Vestibular migraine is a migraine disorder in which dizziness or vertigo is the dominant symptom.
Unlike typical migraine attacks that feature prominent head pain, vestibular migraine may present with:
spinning sensation (true vertigo)
rocking or swaying imbalance
motion sensitivity
lightheadedness
visual motion intolerance
nausea
sensitivity to light or sound
Headache may be mild — or even absent — during some attacks.
Vestibular migraine reflects dysfunction in the brain–inner ear network that integrates balance, visual input, and spatial orientation.
It is one of the most common causes of recurrent spontaneous vertigo.
At the Ottawa Headache Centre we approach all presentations systematically and we use the ICHD-3 criteria to diagnose vestibular migraine.
Vestibular migraine is suspected when people have attacks with the following characteristics:
Vestibular symptoms lasting 5 minutes to 72 hours including:
Spontaneous vertigo
Positional vertigo
Visually induced vertigo
Head-motion–induced vertigo
Head-motion–induced dizziness with nausea
At least 50% of episodes associated with at least one of:
Headache with migraine features
Sensitivity to light and sound
Vestibular migraine is frequently underrecognized and it may be among the top 2 causes of recurrent vertigo attacks.
Vestibular migraine is more common in women, often associated with a personal or family history of migraine, and frequently misdiagnosed as:
BPPV
Ménière’s disease
Anxiety
Persistent postural-perceptual dizziness (PPPD)
Correctly diagnosing vestibular migraine matters because treatment is different.
At the Ottawa Headache Centre we systematically approach recurrent vestibular symptoms to manage vestibular migraine in four steps:
We characterize:
Attack duration
Triggers
Motion sensitivity patterns
Headache association
Auditory symptoms
Red flags
When indicated, we evaluate for:
Structural brain pathology
Demyelinating disease
Stroke
CSF pressure disorders
We distinguish vestibular migraine from other causes:
BPPV
PPPD
Orthostatic syndromes
Functional neurological disorders
Treatment is personalized according to attack frequency, impairments, and individual factors.
We coordinate with vestibular physiotherapists and trusted vestibular otolaryngologists.
Managing vestibular migraine begins at arriving at an accurate diagnosis.
Once vestibular migraine is diagnosed, its treatment mirrors migraine biology with additional vestibular-specific considerations.
At the Ottawa Headache Centre we manage vestibular migraine with these three considerations:
If attacks are frequent or disabling, preventive treatments can include:
Blood pressure meds
Antidepressants
Anticonvulsants
Coordination to engage in vestibular rehabilitation by trusted evidence-based vestibular physiotherapists and assessment by vestibular otolaryngologists.
Sudden vestibular symptoms can be caused by stroke. Seek urgent medical attention if you experience:
A new focal neurological deficit (i.e., paralysis, sensation loss, speech or language difficulty)
A sudden instantaneously peaking "worst headache ever"
Continuous vertigo with an inability to walk
New hearing loss
Vestibular migraine is treatable. With proper diagnosis and tailored therapy:
Attack frequency can be reduced
Severity can improve
Motion sensitivity can diminish
Quality of life can significantly improve
Early diagnosis prevents years of unnecessary testing and misdirected treatment.
Whether you are seeking a first-time diagnosis or advanced relief, our specialized pathways are designed to get you the right care, faster.
Learn how to get referred and how to prepare for your first specialist consultation to ensure an accurate diagnosis.
If your auras are frequent or disabling, lifestyle changes alone may not be enough. Explore our specialized medical programs:
This material is provided for educational purposes and does not replace independent clinical judgment or institutional protocols. Management decisions remain the responsibility of the treating clinician.