Understanding and Managing Vestibular Migraine: A Complete Overview

Vestibular migraines are a type of migraine that comes with dizziness, balance issues, and vertigo, sometimes without a headache. This can cause nausea, sensitivity to movement, and a spinning sensation leading to disruptions in daily activities. The cause is still unknown; triggers include stress, poor sleep, certain foods, and hormonal changes. Family history can also be a risk factor.

Management of vestibular migraines is achieved through prevention and symptom management using medication, lifestyle changes, and physiotherapy. Balance exercises and proper care planning can help reduce dizziness and improve stability. Determining triggers and receiving expert advice are important steps in management. Knowing the difference between vestibular migraines and other forms can help you identify appropriate strategies for regaining control and optimising well-being.

What is Vestibular Migraine?

Vestibular migraine involves the inner ear and equilibrium areas of the brain affecting balance and stability. Unlike regular migraines, it may not cause headache, but causes dizziness, vertigo, nausea, or sensitivity to sound and movement. Being able to notice this or identify its triggers, which can help manage the condition more easily.

How Vestibular Migraine Differs from Other Migraines

The main difference between the two is that vestibular migraines mainly affect balance, rather than causing pain. A typical migraine, on the other hand, features severe pain or sensitivity to light or aura, whereas vestibular may not even present with head pain. Dizziness and spinning, along with a sense of instability or visual disorientation are introduced instead.

Causes and Triggers of Vestibular Migraine

Vestibular migraines are caused by various triggers, including stress, diet, weather changes, and sensory overload, most of which are genetically linked.

Genetic Factors

Vestibular migraines are influenced by genetics, with family history increasing susceptibility. There are some nerves that continue to inherit the messages, and this heightens susceptibility to triggers and modulates symptom severity. Genetics cannot be changed, but understanding this allows you to focus on what you can do to effectively manage triggers and minimise the impact of vestibular migraines.

Hormonal Changes

Hormonal fluctuations significantly impact women with vestibular migraines, often worsening during menstruation, pregnancy, or menopause, since oestrogen alters the nervous system of a female. The migraine symptoms may vary through cycles of hormones.

Dietary Triggers

Certain foods and drinks, including caffeine, alcohol, cheese, processed meats, MSG, and artificial sweeteners, for example, can trigger vestibular migraines. Observing patterns between consumption and symptoms helps narrow down dietary choices to fewer episodes and lower intensities over time.

Stress and Emotional Factors

Stress activates vestibular migraines by releasing chemicals that enhance one's sensitivity to triggers. Emotional factors such as anxiety or sadness can also increase the risk factor. 

Sleep Disruptions

Poor sleep disrupts recovery and stress management, making a person more susceptible to episodes of vestibular migraine. Unpredictable, disrupted, or changed sleep, like shift work or travel, can cause a flare-up.

Environmental Factors

Environmental factors such as a weather change, altitude shift, bright lights, or loud noises can activate the vestibular migraine.They may interfere with the nervous system making it more sensitive to environmental changes around it eventually leading to dizziness or vertigo.

Symptoms of Vestibular Migraine

The symptoms of vestibular migraine vary and may include dizziness, vertigo, nausea, photosensitivity, audiophobia, tinnitus, or blurred vision. Headaches may be present or absent. Symptoms vary in severity, onset, and presence, which is helpful in the diagnosis.

Vertigo and Dizziness

The most common symptoms of vestibular migraines include vertigo and dizziness, causing instability and a spinning sensation that lasts minutes to hours. This interferes with daily activities, resulting in disorientation. Vertigo can be highly disabling during movement; its onset is unpredictable, making it hard to stand, walk, or focus.

Headache

Headaches can occur in vestibular migraines and, when present, are not always constant but instead are frequent as unilateral, pulsating pain with sensitivity to light and noise. Head pain is less common compared to other forms of migraines, and when it does occur, headache affects the severity and nature of the attack.

Sensitivity to Light and Sound

Vestibular migraines most often trigger sensitivity to light and sound, with bright lights and sudden noises being unbearable. Such patients often need dark, quiet surroundings to alleviate symptoms. Sensitivity may even remain after the active migraines have subsided, which may require adjustments in the environment to improve symptoms.

Nausea and Vomiting

Often, nausea and vomiting are associated with vestibular migraines, especially during more prolonged vertigo or dizziness episodes. These can make eating and drinking difficult. Management includes immobilisation, avoidance of sudden movements, and anti-nausea medication, since nausea usually worsens with movement or exposure to light, making this a primary concern during episodes.

Visual Disturbances

Blurred vision, flashing lights, or even transient vision loss in one eye characterise vestibular migraines. Patients see spots, zigzags, or shadows during these episodes. Such symptoms interfere with activities such as reading, driving, or walking and can last from a few minutes up to the entire episode.

Hearing and Ear Symptoms

Vestibular migraines often include ear symptoms such as fullness, tinnitus, or temporary hearing changes. Ear fullness feels like pressure, but tinnitus generates ringing or buzzing sounds. Hearing might also feel muffled.

Duration and Intensity of Symptoms

Symptoms of vestibular migraine may last for seconds to hours or even days, while fluctuating in intensity. The severity is also affected by stress, sleep, and other stimuli. Since the condition can be unpredictable, keeping an eye on its pattern over time can help regulate the occurrence and severity of the episodes.

Diagnosis of Vestibular Migraine

Diagnosis of vestibular migraine is based upon history of symptoms, triggers, and family history, but imaging tests cannot confirm the condition.

