{"id":672,"date":"2025-10-31T18:48:07","date_gmt":"2025-10-31T15:48:07","guid":{"rendered":"https:\/\/www.pinaryalinaydikmen.com\/en\/?p=672"},"modified":"2025-11-19T19:50:11","modified_gmt":"2025-11-19T16:50:11","slug":"vestibular-migraine","status":"publish","type":"post","link":"https:\/\/www.pinaryalinaydikmen.com\/en\/vestibular-migraine\/","title":{"rendered":"Vestibular Migraine"},"content":{"rendered":"

Vestibular migraine is one of the subtypes of migraine that progresses with dizziness (vertigo)<\/strong> and balance disorder<\/strong>. The majority of patients apply to different branches for many years saying “Everything is normal but I have dizziness,” “My examinations came out clean but my complaint doesn’t go away”; they often receive wrong diagnoses and are exposed to unnecessary treatments. This delay seriously reduces quality of life.<\/p>\n

Headache is not always<\/strong> present in vestibular migraine. In fact, in some people, the headache period ended years ago but dizziness attacks appear with hormonal periods such as menopause. Therefore, vestibular migraine should definitely be considered in people with a history of migraine and experiencing unexplained dizziness.<\/p>\n

During vestibular migraine attacks, spinning sensation, dizziness, imbalance in the form of swaying<\/strong>, nausea<\/strong>, ear pressure<\/strong>, and light-sound-smell sensitivity<\/strong> can be seen. While some attacks are accompanied by classic migraine headache, sometimes only dizziness can be the symptom. This situation is also an important factor that makes diagnosis difficult.<\/p>\n

Scientific research shows that vestibular migraine is the second most common cause of vertigo<\/strong>. It is seen 2-3 times more in women compared to men and appears especially in the 30-50 age range<\/strong>. When it becomes chronic, it can significantly affect the person’s social life, work performance, and mental health.<\/p>\n

The good news is: Vestibular migraine is a treatable disease.<\/strong> With correct diagnosis and neurology follow-up, dizziness attacks can be completely controlled and quality of life can be regained.<\/p>\n

In this guide, you will find causes, symptoms, diagnostic methods, and the most current treatment options<\/strong> for vestibular migraine with scientific accuracy, in a language everyone can understand.<\/p>\n

What is Vestibular Migraine?<\/h2>\n

Vestibular migraine is a special form of migraine that appears with dizziness (vertigo)<\/strong> and balance disorder<\/strong>. Unlike classic migraine headache, dizziness is the main symptom of this disease and can develop even without headache<\/strong>. Therefore, many patients can receive different diagnoses for a long time and reach correct treatment late.<\/p>\n

Vestibular migraine occurs as a result of disruption of sensitive connections between the brain’s migraine mechanisms and balance system (vestibular system)<\/strong>. Excessive stimulation of the trigeminovestibular network, imbalance of neurochemical substances such as serotonin and CGRP trigger vertigo attacks.<\/p>\n

Dizziness seen in this disease can be in different forms:
\n\u2022 Rotational vertigo
\n\u2022 Floating \/ sliding sensation in space
\n\u2022 Imbalance in walking
\n\u2022 Dizziness triggered by visual stimuli<\/p>\n

Attacks can last from seconds to days<\/strong> and are generally triggered by light, sound, movement, stress, sleep deprivation, or hormonal changes. While some attacks are accompanied by migraine-type headache, sometimes only dizziness can be seen.<\/p>\n

For vestibular migraine diagnosis, the patient generally needs to have migraine history<\/strong> and vestibular complaints need to be related to migraine attack characteristics<\/strong>. This diagnosis is made according to criteria determined by the International Classification of Headache Disorders (ICHD)<\/strong> and B\u00e1r\u00e1ny Society<\/strong>. Additionally, ear diseases and other causes of vertigo must be excluded.<\/p>\n

Vestibular migraine, which is a treatable<\/strong> disease when correctly diagnosed, can greatly improve patients’ quality of life when followed by neurology specialists.<\/p>\n

What Causes Vestibular Migraine?<\/h2>\n

Although the exact cause of vestibular migraine is not fully known, it is accepted that the disease occurs as a result of complex interaction between migraine mechanisms and the balance system<\/strong>. Genetic predisposition, hormonal fluctuations, changes in brain chemistry, and environmental triggers are the main factors of the disease.<\/p>\n

Research shows that a large portion of vestibular migraine patients have family members with migraine history<\/strong>. This suggests that genetic predisposition<\/strong> has an important role in the disease.<\/p>\n

Irregular functioning of neurochemical systems such as serotonin, dopamine, and CGRP<\/strong> in the brainstem can trigger both migraine pains and dizziness attacks. When these substances affect balance centers, vertigo, dizziness, and imbalance<\/strong> can appear.<\/p>\n

