It feels like a great day for some migraine mythbusting. So, true or false: Migraines always come with debilitating head pain. If you guessed true, we can’t blame you—pain is typically seen as the main symptom of migraines—but it’s actually false. Some forms of migraines can come without pain. Vestibular migraines are one of them.
What exactly are vestibular migraines, and what are the most common symptoms?
Vestibular migraines are a neurological condition that center around symptoms like dizziness and vertigo and may or may not come with head pain, according to Johns Hopkins Medicine. Here are the main vestibular migraine symptoms you should know:
Dizziness: It’s not unusual to feel woozy or lightheaded during a migraine. This is thought to be because of heightened sensitivity in your inner ear as the migraine happens, Katherine S. Carroll, M.D., a neurologist and migraine expert at Northwestern Memorial Hospital, tells SELF. You might even feel unsteady on your feet.
Vertigo: This symptom is essentially a kind of dizziness that happens when you feel like the room or your own body is spinning, and it’s a big tip-off that someone may have vestibular migraines, Amit Sachdev, M.D., an assistant professor and director of neuromuscular medicine at Michigan State University, tells SELF.
Nausea and vomiting: The mechanism behind why migraines can cause these symptoms isn’t totally clear, but unfortunately they can come along with the territory when you have a condition that involves dizziness, Dr. Sachdev says.
Sensitivity to light, smell, and noise: These are typical migraine symptoms that might accompany your vestibular migraine experience, or you may be lucky enough to skip them.
A headache…maybe: You may or may not have head pain when you have vestibular migraines. If you do, the pain might be severe, throbbing, and affect one or both sides of your head. “Currently, it is unknown why some patients get the headache with the vertigo, and others do not,” Gail Ishiyama, M.D., professor of neurology at the Reed Neurological Research Center at the UCLA School of Medicine, tells SELF.
People with vestibular migraines can have specific triggers that bring on these symptoms, like changes in sleep patterns, menstruation, and foods like chocolate, ripened or aged cheese, and red wine, Johns Hopkins Medicine says.
How do vestibular migraines differ from classic migraines?
The main differences between a vestibular migraine and a classic migraine are that the vestibular version is dominated by a feeling of dizziness and vertigo and might not involve head pain, Neil Cherian, M.D., a neurologist at the Center for Neuro-Restoration at Cleveland Clinic, tells SELF. Otherwise, they can be pretty similar, including in their progression.
Migraines can follow a pattern that moves through four stages: prodrome, aura, headache, and post-drome (also called the migraine hangover), the Mayo Clinic says. One person with migraines may deal with this exact progression every single time, while another may have more of a mix-and-match experience that involves some aspects but not others.
The prodrome happens one or two days before the actual migraine strikes, and it can cause symptoms like constipation, mood changes, food cravings, neck stiffness, increased thirst and urination, and yawning a lot, the Mayo Clinic says.
Aura may follow, usually involving sight-related disturbances like flashes of light or wavy, zigzag vision. (In a phenomenon known as ocular migraine, some people experience migraines that mainly involve these kinds of visual disturbances, often without the head pain.) However, aura can also cause other sensory issues, like pins and needles, weakness or numbness in the face or one side of the body, or hearing things that don’t exist, the Mayo Clinic says. Whichever type you have, aura tends to last between 20 and 60 minutes, according to the Mayo Clinic.
For some people, after the aura comes the attack, which is that part of the migraine that can involve throbbing or pulsing pain on one side or both sides of your head, nausea and vomiting, blurry vision, lightheadedness, fainting, and sensitivity to light, sounds, and possibly smells and touch. If you have vestibular migraines, this is where those symptoms like dizziness and vertigo come in. The attack can last anywhere from four hours to a whopping 72 hours, the Mayo Clinic says.
After the attack, some people make their way through the post-drome, which can cause you to feel drained, confused, moody, dizzy, and weak if you’re unlucky, but possibly elated if you’re fortunate, the Mayo Clinic says. Some people still have some residual sensitivity to light and sound at this point.
What even causes vestibular migraines, and who’s most likely to get them?
Neurologists don’t know exactly why vestibular migraines happen, but there are some theories. One is that hyperactivity of the neurons in your brainstem can overstimulate your vestibular system, the part of your inner ear that’s involved in your balance, Dr. Carroll says. Another is that certain triggers can make your blood vessels dilate, setting off the release of inflammatory chemicals that trigger migraine symptoms, she says. It also seems as though, much like with classic migraines, the trigeminal nerve that interprets sensation in your head and face may be involved somewhere in the process.