Clinical Diagnosis

Diagnosis of a vestibular migraine in the clinical setting is dependent on considering symptoms such as dizziness, vertigo, and associated headaches or photophobia. A family history and response to migrainous-type treatments support diagnosis.

Diagnostic Tests

Although no particular test is used in diagnosing vestibular migraine, physicians perform hearing tests, balance tests, and imaging studies such as MRI or CT scans to rule out other conditions. Vestibular function tests check the reaction and balance response to various movements with the goal of solving differential diagnosis.

Differential Diagnosis

Differential diagnosis for vestibular migraine includes such conditions as Meniere's disease, BPPV, and vestibular neuritis due to which dizziness may also be seen but due to different causes. Distinguishing these disorders through physical exams and vestibular function tests assist in obtaining the precise treatment and proper management of the symptoms.

Treatment Options for Vestibular Migraine

Treatment for vestibular migraine is medication, lifestyle modifications, vestibular rehabilitation, and alternative therapies, all with tailored approaches for effective long-term management.

Medications

Treatment may include triptans, beta-blockers, anti-seizure drugs, and anti-nausea medications to prevent or control symptoms. Dosage may need to be adjusted in patients to find the right response.

Vestibular Rehabilitation Therapy

Vestibular Rehabilitation Therapy (VRT) is a set of exercises performed by patients to reduce dizziness and improve balance, conditioning the brain and inner ear to handle changes in motion. VRT, specifically designed for individual patients, gradually increases tolerance to multiple triggers for dizziness, contributing significantly to reducing recurrence of attacks of vestibular migraine.

Balance Exercises

Balance exercises such as standing on one leg, heel-to-toe walking, and head movements can reduce dizziness associated with vestibular migraines. A physiotherapist will create an exercise plan for the severity of your condition, gradually increasing the challenge as the brain builds strength in maintaining balance, reducing episodes from sudden motion.

Physical Therapy

Vestibular migraine needs strengthening of muscles, improvement of posture, and balance exercises. The role of the therapist focuses on the relevance of head and neck tension in enhancing stability. At PhysioTattva, we offer personalised manual therapy and vestibular rehabilitation techniques tailored to your specific symptoms and condition, helping you regain stability for everyday activities. Contact us today for more details.

Alternative Therapies

Alternative treatments, such as acupuncture, relaxation therapies, mindfulness, yoga, and breathing exercises, can help manage stress, an event common enough to trigger vestibular migraines. They are not a cure but may complement other treatments while reducing tension and sensitivity to triggers, allowing for a holistic approach to symptoms.

Preventing Vestibular Migraine Episodes

Preventing vestibular migraines requires regular sleep, balanced meals, stress reduction, avoidance of triggers, hydration, and combining lifestyle changes with treatment.

Avoiding Triggers and Managing Stress

Managing vestibular migraines requires avoiding such triggers as certain foods, bright lights, or loud noises. Stress reduction through meditation, deep breathing, and regular breaks are also beneficial. Hobbies, exercise, and outdoor time also help alleviate daily pain, making management more effortless once triggers can be identified and stress controlled.

Importance of Regular Sleep and Meal Schedules

Regular sleep patterns and time intervals for meals stabilise the response of the body to vestibular migraine triggers. Better rest balances brain function, and balanced meals avoid worsening symptoms. This routine eventually reduces interruptions, thereby creating a balanced environment for managing vestibular migraines effectively.

Staying Active: Exercise and Vestibular Rehabilitation

Exercises and rehabilitation involving the vestibular system improve stability and reduce symptoms of dizziness. Simple exercises like walking and stretching strengthen muscles and enhance circulation, while targeted exercises train the brain and body to better respond to motion; physical activity can build resilience, making daily management of vestibular migraines easier.

Dealing with Co-Existing Conditions

Other conditions that might coexist with anxiety and neck pain can worsen vestibular migraines. Treatments for these, such as physical therapy or relaxation techniques, help in general patient well-being and facilitate more comprehensive migraine management.

Managing Vestibular Migraine Effectively with Physiotattva

Take control of your life with Physiotattva. Our treatments are customised to target both migraine as well as balance symptoms, combining vestibular rehabilitation, tailored exercises, and stress-reduction techniques. Our experts will map out a personal plan for long-term relief. Contact us today to begin living your balanced, symptom-free life.

At Physiotattva physiotherapy clinics in Bangalore and Hyderabad, you receive personalised care tailored to your specific needs, ensuring effective results and comfort throughout your journey to recovery. 

Don’t wait to start your recovery! Get in touch with Physiotattva for more details! Contact us at +91 89510 47001.

FAQ

How is vestibular migraine diagnosed?

Doctors diagnose vestibular migraine by assessing symptoms, medical history, and any patterns of dizziness or migraines. They may perform tests to rule out other conditions, but diagnosis primarily relies on clinical evaluation and response to treatments.

What treatments are available for vestibular migraine?

Treatments include medications to prevent episodes or reduce symptoms, vestibular rehabilitation to improve balance, and lifestyle changes to avoid triggers. Some may benefit from alternative therapies like acupuncture, with a treatment plan customised to individual needs.

What should I do if my vestibular migraine symptoms worsen?

If symptoms worsen, consult a healthcare provider to reassess your treatment plan. They may adjust medications or recommend additional therapies to control symptoms, such as increased vestibular exercises or other supportive care options.

Can lifestyle changes help manage vestibular migraine?

Yes, regular sleep, balanced meals, stress management, and avoiding known triggers can help reduce the frequency and intensity of episodes.