04/12/2025
Could it be Vestibular Migraine even though I don’t have a headache??
What is vestibular migraine?
For many people, a migraine attack includes severe head pain. It’s the kind that makes you want to lay in a dark room until it passes. But it’s important to remember that not all types of migraine look or feel the same.
Vestibular migraine, for example, affects your sense of balance. Often during an attack, you can feel like you’re moving, falling or spinning when you’re actually sitting still. We call this sensation vertigo. Alongside vertigo, a vestibular migraine can also include more typical migraine symptoms such as sound sensitivity, light sensitivity and often ear pain, pressure or ringing—but not necessarily headache.
The word vestibular relates to the inner ear and the balance systems of your body. It is associated with symptoms of vertigo. Vertigo is the sensation that you’re moving, falling, or spinning when you are sitting still. It can also be the sense that the world is moving around you.
The condition can come on spontaneously or can be triggered by specific factors such as moving your head, looking at specific patterns or moving objects, or placing your head in a specific position.
Some people who experience migraine can also experience an unusual symptom called “Alice in Wonderland“ syndrome, where things can look bigger or smaller than they actually are.
Vestibular migraine is the second-most common cause of vertigo in adults. Vertigo can happen at any point during a migraine attack.
A headache isn’t always present during vestibular migraine attacks. Depending on the study, anywhere from 25-75% of patients have headache during a vestibular migraine attack, according to Dr. Beh.
Since headache isn’t a consistent symptom, patients should also look for other migraine-type symptoms like light sensitivity and sound sensitivity to help their doctor diagnose their condition. Many with vestibular migraine also report a history of motion sensitivity or motion sickness beginning in childhood.
In addition, patients can experience brain fog, fatigue or difficulty finding words as well as other symptoms such as dry mouth, sweating, diarrhea, excessive yawning, tingling, scalp tenderness and visual blurring.
If you are affected by vestibular migraine, it’s important to notice your triggers. In other words, know what experiences or situations seem to come before an attack. “Most of them are very similar to migraine—weather changes, not enough sleep, stress, menstrual cycle, bright light, flashing lights, missing meals, food-type triggers like caffeine, chocolate or alcohol,” says Dr. Beh. Your triggers can be very unique and sometimes difficult to pinpoint, so it is important to keep track of them.
Consider what happens before, during, and after a migraine attack. How do you feel? Is there something, in particular, that seems to come along with your migraine symptoms? Keeping a headache journal is a good way to identify patterns—and to share this information with your doctor.
Note specific examples of all your symptoms, such as dizzy spells or visual disturbances. Tracking your symptoms, noting possible triggers, and discussing treatment options with a doctor can help prevent and relieve vestibular migraine attacks.
Not all attacks have a trigger, so it’s also important to consult your doctor and discuss treatment options. “A lot of the treatments I use for migraine also can work really well in patients who have vestibular migraine,” says Dr. Beh. “The key is to find what works for you.” He often recommends options such as Vitamin B2, magnesium and Coenzyme Q10. Other treatments include prescription medications such as triptans as well as neuromodulation devices like the vagus nerve stimulator or external trigeminal nerve stimulator.
https://americanmigrainefoundation.org/resource-library/vestibular-migraine/
