Vestibular Migraine: Dizziness and Vertigo

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Vestibular migraine can affect more than just the brain. It may cause dizziness, blurry vision, a spinning sensation (vertigo), or difficulty maintaining balance, sometimes without headache. Some people feel worse when moving their head, walking, or travelling in a vehicle. Nausea and sensitivity to light may also occur. These symptoms can last for a few minutes to several hours depending on the person's overall health.

What Vestibular Migraine Is

Vestibular migraine is a type of migraine that affects the body's sense of balance. It can make a person feel dizzy, lightheaded, or as if surroundings are spinning. Unlike a typical migraine attack, a headache may not always be present. Some people also feel nausea, sensitivity to light and sound, or discomfort in head movements. The symptoms can come and go, and their intensity varies from person to person. There is no direct cure for vestibular migraine, but lifestyle changes and medication can help ease symptoms.

Dizziness And Vertigo Symptoms

Vestibular migraine is a neurological condition where dizziness can make a person feel light-headed, unsteady, or uncomfortable while moving around. Vertigo is slightly different, as it creates a spinning sensation.

Common Symptoms Include:

• Spinning sensation or feeling as though the room is moving
• Loss of balance or feeling unsteady while standing or walking
• Sensitivity to movement or dizziness when moving fast, crowds, or riding a vehicle
• Nausea during vertigo
• Feeling confused about movement or position of the body
• Difficulty in daily activities such as travelling, walking, and concentrating.

Motion Sensitivity

Motion sensitivity means feeling dizzy, uneasy, and nauseated when moving your head, travelling in a vehicle, or watching moving images. In vestibular migraine, it can trigger or worsen symptoms, sometimes even after movement stops.

Balance

Vestibular migraine can make it difficult to maintain balance while standing or walking. You may feel unsteady, as if the ground is moving, or find it hard to walk in a straight line. These symptoms can occur with or without a headache and can make everyday activities more challenging.

Headache And Sensory Symptoms

Vertigo-related migraine may cause a headache along with dizziness or vertigo, although some people experience balance problems without any headache. 

Common Symptoms Include:

• Throbbing or pulsating pain often on one side of the head
• Bright light may feel uncomfortable or make symptoms worse
• Sensitivity to everyday sounds
• Sensitivity to smell, such as strong perfumes 
• Nausea or feeling sick when dizziness and vertigo symptoms occur.

Common Triggers

Vertibular migraine symptoms may occur after exposure to certain triggers, although these can differ from person to person . Some people may notice a pattern between their daily routine, environment, and migraine episodes.

Common Triggers Include:

• Lack of sleep or frequent changes in sleep cycle
• Emotional stress or changes in stress levels
• Skipping meals 
• Consuming certain foods like aged cheese and caffeinated or high-sugar drinks
• Dehydration or not taking enough fluids throughout the day
• Hormonal changes during menstruation or menopause
• Motion and visual stimulation while walking, travelling, or scrolling screens.

How It Is Diagnosed

Diagnosing vestibular migraine involves understanding a person's symptoms and how often the migraine attack occurs. A doctor may ask about your daily symptoms, medical history, and your medications to understand your condition. There is no single test that can confirm the condition, so doctors generally look for causes that affect the ongoing difficulties and use multiple tests for diagnosis.

Diagnosis May Include:

• Medical history to review past patterns
• Symptoms assessment to check for dizziness, sensitivity, and vertigo
• Neurological examination to assess brain function and the nervous system
• Vestibular tests to check coordination and eye movements
• Hearing tests to check the possibility of one-ear problems
• Imaging tests like MRI or CT scans if another condition is suspected.

Inner-Ear And Neurological Look-Alikes

Dizziness and Vertigo are not always caused by migraine; some inner ear and neurological conditions can produce similar symptoms, so identifying the underlying cause is important. 

Common Inner-Ear And Neurological Conditions: 

• Benign Paroxysmal Positional Vertigo (BPPV): Brief spinning sensations triggered by specific head movements caused by loose calcium crystals in the inner ear canals.
• Meniere’s Disease: Episodes of vertigo that may occur with hearing loss, ringing in the ears, or ear pressure.
• Vestibular Neuritis: Sudden, prolonged vertigo, often with nausea and difficulty maintaining balance.
• Stroke: Can cause sudden dizziness, severe imbalance, double vision, or difficulty speaking.
• Other Neurological Conditions: Certain conditions affecting the brain or nervous system can also cause balance problems. 

A doctor can distinguish between these conditions by reviewing symptoms and performing appropriate examinations.

Hearing Symptoms May Suggest Another Cause

Hearing changes are not typical symptoms of vestibular migraine and may include an inner-ear problem. Ringing in the ear, ear pressure, or reduced hearing can occur in conditions such as Meniere disease. If you notice sudden hearing loss, emergency treatment is important.

Attack And Prevention Overview

In Ayurveda, symptoms such as dizziness and Vertigo may be understood in relation to an imbalance. However, vestibular migraine requires proper medical assessment, as dizziness can also have other causes.

During An Attack: 

• Rest in a quiet, dimly lit room if light or sound worsen symptoms.
• Sip water and eat light, regular meals as tolerated.
• Apply cooling, calming Ayurvedic oils or herbal pastes, such as sandalwood, rose water, or camphor-infused balms, to the temple and forehead.
• Avoid sudden head movement and activities that increase dizziness.
• Shiro-Abhyanga (head massage) and herbs like Godanti Bhasma, Laghu Sutashekhara Rasa, and Pathyadi Kwath can help reduce headaches. 
• Consult a doctor before taking Ayurvedic medicine or other remedies, as some may cause side effects.

Long-Term Prevention: 

• Maintain regular sleep and eating times.
• Strictly limit foods that are aged or fermented, such as cheese, processed foods, excess caffeine or alcohol, and sour, spicy items.
• Stay hydrated throughout the day or maintain Fluids in the body.
• Practice Abhyanga (warm oil massage) with sesame or medicated oils.
• Practice gentle relaxation techniques such as Pranayama (breathing exercises) and Bhramari, if comfortable.
• Track symptoms and possible triggers to identify personal patterns.
• Discuss Ayurvedic treatment with a qualified Ayurvedic practitioner.

When Dizziness Needs Urgent Care

Dizziness or vertigo should not always be assumed to be a migraine symptom. Seek emergency medical care if it starts suddenly or occurs with any of these warning signs:

• Weakness or numbness
• Speech difficulties
• Vision changes
• Severe balance problem
• Sudden or severe headache
• Fainting or chest pain
• Sudden hearing loss

Reference 

Similarities and Differences between Vestibular Migraine and Recurrent Vestibular Symptoms—Not Otherwise Specified (RVS-NOS) - PMC

Vestibular and Auditory Manifestations of Migraine - PMC

Ayurveda for management of migraine: A narrative review of clinical evidence - PMC

Advances in diagnosis and treatment of vestibular migraine and the vestibular disorders it mimics - PMC