Vestibular Migraine

Explained in simple words

1Vestibular migraine is one of the commonest causes of repeated giddiness, and one of the most frequently missed.

2Most people think migraine only means a severe headache. In fact, migraine is a disorder of how the brain processes signals.

3When migraine affects the balance pathways in the brain, it produces giddiness instead of, or along with, headache.

4This is why the diagnosis is often delayed. The patient has giddiness but no headache, so migraine is never suspected.

5The giddiness can last minutes, hours, or even a day or two. This is different from BPPV, where attacks last less than a minute.

6Some patients feel spinning. Others feel rocking, swaying, or as if they are on a boat.

7Many describe a strong discomfort in busy visual places — supermarkets, crowded markets, scrolling on a phone, or watching fast-moving traffic.

8Sensitivity to light and to sound during the attack is a very useful clue that points to migraine.

9Nausea is common. Some patients get a visual aura, such as flashing lights or zigzag lines, before the attack.

10There may be a personal or family history of migraine headaches, often going back to youth.

11Importantly, hearing is normal in vestibular migraine. There is usually no significant hearing loss and no ear fullness.

12This helps to separate it from Meniere's disease, where hearing is clearly affected.

13Attacks are usually set off by triggers. Identifying your own triggers is a large part of the treatment.

14Common triggers are missed meals, missed or disturbed sleep, dehydration, stress or the relaxation after stress, and bright or flickering light.

15Certain foods can trigger attacks in some people — cheese, chocolate, packaged and fermented foods, ajinomoto, and excess tea or coffee.

16In women, attacks may be linked to the monthly cycle because of hormone changes.

17Diagnosis is clinical, meaning it is made mainly from a careful history. Tests such as VNG and hearing tests are done to rule out ear disease.

18The most useful thing you can do is keep a simple diary — note the date, how long the attack lasted, what you ate, how you slept, and your stress level.

19After a few weeks the pattern usually becomes clear, and avoiding those triggers alone reduces attacks considerably.

20Lifestyle regularity is the foundation of treatment — fixed meal times, seven to eight hours of sleep, adequate water, and regular gentle exercise.

21For an acute attack, medicines are given to control the giddiness and nausea.

22If attacks are frequent, preventive medicines taken daily for a few months can reduce their number and severity a great deal.

23Vestibular rehabilitation exercises help those who feel constantly unsteady between attacks.

24This condition is not dangerous and does not damage hearing, but it can seriously affect daily life and work if left untreated.

25With correct diagnosis and steady treatment, the great majority of patients improve markedly.