Just like classic migraines, anyone can get the vestibular kind, Daniel Franc, M.D., Ph.D., a neurologist at Providence Saint John’s Health Center in Santa Monica, California, tells SELF. And, again, much like with classic migraines (you’ll notice a pattern here), the vestibular form tends to run in families, Johns Hopkins Medicine says. Women are also more vulnerable than men in the face of vestibular migraines, which is no surprise, since women are around three times more likely to grapple with migraines in general, the Mayo Clinic says. This is likely due at least in part to the role that hormonal changes involved in menstruation, pregnancy, and birth control can play in bringing on or exacerbating migraines.
How do you actually get diagnosed with vestibular migraines?
Here’s where things get a little weird: The majority of people with vestibular migraines don’t have the dizziness at the same time as the headache, and that’s if they have a headache at all, Johns Hopkins Medicine says. Because of that, it may be easy for doctors to confuse the symptoms with those of other health conditions like benign paroxysmal positional vertigo (one of the most common causes of vertigo), Meniere’s disease (a disorder of the inner ear that causes episodes where you feel like you're spinning), and a transient ischemic attack (a temporary blockage of bloodflow to the brain).
Unfortunately, there’s no clear-cut test for vestibular migraines. If your doctor suspects that this is your issue, they may ask you diagnostic questions that are spelled out in the International Classification of Headache Disorders (ICHD), Dr. Franc says. People with vestibular migraines usually meet the following criteria, as outlined in the ICHD:
- At least five moderate or severe vertigo episodes lasting five minutes to 72 hours.
- At least half of episodes have included at least one of the following:
- Sensitivity to light or sound
- A visual aura
- A headache that feels like it’s centered on one side of the head, feels like it’s pulsing, the intensity is moderate or severe, and it gets worse with physical activity
- A past history of migraines with or without aura
- No other diagnosed condition that explains the symptoms
Your doctor may also order some tests to check for other health conditions, like blood tests to look for blood vessel problems, an MRI or CT scan to rule out stroke, brain tumor, and other neurological conditions, or a spinal tap to weed out infections, bleeding in the brain, or another underlying condition, the Mayo Clinic says.
What can doctors do to treat vestibular migraines?
Treatment for vestibular and classic migraines is pretty similar, Dr. Carroll says. In general, you can think of treatment options in two categories: pain relievers and preventive drugs.
Pain relievers include over-the-counter options like aspirin, ibuprofen, and acetaminophen, along with drugs that are specifically made to treat migraines. There are also medicines called triptans, which make your blood vessels constrict and affect your pain threshold, and ergots, which reduce transmission of the pain messages in your nerve fibers, according to the National Institute of Neurological Disorders and Stroke. Other pain-relieving options are out there, too. What’s best for you can differ from what’s best for others with migraines, so it’s smart to have an in-depth conversation with your doctor before just choosing a migraine medication on your own.
When it comes to prevention, your doctor might recommend drugs like beta blockers and calcium channel blockers, which both work on blood vessels, Dr. Sachdev says. Beta blockers may reduce the frequency and severity of migraines, and calcium channel blockers can help prevent migraines altogether, according to the Mayo Clinic.
Tricyclic and some other antidepressants can also be helpful, potentially cutting back on how often you get migraines by affecting your levels of serotonin and other brain chemicals, the Mayo Clinic says. Much like with pain relievers, there are other kinds of preventive drugs that may work for your migraines, so check in with your doctor for guidance.
Keep in mind that no one medication is guaranteed to work for everyone with vestibular migraines. “Migraine is a complex disorder which we do not fully understand,” Dr. Cherian says. “Medications may be helpful to treat migraine, though they do not help in every patient.”
That’s why, along with medication, you may need to treat your migraines in other ways. This may include things like sticking with a regular sleep pattern and reducing your stress if possible, Dr. Ishiyama says. You may also want to explore whether or not exercise might help your migraines, although workouts can actually trigger migraines in some people, so you should be on the lookout for any pattern indicating that connection may be at play.
If you do indeed have vestibular migraines, treating them may involve some trial-and-error, but it’s worth it to finally feel like you’re back on solid ground.