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?

Up to 40% of migraine sufferers will experience spinning as part of their migraine.  It is probably the second most common condition we see within the ENT Vestibular service.

What can help with Vestibular Migraine?

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

1. 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.
2. Avoid migraine triggers like cheese, 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.
3. 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.
4. Keep regular mealtimes, avoid skipping meals and eat a healthy diet. Regular mealtimes will prevent your blood sugar from dipping through the day.
5. 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 is beneficial.
6. Be kind to yourself, stress can trigger migraines so practising mindfulness or relaxation can be helpful.
7. 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.
8. Regular exercise is beneficial; evidence suggests a moderate level of activity 3-5 times per week for 20 -30 minutes. 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.

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, this is what you should do:

• If you are currently under the care of the Lanarkshire ENT service or were directed to this page by one of the members of the ENT team, please contact us on 01236 712332.
• Otherwise, contact your GP who can refer you to your local vestibular balance service

When to speak to a health professional

 If you are struggling to manage your symptoms or if you notice a change in your symptoms.

Help and Support

If, after following the above advice, your symptoms have not improved, a referral to the ENT Vestibular Service may be useful.

You can contact your GP to refer you if they think it will help.