysmal positional vertigo (BPPV), labyrinthitis, vestibular neuritis and Meniere's disease, and says other causes include migraine and some medicines, so the picture needs sorting out carefully.

The NHS vertigo page says inner ear problems are the most common causes of vertigo, and that other causes include migraine and some types of medicine. Because several conditions cause similar symptoms, a clinician looks at the pattern of symptoms and history.

Not all dizziness is migraine, and some symptoms need emergency assessment. The NHS vertigo page says to call 999 or go to A&E if you have vertigo with double vision or loss of vision, hearing loss, trouble speaking, or leg or arm weakness, numbness or tingling. It says to ask for an urgent GP appointment or call NHS 111 if you have vertigo with a severe headache, are being sick or feel very sick, or have a very high temperature or feel hot, cold or shivery.

The NHS also says to see a GP if vertigo will not go away or keeps coming back, and that people who drive must tell the DVLA about vertigo. If symptoms are new and sudden, do not assume migraine without a medical assessment.

On the NHS, the route is usually the GP, then ENT, audiology, neurology or a balance clinic if symptoms are persistent or unclear. Some people use private neurology or ENT balance services for a quicker appointment. The key difference is usually waiting time, not the approach, because the diagnosis rests on history either way. Whichever route you use, take your symptom diary with you.