Vestibular Migraine: When Dizziness Is the Migraine
Vestibular migraine is one of the most common causes of recurrent dizziness and vertigo, yet it’s still frequently misunderstood. Many people never develop a classic migraine headache. Instead, the migraine shows up as balance problems, motion sensitivity, and visual overload.
That’s why it’s so often missed.
What Does Vestibular Migraine Feel Like?
Symptoms vary, but commonly include:
- Spinning, rocking, or swaying sensations
- Persistent dizziness or light-headedness
- Sensitivity to head movement, busy environments, or screens
- Sensitivity to light or sound
- Nausea, fatigue, brain fog
- Unsteadiness when walking
Headache may be mild—or absent altogether. Dizziness can be the main feature.
What’s Actually Going On?
Vestibular migraine is a neurological condition, not an inner ear disease. Migraine activity causes the brain to become over-responsive to sensory input, disrupting balance, eye-movement control, and spatial awareness. The ears are usually normal—the processing isn’t.
Why Vestibular Assessment Matters
Dizziness has many causes. Before vestibular migraine can be confidently diagnosed, it’s essential to rule in or rule out inner ear disorders.
A comprehensive vestibular assessment helps determine whether symptoms are due to:
- Peripheral vestibular conditions (such as BPPV, vestibular neuritis, or Ménière’s disease etc.), or
- Central causes i.e. cerebrovascular or neurological changes in the brain
This step is crucial. Treating migraine when the problem is actually inner ear—and vice versa—leads to poor outcomes. Proper testing allows the diagnosis to be made with confidence, not guesswork.
How Is Vestibular Migraine Diagnosed?
There is no single scan or blood test. Diagnosis is clinical, based on internationally recognised Bárány Society criteria, used alongside vestibular assessment findings.
In simplified terms, vestibular migraine is diagnosed when:
- Five or more episodes of moderate to severe dizziness or vertigo occur
- Episodes last between 5 minutes and 72 hours
- There is a current or past history of migraine, with or without aura
- At least half of episodes include one or more migraine features:
- Migraine-type headache
- Sensitivity to light and/or sound
- Visual aura
- Symptoms are not better explained by another vestibular or neurological condition
There is also a “probable vestibular migraine” category for people who nearly meet these criteria—often seen early in the condition or when headache features are subtle.
MRI scans are frequently normal. That doesn’t mean nothing is wrong—it means the problem is functional, not structural.
Why It Can Feel So Debilitating
Vestibular migraine disrupts systems you rely on constantly: vision, balance, concentration, and orientation. Patients often say:
- “I feel drunk without drinking.”
- “Busy places wipe me out.”
- “I don’t trust my balance.”
That’s not anxiety causing the symptoms—it’s a brain under sensory overload.
Treatment: What Actually Helps
There’s no instant cure, but vestibular migraine is very manageable with the right plan:
- Education to reduce fear and symptom amplification
- Lifestyle consistency (sleep, meals, hydration, caffeine stability)
- Preventive migraine medication when symptoms are frequent or disabling
- Migraine-informed vestibular rehabilitation, not generic balance exercises
The Bottom Line
Vestibular migraine is real, common, and treatable. Dizziness doesn’t automatically mean an ear problem—and migraine doesn’t need a headache to qualify.
But diagnosis matters.
A proper vestibular assessment comes first.
Only then does the label make sense.
If dizziness is the migraine, getting this right changes everything.
