Vestibular Migraine
What is Vestibular Migraine?
Many people know of migraines as headaches associated with other symptoms like nausea and/or vomiting, sensitivity to light, sound or movement. This is why most people like to lie down in a quiet and dark room until the symptoms subside. It is sometimes accompanied by an Aura (Visual Aura -visual disturbance like patterns, lines, dots, bright lights or Sensory Aura -tingling or numbness).
Migraine can sometimes trigger attacks of sensation of spinning and movement affecting you or your surroundings. This is known as vertigo. Up to 40% of migraine sufferers will experience spinning or balance problems as part of their migraine symptoms. This is called Vestibular Migraine. There is usually a strong link between headaches and vertigo but not all episodes of vertigo are accompanied with a migraine headache which is what makes diagnosing this condition difficult.
What are the symptoms of Vestibular Migraine?
There are several symptoms that can accompany a vestibular migraine, during an episode you can experience any of the following symptoms:
- Room spinning/vertigo
- Imbalance
- Nausea/vomiting
- Floaty/fuzzy/dizziness
- Sweating/panic
- Sensitivity to light/noise/motion
- Tinnitus, hearing loss and fullness in the ear
- Headache/pressure feeling in your head
- Visual changes/aura
- Tiredness
- Pins and needles/numbness in the face
The symptoms can build over the course of a few hours and often leave you feeling tired and drained.
How common is Vestibular Migraine?
It is probably the second most common condition we see within the Ear Nose and Throat (ENT) Vestibular service.
What causes Vestibular Migraine?
The cause of this is unknown although it does tend to run in families and is more likely in those with a history of migraine. It may be due to temporary changes in the chemicals, nerves and blood flow in the brain.
There are many different things that can trigger migraines and understanding your own triggers can be key to managing this condition. Keeping a diary can help identify these.
Triggers can be in the form of stress (emotional or physical), sleep disruption, dietary, hormonal, environmental factors, muscle tension, or medication related.
The trigger can vary from person to person and can occur several hours before you start feeling any symptoms. Commonly people will describe feeling “off” or “out of sorts” prior to a migraine episode.
Migraine triggers
- Stress
- Hormonal changes
- Bright lights or sunshine
- Flickering or flashing lights
- Loud noises
- Not drinking enough water
- Weather changes
- Low blood sugar
- Reduce salt
- Allergies
- Certain foods
- Caffeine
- Alcohol
- Medication
- Travel
- Screen use
- Sleep deprivation
What can help with Vestibular Migraine?
You should treat this condition like how you would normally treat a migraine attack. Taking painkillers or preventative anti-migraine medication can help all the symptoms that come with an attack. Speak to your doctor about migraine medication, to look at the best option for you. There are medications that help prevent migraine and those that are taken at the time of an attack to help settle it.
If your dizziness is severe a short course of anti-sickness and anti-vertigo medication can help e.g. Prochlorperazine. It is important to stop taking these anti-vertigo tablets once the dizziness has settled as long term use will have side-effects. Please do not these tablets to “prevent dizziness”.
It is important to treat the migraine adequately as this is likely to help your vertigo and you may not need to attend the vestibular team if your symptoms go away.
Everyone is different some can manage migraine with lifestyle changes alone other people need more help like medication, supplements or advice in managing symptoms. It is important to work out what feels best for you. The helpful tips below should give you some ideas.
If you have a history of migraine headaches then treating this with anti-migraine medication can help vestibular migraine. You may need to speak to your GP about this. Vestibular physiotherapy may complement this by helping you manage your triggers and desensitising the vestibular system to reduce the strength of attacks. We also help you return to normal activities in a phased and controlled way.
If you avoid moving normally then you may get other problems within your balance system so it is always best to move as naturally as possible.
Helpful tips
- You should treat this condition like how you would normally treat a migraine attack. Taking painkillers or anti-migraine medication can help both the headache and vertigo. Lying down in a dark and quiet room can help too. Taking too many painkillers can cause rebound headaches, please only take as prescribed. This should mean you are not taking more than twice a week or 8 days a month. If you are doing this please contact your GP to advise and review your mediation.
- Avoid migraine triggers like cheese, salt, caffeine, chocolate, citrus, alcohol, dehydration, missed meals and lack of sleep. If your symptoms of vestibular migraine respond to migraine treatment this helps to confirm the diagnosis.
- If screen use is difficult then you find reducing brightness on the screen or adding a coloured tint helpful. Ensure you take regular breaks away from the screen. If you do this when your symptoms start it will be more manageable than if you wait until they force you to take a break.
- Keep regular mealtimes, avoid skipping meals and eat a healthy diet. Regular mealtimes will prevent your blood sugar from dipping through the day.
- You may find eating at regular times also helpful. Keeping a diary can help identify any foods that may be triggers for you. Generally, the evidence suggests a low carbohydrate or low sugar diet can be beneficial.
- Be kind to yourself, stress can trigger migraines so practising mindfulness or relaxation can be helpful.
- Try to keep a regular sleep routine, going to bed and getting up at the same time every day, even at weekends or days off.
- Regular exercise is beneficial. To stay healthy, the UK Chief Medical Officers’ Physical Activity Guidelines, on GOV.UK, state that adults should try to be active every day and aim to do at least 150 minutes of physical activity over a week, through a variety of activities. This can be broken up to 40 minutes of exercise 3 x weekly or 15 minutes 3 x daily. Start off low level and build up to avoid triggers. This can be any activity, walking, cycling, swimming, tai chi, yoga or gym. It is best to do what you enjoy as those healthy habits are easier to keep. When walking ensure you look around and take in the environment.
- There is evidence to suggest using different supplements can be beneficial at controlling symptoms of migraine. Please see the websites below for information. Specifically magnesium oxide 400-500mg p/day and Q10 150 mg per day is recommended however please seek advice before taking.
Useful Websites
- Migraine trust
- NHS Inform – Mental wellbeing
- NHS Inform – Migraine
- nhs.uk – migraine
- NHS Lanarkshire Mental wellbeing
Further Advice
- After following the above advice, and if your symptoms have not improved, contact your GP who can refer you to your local vestibular balance service if deemed appropriate.
- For information on how to plan for holidays and events visit: https://vestibular.org/article/coping-support/living-with-a-vestibular-disorder/
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