İşitmeAtölyesiAt a glance
Recurrent dizziness attacks from migraine mechanisms affecting the balance system; central in origin.
Dizziness lasting 5 min–72 h; in at least half of attacks, headache, light/sound sensitivity or aura.
Usually not urgent; if there is permanent hearing loss, Ménière’s and other causes should be investigated.
Acute attack treatment + preventive treatment; above all trigger management and vestibular rehabilitation.
Medical disclaimer. This content is for informational purposes only and does not replace a physician’s examination, diagnosis or treatment; it should not be used as medical advice. For your complaints or personal situation, always consult an ear, nose and throat physician and an audiologist.
If you have a migraine history and experience recurrent dizziness attacks (especially with headache, light/sound sensitivity or visual aura), see a physician. If dizziness is accompanied by permanent/progressive hearing loss, Ménière’s and other causes need to be investigated.
Definition and epidemiology
Vestibular migraine (VM) is a picture characterised by recurrent dizziness attacks arising when migraine mechanisms affect the balance system. It is classified as a central vestibular disorder.
It is one of the most common causes of episodic dizziness; it is more prevalent in people with migraine and more common in women. Nonetheless, its diagnosis is often delayed or missed (Lempert et al., 2012).
Because VM shares symptom similarities with Ménière’s disease and other vestibular conditions, differential diagnosis is important.
Symptoms and signs
Attacks can last from 5 minutes to 72 hours. The dizziness may be a spontaneous spinning sensation, imbalance triggered by head movement, or dizziness increased by visual stimuli.
In at least half of attacks migrainous features accompany it: one-sided throbbing headache, sensitivity to light/sound (photo/phonophobia) or visual aura. However, headache is not obligatory in every attack.
Hearing loss in VM is typically not permanent and progressive; if there is a permanent hearing loss, Ménière’s and other causes should be investigated.
Causes and risk factors
VM is associated with sensitisation mechanisms in the central nervous system; attacks arise with triggers on a background of genetic predisposition.
Common triggers include stress, irregular sleep, hormonal changes, hunger, dehydration and certain foods (caffeine, excess salt).
A migraine history and a family history of migraine are the most important risk indicators.
Audiological and clinical assessment
Diagnosis rests on international criteria (ICHD-3 / Bárány): a migraine history, recurrent vestibular attacks of appropriate duration and severity, and migrainous features accompanying most of these attacks. Other causes must be excluded.
- vHIT and VNG: often normal in VM, because the problem is in central processing rather than peripheral receptors.
- VEMP: otolith function is usually preserved; some asymmetries may be seen.
- Pure-tone audiometry: permanent/progressive hearing loss is not expected; if there is a loss, the differential is deepened.
- Imaging (when needed): to exclude central causes.
Normal vestibular test results support a diagnosis of centrally-originating VM.
| Feature | Vestibular migraine | Ménière’s disease |
|---|---|---|
| Attack duration | 5 min – 72 hours | 20 min – several hours |
| Hearing | Usually preserved | Low-frequency fluctuating loss |
| Migrainous feature | Common (headache, light/sound) | Little |
| Vestibular tests | Often normal | Often abnormal |
| Main approach | Trigger management + prophylaxis | Diet + medical + procedures |
Treatment and audiological rehabilitation
Management has two steps: acute attack treatment and preventive treatment. In the acute period, drugs used for migraine and anti-nausea agents can relieve symptoms.
For frequent and severe attacks, preventive treatment (drugs used in migraine prophylaxis) and, above all, trigger management (regular sleep, meals, stress control) are applied. Drug decisions rest with the physician.
For imbalance and head-movement sensitivity between attacks, vestibular rehabilitation reduces symptoms by supporting the brain’s adaptation.
Impact on quality of life and advice
The unpredictability of attacks can lower quality of life through anxiety and fear of falling. A correct diagnosis is important for the patient to move past uncertainty and reach effective treatment.
Keeping a trigger diary (sleep, meals, stress, foods), maintaining a regular life rhythm and consistency in exercise are recommended. Resting in a dim, quiet environment during an attack can ease symptoms.
If you used this review, you can cite it as follows (APA 7):
İşitme Atölyesi. (2026). Vestibular Migraine. Hearing & Balance Health Guide. https://www.isitmeatolyesi.com/en/guncel-haberler/categories/isitme-sagligi-rehberi/vestibuler-migren/Permanent link: isitmeatolyesi.com/en/guncel-haberler/categories/isitme-sagligi-rehberi/vestibuler-migren/ · Last reviewed: July 2026 · License: CC BY-NC-ND 4.0
References
- Lempert, T., Olesen, J., Furman, J., et al. (2012). Vestibular migraine: Diagnostic criteria. Journal of Vestibular Research, 22(4), 167-172.
- Lempert, T., Olesen, J., Furman, J., et al. (2022). Vestibular migraine: Diagnostic criteria (update). Journal of Vestibular Research, 32(1), 1-6.
- Stolte, B., Holle, D., Naegel, S., Diener, H. C., & Obermann, M. (2015). Vestibular migraine. Cephalalgia, 35(3), 262-270.
Frequently asked questions
Can I have vestibular migraine without a headache?
Yes. In vestibular migraine, a headache does not have to accompany every attack. Some attacks may involve only dizziness with light/sound sensitivity or visual symptoms. So the absence of a headache does not exclude the diagnosis.
How is vestibular migraine distinguished from Ménière’s disease?
Both cause dizziness attacks, but in Ménière’s there is a tendency to develop a permanent, progressive hearing loss; in vestibular migraine, hearing is usually preserved and migrainous features are prominent. The distinction is made by your physician with the history and hearing tests.
Do foods really trigger attacks?
In some patients, irregular sleep, skipping meals, caffeine and excess salt can trigger attacks. Although the same triggers do not apply to everyone, keeping a personal diary to identify your own triggers can help reduce attack frequency.
Does exercise trigger attacks?
Sudden, vigorous movements during an acute attack can increase discomfort. However, in the attack-free period, balance exercises done under expert guidance support recovery by developing the brain’s adaptability and are recommended.
Does it respond well to treatment?
Yes. When correctly diagnosed, vestibular migraine is usually well controlled with trigger management, preventive treatment and vestibular rehabilitation. Many patients experience a marked decrease in attack frequency and severity.
Scales that can be used to monitor vestibular-migraine diagnosis and the impact of dizziness: