By Dr Tony Briggs, Neuro Rehab Chiropractor, Melbourne
Vestibular migraine is a type of migraine where dizziness, vertigo or feeling off-balance are the main symptoms. It doesn't always come with a headache, which is why it's often mistaken for an inner ear problem. Episodes can last from a few minutes to several days, and they're often set off by light, movement, stress, poor sleep or hormonal changes.
Key points
- Vestibular migraine causes dizziness, vertigo and imbalance, with or without head pain.
- Episodes typically last anywhere from 5 minutes to 72 hours.
- Most people have a history of migraine, even if the headaches have eased.
- It's diagnosed from your symptoms and history, so normal scans are common.
- Care usually combines medical management, trigger management and vestibular rehabilitation.
What is vestibular migraine?
Your vestibular system, which includes your inner ear and the parts of your brain that process balance, tells you where you are in space. In vestibular migraine, the migraine process affects how your brain handles those balance signals. The result is dizziness or vertigo that behaves like a migraine attack. It comes in episodes, has triggers, and often comes with light sensitivity, sound sensitivity or visual aura.
It's one of the most common causes of recurring vertigo. Researchers have described it as the most frequent entity of episodic vertigo. Yet many people spend years being told it's anxiety or an inner ear infection that "should have cleared up by now".
Vestibular migraine symptoms
Symptoms vary from person to person and from episode to episode. Common ones include:
- Spinning vertigo, or a feeling that the room is moving
- Rocking or swaying, like you're on a boat
- Dizziness when turning your head or moving quickly
- Feeling unsteady on your feet
- Sensitivity to busy visual environments such as supermarkets, scrolling or traffic
- Light and sound sensitivity
- Nausea
- Brain fog and fatigue after an episode
- Headache, though not always
How is it different from other causes of dizziness?
- Vestibular migraine: Episodes lasting 5 minutes to 72 hours, often with migraine features such as light sensitivity or headache.
- BPPV: Brief spinning (under a minute) triggered by rolling over, lying down or looking up.
- Ménière's disease: Vertigo attacks with hearing loss, ringing in the ears (tinnitus) and a feeling of fullness in the ear.
- Vestibular neuritis: A sudden, severe vertigo episode lasting days, often after a viral illness.
- Cervicogenic dizziness: Dizziness linked to neck pain, stiffness or neck movement.
These conditions can overlap, and it's common to have more than one. That's why a thorough assessment matters.
Common triggers
- Stress, and the let-down period after stress
- Poor or irregular sleep
- Hormonal changes, especially around your period
- Bright or flickering lights and screens
- Busy visual environments
- Skipped meals or dehydration
- Weather and pressure changes
- Certain foods or alcohol, which vary from person to person
A symptom diary can help you spot your personal patterns.
How is vestibular migraine diagnosed?
There's no single test for vestibular migraine. Diagnosis is based on your history and symptom pattern: repeated episodes of dizziness or vertigo, a history of migraine, and migraine features during at least some episodes. Other causes also need to be ruled out.
Scans and hearing tests are often normal. That doesn't mean nothing is wrong. It means the problem is in how your nervous system is processing information, not in the structure of your ear or brain. Your GP, a neurologist or an ENT specialist can confirm the diagnosis.
When to seek urgent help
Call 000 or go to an emergency department if dizziness comes with any of the following:
- Sudden severe headache unlike any you've had before
- Slurred speech, facial drooping, or weakness or numbness on one side
- Double vision or loss of vision
- Difficulty walking or loss of coordination that's new
- Fainting or chest pain
These can be signs of a stroke or another serious condition and need immediate medical care.
What can help vestibular migraine?
Vestibular migraine is usually managed with a combination of approaches.
Medical care. Your GP or neurologist may recommend medication to prevent attacks or to manage symptoms during an episode.
Trigger and lifestyle management. Regular sleep, regular meals, hydration, stress management and gradual, steady exercise can raise your threshold for attacks.
Vestibular rehabilitation. This uses targeted exercises to retrain how your brain processes balance, eye movement and motion information. The evidence is still developing, but it's encouraging. A 2025 meta-analysis found that, on average, people reported meaningful improvements in dizziness scores. The authors also noted that the studies varied widely, and another review found that vestibular rehabilitation used alongside other treatment showed functional benefits.
How I help people with vestibular migraine
Most people I see with vestibular migraine have already been to their GP, and often an ENT or neurologist too. They're still dealing with dizziness that affects their work, driving, exercise and confidence.
My approach starts with a full neurological assessment of the systems involved in balance: your inner ear, eye movements, balance and your upper neck, which sends a large amount of position information to the brainstem. From there, care may combine vestibular and eye movement rehabilitation through my Balance Reset Method™, chiropractic care for the neck, medical laser therapy and home exercises. Everything is paced to your tolerance, so we don't push you into a flare.
I work alongside your GP and specialists, not instead of them. You can keep taking any prescribed medication.
FAQ
Can you have vestibular migraine without a headache?
Yes. Many people have dizziness or vertigo episodes with little or no head pain, which is one reason it's often missed.
How long does a vestibular migraine attack last?
Episodes can last from a few minutes to up to 72 hours. Some people also feel off-balance or foggy between attacks.
Is vestibular migraine dangerous?
Vestibular migraine itself isn't dangerous, but it can seriously affect daily life. New or sudden dizziness should always be checked by a doctor to rule out other causes.
Can vestibular migraine go away?
For many people, symptoms can be well managed with the right combination of medical care, trigger management and rehabilitation. How long that takes varies from person to person.
Can neck problems make vestibular migraine worse?
They can contribute. Your upper neck sends balance and position information to your brain, and neck dysfunction may add to dizziness and headaches in some people.
Do I need a referral to see you?
No. You can book directly without a GP referral.
About the author
Dr Tony Briggs is a neuro rehab chiropractor in Melbourne with 37 years of clinical experience. He has advanced functional neurology training through the Carrick Institute and a background as a registered critical care nurse, and he works with people experiencing dizziness, vestibular migraine, POTS and concussion.
References
- Lempert T, et al. Vestibular migraine: diagnostic criteria. Journal of Vestibular Research. 2012;22(4):167–172.
- Dieterich M, Obermann M, Celebisoy N. Vestibular migraine: the most frequent entity of episodic vertigo. Journal of Neurology. 2016.
- El Ahdab et al. The effect of vestibular rehabilitation in the management of vestibular migraine in adults: a systematic review and meta-analysis. Headache. 2025.
- Alghadir AH, Anwer S. Effects of vestibular rehabilitation in the management of a vestibular migraine: a review. Frontiers in Neurology. 2018.
