Vestibular Migraine

Vertigo is the feeling like you are spinning in circles when you aren’t. Vestibular migraines are a medical diagnosis where vertigo often accompanies intense headaches. The vestibular system is the sensory system that helps your brain detect motion, maintain balance, and determine your body's orientation in space. When a migraine alters the way the brain processes and integrates vestibular signals, dizziness and vertigo can occur as part of a vestibular migraine.

Vertigo feels like the entire room is spinning. Dizziness feels like you are lightheaded, faint, or weak. Sometimes they occur simultaneously.

Dizziness is an altered sense of spatial orientation. Your balance feels off. You may also feel woozy or light-headed. You could even fall if you don’t sit down.

Vertigo is the sensation of self-movement or movement of your surroundings. It can feel as though you, or the room around you, are spinning or moving when you aren't. Vertigo is the sensation of self-movement or the movement of your surroundings. It’s a spinning sensation. The atmosphere around you may feel like it’s moving or spinning when it isn’t.

A vestibular migraine is a migraine disorder in which vestibular symptoms, such as vertigo, dizziness, motion sensitivity, or spatial disorientation, are a prominent part of the episode.

A headache does not have to occur at the same time as the vestibular symptoms. Other migraine features may be present instead, such as sensitivity to light or sound, visual aura, or a characteristic migraine headache.

To accurately assess, more information is needed beyond the generic questions required for diagnosis. For the migraine portion, what type of pain is there? Is it a burning pain? Pulsating pain? Bursting pain? I ask my patients to use the phrase “sensation as if”. It is the “sensation as if there is a hot metal rod going in through my eye socket.” For the vertigo portion, what makes it better? What makes it worse? Turning over while lying down makes it worse. Or standing makes it better. These are all nuances that are different between different people.

The thalamus is a deep structure within the brain that plays an important role in sensory processing. It receives and integrates information from multiple sensory systems, including vestibular, visual, and other signals, before relaying information to areas of the brain involved in perception.

In vestibular migraine, research suggests that the normal processing and integration of sensory information may become altered. Normal amounts of light, sound, movement, or other sensory input can become disproportionately intense or overwhelming.

The trigeminal nerve is the largest of the cranial nerves and carries sensory information from much of the face and head. During migraine, activation and sensitization of the trigeminal system can contribute to the amplification of normally non-painful or mildly painful sensory signals.

Another cranial nerve activated during a vestibular migraine is called the vestibulocochlear nerve. The vestibulocochlear nerve carries information from the inner ear to the brain, including information related to hearing and balance. Interactions between the vestibular system and migraine-related neural pathways may disrupt normal sensory processing, contributing to imbalance, motion sensitivity, dizziness, and vertigo.

The causes and triggers of vestibular migraine are not completely understood. Research has explored a variety of potential contributors, including inflammatory, infectious, environmental, metabolic, hormonal, and neurologic factors.

Some preliminary research has explored possible relationships between herpes-family viruses, environmental mold exposures, and vestibular symptoms. However, these relationships remain an area of ongoing investigation and do not establish that these factors cause vestibular migraine.

In my practice, I therefore look at the individual rather than assuming that every patient has the same underlying trigger.