The main reason vestibular migraine is seen more frequently in women is hormonal changes<\/strong>. Situations such as menstrual period, pregnancy, menopause, or birth control pills affect estrogen levels and can increase attack frequency.<\/p>\n

In some patients, hypersensitivity of the network mechanism called trigemino-vascular system<\/strong> can lead to vertigo attacks by affecting balance centers in the brainstem.<\/p>\n

Additionally, vestibular migraine can also be triggered by many environmental factors:
\n\u2022 Sleep deprivation, stress, anxiety
\n\u2022 Staying hungry, skipping meals
\n\u2022 Light, sound, smell sensitivity
\n\u2022 Long-term screen use
\n\u2022 Weather and pressure changes
\n\u2022 Sugary and processed foods, caffeine, alcohol<\/p>\n

In some people, movement sensitivity<\/strong>, motion sickness<\/strong> since childhood, panic disorder, or presence of other pain syndromes can increase the risk of developing vestibular migraine.<\/p>\n

In conclusion, vestibular migraine is not due to a single cause<\/strong>; it is a neurobiological disease<\/strong> that occurs with the interaction of many factors. Therefore, treatment approach should also be personalized.<\/p>\n

International Classification of Headache Disorders (ICHD-3) and B\u00e1r\u00e1ny Society<\/strong> Diagnostic Criteria- A1.6.6 Vestibular Migraine<\/h2>\n
    \n
  1. At least five<\/strong> attacks meeting criteria C and D<\/li>\n
  2. Current or past history of
    \n1.1 Migraine without aura<\/strong> or 1.2 Migraine with aura<\/strong> diagnosis in the patient<\/li>\n
  3. Vestibular symptoms<\/strong> of moderate or severe intensity\u00b3, lasting between 5 minutes and 72 hours<\/strong>\u2074<\/li>\n
  4. At least one<\/strong> of the following three migrainous features accompanies at least half of the attacks:<\/li>\n
  5. Headache with at least two of the following features:\n
      \n
    • Unilateral location<\/li>\n
    • Pulsating character<\/li>\n
    • Moderate or severe intensity<\/li>\n
    • Aggravation by routine physical activity<\/li>\n<\/ul>\n<\/li>\n
    • Photophobia and phonophobia<\/li>\n
    • Visual aura<\/li>\n
    • Not better accounted for by another ICHD-3 diagnosis or another vestibular disorder<\/li>\n<\/ol>\n

      Notes<\/strong><\/h2>\n
        \n
      1. Underlying migraine diagnosis should be coded separately.<\/li>\n
      2. Vestibular symptoms<\/strong>, according to B\u00e1r\u00e1ny Society Vestibular Symptom Classification and compatible with A1.6.6 Vestibular Migraine diagnosis, include:\n
          \n
        • Spontaneous vertigo<\/strong>:
          \nInternal vertigo (feeling of self-movement)
          \n\u2022 External vertigo (feeling that surroundings are spinning\/flowing)<\/li>\n
        • Positional vertigo<\/strong>: Occurs following head position change<\/li>\n
        • Visually induced vertigo<\/strong>: Triggered by large or complex visual movement<\/li>\n
        • Head movement-induced vertigo<\/strong>: Appears during head movement<\/li>\n
        • Head movement-induced dizziness + nausea<\/strong>
          \n(Dizziness here is defined as spatial orientation disorder sensation; other dizziness types are not included in this classification.)<\/li>\n<\/ul>\n<\/li>\n
        • Vestibular symptom severity:\n
            \n
          • Moderate<\/strong>: Makes daily activities difficult but doesn’t completely prevent them<\/li>\n
          • Severe<\/strong>: Daily activities cannot be maintained<\/li>\n<\/ul>\n<\/li>\n
          • Attack duration is quite variable:\n
              \n
            • Minutes in 30% of patients<\/li>\n
            • Hours in 30% of patients<\/li>\n
            • Can last several days in 30% of patients<\/li>\n
            • In 10% of patients, short attacks lasting only seconds but repetitive<\/strong> with head movement or visual stimulus can be seen
              \nIn these cases, attack duration is evaluated as the total period<\/strong> when repetitions are seen.
              \nRarely, complete recovery can take 4 weeks but core attack generally doesn’t exceed 72 hours<\/strong>.<\/li>\n<\/ul>\n<\/li>\n
            • Single accompanying symptom<\/strong> is sufficient in a single attack; there can be different symptoms in different attacks.
              \nAccompanying symptoms can appear before, during, or after vestibular symptoms.<\/li>\n
            • If clinical evaluation doesn’t indicate another vestibular disease; or if excluded by investigations; or even if there is another accompanying vestibular disease but attacks are clearly distinguishable<\/strong>, vestibular migraine diagnosis can be made.
              \nAdditionally, since vestibular stimulus can trigger migraine attack<\/strong>, conditions where migraine is added to vestibular disorder should also be considered in differential diagnosis.<\/li>\n<\/ol>\n

