Vestibular migraine is a sensory processing disorder characterized by vertigo, dizziness, and disequilibrium, often occurring without the typical head pain associated with traditional migraines. Affecting an estimated 3 percent of the American population, the condition frequently goes undiagnosed because it falls into a diagnostic gap between neurology and otology, according to Dr. Jeffrey Sharon of the University of California, San Francisco.
Why is vestibular migraine difficult to diagnose?
Diagnosis remains elusive because the condition lacks the hallmark headache that most patients and primary care physicians associate with migraines. According to a 2018 study, only one in ten patients experiencing vestibular migraine were told that migraine was causing their dizziness. Dr. Sharon notes that the vestibular system is often a “forgotten corner of medicine,” frequently leading patients to visit at least five providers before reaching him.
The condition is often misidentified as Ménière’s disease or persistent postural-perceptual dizziness. Because vestibular migraine did not have formal diagnostic criteria until 2012, many primary care providers remain unfamiliar with the condition, says Cynthia Ryan, executive director of the Vestibular Disorders Association.
The trigeminal nerve, when triggered by abnormal brain activity, releases calcitonin gene-related peptides (C.G.R.P.). These molecules inflame nearby blood vessels and sensitize the nerve itself, which can cause extreme sensitivity to light, sound, and smells even in the absence of head pain.
How does the brain trigger vestibular symptoms?
Experts categorize migraine as a sensory processing disorder. Dr. Jeffrey Staab of the Mayo Clinic identifies the release of C.G.R.P. molecules as “the first really unique migraine pathology clue” in understanding the disease. The insula, the brain’s hub for integrating sensory information with emotional and cognitive processing, has also been identified as a key area of hyperactivity during attacks, based on unpublished research by Dr. Sharon and Dr. Jason Allen of Indiana University.
Risk factors for the condition include a history of migraine in any form, being under age 40, and being female. According to Dr. Margaret Aron of the University of British Columbia, patients who experienced migraines in their teens often assume they have “outgrown” the condition, though the brain remains susceptible.
What are the latest developments in treatment?
While there is no one-size-fits-all approach, treatment is typically multidisciplinary. Patients like Alicia Wolf, who spent years seeking a diagnosis, found success through a combination of lifestyle changes—such as eliminating caffeine and alcohol—and medication. Dr. Shin Beh, a neurologist in Irving, Texas, has used magnesium, CoQ10, and vitamin B2, alongside “rescue” medications like beta blockers or anti-anxiety drugs to manage symptoms.
Emerging research into C.G.R.P. inhibitors offers a new frontier. A 2024 study led by Dr. Sharon found that galcanezumab (Emgality) reduced dizziness more effectively than a placebo. However, experts caution that some patients see only modest benefits or none at all. Unlike traditional migraine treatments, triptans have shown little effect on vestibular migraine, highlighting the biological differences between the two conditions.
Pro Tips for Managing Triggers
- Prioritize Sleep: Poor sleep is one of the “trifecta of triggers” alongside stress and inflammation.
- Track Your Environment: Many patients find that high-stress work environments or travel can precipitate an attack.
- Consult a Specialist: If an E.N.T. or neurologist dismisses your symptoms as simple anxiety, seek a provider who specializes in vestibular disorders.
Frequently Asked Questions
- Can you have a vestibular migraine without a headache?
- Yes. This is a primary characteristic of vestibular migraine, which centers on dizziness, vertigo, and disequilibrium rather than head pain.
- Are vestibular migraines permanent?
- Not necessarily. Through a combination of medication, supplements, and lifestyle adjustments, some patients—like Alicia Wolf—report reaching a state of remission.
- What is the link between anxiety and vestibular migraine?
- Having anxiety is associated with “significantly increased odds” of experiencing vestibular migraine.
Have you struggled to get a diagnosis for chronic dizziness? Share your experience in the comments below or subscribe to our newsletter for the latest updates on neurological research and vestibular health.
