Vestibular Migraine: It's Not Just a Headache

Vestibular migraine isn’t just a headache. It is a potentially disabling neurologic disorder.

Author: Stuart Johnson, PT

Most people know migraine as a severe headache that makes it difficult to perform routine activities. But it is important to understand that you can have a migraine without pain. A vestibular migraine can cause visual disturbances or vertigo without a headache. Sensitivity to light, noise, head movement, and busy environments are common and can make performing daily tasks difficult.

Vestibular migraine symptoms can include constant dizziness, dizziness triggered by head and eye movement, vertigo (spinning), nausea and vomiting, blurred vision, light sensitivity, noise sensitivity, imbalance, neck pain, anxiety, and difficulty with concentration and memory. These symptoms can occur hours or days before or after the headache, or with no headache at all.

The most recent version of the International Classification of Headache Disorders recognizes vestibular migraine as a subtype of migraine. People suffering from vestibular migraine may develop persistent dizziness and balance problems that last long after the migraine has stopped.

How do I know if I have Vestibular migraine?

A migraine can occur with some of the neurologic symptoms described above, including dizziness and vertigo but no pain or headache. People suffering from these unusual and alarming symptoms may go to the emergency room, where testing and imaging often yield normal results, which can make the sufferer feel more anxious and confused.

Diagnostic testing can rule out other problems, but there is no test to confirm migraine. Ruling out other conditions is part of the difficult process of identifying migraine, which can take multiple visits to different medical practitioners. The exact mechanisms of migraine are still not well understood, and some medical providers may not recognize the broad range of symptoms that can be part of a migraine. Assessing other similar episodes in your medical history and the history of close family members is important.

What causes Vestibular migraine, and what can i do about it?

Learning to identify and mange your migraine triggers is the most important step. Avoiding dietary triggers and getting consistent aerobic exercise are key steps that are within your control. Consistency is important: not skipping meals, getting some exercise almost every day, and keeping a regular sleep schedule.

Medications may or may not be appropriate; discuss this with your doctor. Vestibular rehabilitation, a specialized type of physical therapy, is helpful for managing persistent dizziness and balance problems and for getting you back to your usual activities.


These triggers don’t all apply to everyone who gets vestibular migraines. There may be only a few things on this list that affect you. Triggers tend to have a genetic component, so if there are other people in your family who suffer from migraines, ask if they know what triggers apply to them.

Triggers are also cumulative: any one of these alone may not give you a migraine, but 2 or 3 at the same time can be a problem. This inconsistency can make it harder to figure out what affects you. Small quantities may be okay. Test foods with caution over time to see what affects you.

Food Triggers

  • Caffeine including coffee, tea and sodas
  • Smoked, cured, or processed meats such as bacon, sausage, ham, salami, pepperoni, pickled herring, bologna, chicken livers, and hot dogs
  • Alcoholic beverages, especially red wine, port, sherry, Scotch, gin, and bourbon
  • Food prepared with meat tenderizer, soy sauce, fermented vinegar (white vinegar is okay), or yeast/ yeast extract
  • Fermented or pickled foods, including pickles, olives, sauerkraut
  • Chocolate, cocoa, carob
  • All nuts, all seeds, peanut butter
  • Foods containing monosodium glutamate (MSG). Asian foods may have MSG.
  • Aged or ripened cheeses (examples: cheddar, Swiss, stilton, brie, gouda, romano, parmesan, feta, bleu cheese, camembert)
  • Freshly baked yeast breads
  • Snow peas, fava or broad beans
  • Sour cream, yogurt, buttermilk
  • Artificial sweeteners, diet soda
  • Fruits to eat with caution: figs, avocados, raisins, red plums, passion fruit, papaya, banana, and citrus

Other Triggers:

  • Hormonal fluctuations
  • Poor or inadequate sleep
  • Stress
  • Medications
  • Smoking
  • Barometric-pressure variations
  • Sensory stimuli, such as bright or flickering lights, loud noises, odors
  • Light sensitivity