              How is Vestibular Migraine Diagnosed?<\/h2>\n

              Vestibular migraine diagnosis is a condition that can remain as “dizziness whose cause cannot be found” for years when not done correctly. The foundation of diagnosis consists of detailed disease history<\/strong>, neurological and vestibular examination<\/strong>, and international diagnostic criteria<\/strong>. Because there is no single blood test or imaging method showing vestibular migraine.<\/p>\n

              Clinical Evaluation: The Most Important Stage of Diagnosis<\/h3>\n

              Your doctor queries in detail:<\/p>\n

                \n
              • In which situations dizziness started<\/li>\n
              • How long it lasted<\/li>\n
              • Its relationship with visual movement, light and sound sensitivity<\/li>\n
              • Nausea, headache, aura history<\/li>\n
              • Its relationship with hormonal periods and stress<\/li>\n<\/ul>\n

                This information is decisive in diagnosis.<\/p>\n

                Neurological and Vestibular Examination<\/h3>\n

                The following evaluations are made in examination:<\/p>\n

                  \n
                • Balance tests<\/li>\n
                • Symptom change depending on head position<\/li>\n
                • Presence of nystagmus (eye tremor)<\/li>\n
                • Coordination tests<\/li>\n<\/ul>\n

                  Examination is generally normal outside attacks<\/strong> in vestibular migraine, which is one of the factors making diagnosis difficult.<\/p>\n

                  Supportive Tests (Not Mandatory in Every Patient)<\/h3>\n

                  Auxiliary tests are requested in some cases:<\/p>\n

                    \n
                  • Audiometry (hearing test):<\/strong> Generally normal \u2192 Important in differential diagnosis from Meniere’s<\/li>\n
                  • VNG, caloric test, VEMP:<\/strong> Provides information about vestibular function<\/li>\n
                  • Brain MRI:<\/strong> To rule out another structural disease<\/li>\n<\/ul>\n

                    Normal MRI does not mean there is no vestibular migraine<\/strong> \u2014 in this disease, MRI is often completely normal.<\/p>\n

                    What Needs to Be Excluded in Differential Diagnosis<\/h3>\n
                      \n
                    • Meniere’s disease (hearing loss accompanies)<\/li>\n
                    • BPPV (position-dependent short vertigo)<\/li>\n
                    • Vestibular neuritis (single long-duration attack)<\/li>\n
                    • Cerebellar diseases<\/li>\n
                    • Acoustic neuroma<\/li>\n<\/ul>\n

                      Keeping a Diary Is Very Valuable in Diagnosis!<\/h3>\n

                      With a dizziness diary:<\/p>\n

                        \n
                      • Duration and frequency of attacks<\/li>\n
                      • Headache and dizziness relationship<\/li>\n
                      • Triggers<\/li>\n
                      • Response to treatment<\/li>\n<\/ul>\n

                        clearly emerge. This is very important for correct diagnosis and correct treatment.<\/p>\n

                        Vestibular migraine is a disease requiring clinical diagnosis<\/em>.
                        \nConsulting with a neurology specialist<\/strong> early prevents unnecessary tests and treatments.<\/p>\n

                        Vestibular Migraine Treatment<\/h2>\n

                        Vestibular migraine treatment requires a multifaceted approach. The aim is not only to stop dizziness; but to reduce attacks, increase quality of life, and regain control in daily life. Treatment is planned for each patient and is built on three basic principles:<\/p>\n

                        Lifestyle Adjustments (Foundation Stone of Treatment)<\/h3>\n

                        Identifying migraine triggers and staying away from them is of great importance. Most patients report that their attacks significantly decreased with lifestyle adjustments alone.<\/p>\n

                        Recommendations:<\/strong><\/p>\n

                          \n
                        • Regular sleep hours (going to bed and waking up at the same time every day)<\/li>\n
                        • Healthy eating without skipping meals<\/li>\n
                        • Adequate water consumption<\/li>\n
                        • Stress management (meditation, breathing exercises)<\/li>\n
                        • Daily light exercises<\/li>\n
                        • Avoiding migraine trigger foods
                          \n(Chocolate, cheese, fermented products, caffeine, alcohol, foods with additives)<\/em><\/li>\n<\/ul>\n

                          Acute Attack Treatment (Intervention During Attack)<\/h3>\n

                          During attack, the target is to quickly control dizziness and nausea.<\/p>\n

                          Medications used:<\/strong><\/p>\n