Frequently Asked Questions
Can you have vestibular migraine without a headache? +
Yes. Many spells of vestibular migraine come without a headache, or with only a mild one, and the headache, when there is one, can come before, during or after the dizziness. The diagnosis needs migraine now or in the past, and migraine features, such as a one-sided throbbing headache, a dislike of both light and noise, or a visual aura, in at least half of the spells, so other spells can be dizziness alone. Call 000 for dizziness or spinning with double vision, slurred speech, trouble swallowing, numbness, weakness or drooping of the face, an arm or a leg, a sudden loss of vision, sudden trouble standing or walking, a new kind of headache or new neck pain, fainting while sitting, lying down or exercising, without warning or more than once, or fainting if you are over 60, have a heart condition or are injured, chest pain or a racing or irregular heartbeat, or with a sudden severe headache that reaches its worst within a minute. A first spell of dizziness or spinning, or a spell unlike your usual ones, needs an emergency department the same day, and sudden hearing loss in one ear needs your GP or an emergency department the same day, and an emergency department if it comes with new dizziness or spinning. If a doctor has diagnosed vestibular migraine, your usual spells, even sudden or severe ones, do not need 000 on their own; a spell unlike your usual ones, or longer than your usual ones, needs an emergency department the same day, and 000 if it is sudden and severe or comes with double vision, slurred speech, trouble swallowing, a loss of vision, drooping of the face, numbness or weakness, trouble walking, or unsteadiness much worse than in your usual spells.
How long does a vestibular migraine last? +
In the international criteria, a spell lasts from 5 minutes to 3 days. Roughly a third of people have spells lasting minutes, a third hours and a third days, and some have very brief spins, lasting seconds, that keep coming back when they move their head during an attack. Many people feel off-balance or sensitive to movement for a day or two afterwards. A spell, or a migraine attack, that lasts more than 3 days needs your GP the same day, and dizziness on most days for months may be persistent postural-perceptual dizziness, which is worth asking your doctor about. Call 000 for dizziness or spinning with double vision, slurred speech, trouble swallowing, numbness, weakness or drooping of the face, an arm or a leg, a sudden loss of vision, sudden trouble standing or walking, a new kind of headache or new neck pain, fainting while sitting, lying down or exercising, without warning or more than once, or fainting if you are over 60, have a heart condition or are injured, chest pain or a racing or irregular heartbeat, or with a sudden severe headache that reaches its worst within a minute. A first spell of dizziness or spinning, or a spell unlike your usual ones, needs an emergency department the same day. If a doctor has diagnosed vestibular migraine, your usual spells, even sudden or severe ones, do not need 000 on their own; a spell unlike your usual ones, or longer than your usual ones, needs an emergency department the same day, and 000 if it is sudden and severe or comes with double vision, slurred speech, trouble swallowing, a loss of vision, drooping of the face, numbness or weakness, trouble walking, or unsteadiness much worse than in your usual spells.
What are the stages of vestibular migraine? +
A migraine attack can have up to four phases: warning symptoms in the hours or day before, such as yawning, tiredness, a stiff neck or food cravings; an aura, such as zigzag lines, in some people; the headache; and a washed-out recovery phase afterwards. In vestibular migraine the dizziness can come in any of these phases, or on its own without the others, so not every spell follows the same order. Call 000 for dizziness or spinning with double vision, slurred speech, trouble swallowing, numbness, weakness or drooping of the face, an arm or a leg, a sudden loss of vision, sudden trouble standing or walking, a new kind of headache or new neck pain, fainting while sitting, lying down or exercising, without warning or more than once, or fainting if you are over 60, have a heart condition or are injured, chest pain or a racing or irregular heartbeat, or with a sudden severe headache that reaches its worst within a minute. A first spell of dizziness or spinning, a spell unlike your usual ones, a first aura after 50, or an aura unlike your usual ones, needs an emergency department the same day. If you are 20 or more weeks pregnant or had a baby in the last 6 weeks, a severe headache, blurred vision or flashing lights needs your maternity unit or an emergency department now. If a doctor has diagnosed vestibular migraine, your usual spells, even sudden or severe ones, do not need 000 on their own; a spell unlike your usual ones, or longer than your usual ones, needs an emergency department the same day, and 000 if it is sudden and severe or comes with double vision, slurred speech, trouble swallowing, a loss of vision, drooping of the face, numbness or weakness, trouble walking, or unsteadiness much worse than in your usual spells.
Could my dizziness be a stroke rather than vestibular migraine? +
Usually not, but it is the reason a first spell is always checked. In a US study of people aged 45 and over who went to an emergency department with dizziness, spinning or unsteadiness, about 3 in 100 had had a stroke or a mini-stroke, and when the dizziness came with no other symptom or sign, fewer than 1 in 100 had. A stroke usually comes with other signs, but a stroke in the balance centre at the back of the brain can cause dizziness with few of them, and an early scan can look normal, so the doctor's examination of the eye movements and walking matters. Call 000 for dizziness or spinning with double vision, slurred speech, trouble swallowing, numbness, weakness or drooping of the face, an arm or a leg, a sudden loss of vision, sudden trouble standing or walking, a new kind of headache or new neck pain, fainting while sitting, lying down or exercising, without warning or more than once, or fainting if you are over 60, have a heart condition or are injured, chest pain or a racing or irregular heartbeat, even if it lasts only a few minutes: remember FAST, Face drooping, Arm weakness, Speech difficulty, Time to call 000. This page is for adults; a child with dizzy spells should see their GP, and the same 000 signs apply. A first spell of dizziness or spinning, or a spell unlike your usual ones, needs an emergency department the same day. If a doctor has diagnosed vestibular migraine, your usual spells, even sudden or severe ones, do not need 000 on their own; a spell unlike your usual ones, or longer than your usual ones, needs an emergency department the same day, and 000 if it is sudden and severe or comes with double vision, slurred speech, trouble swallowing, a loss of vision, drooping of the face, numbness or weakness, trouble walking, or unsteadiness much worse than in your usual spells.
What is the difference between vestibular migraine and Ménière's disease? +
In Ménière's disease, spells of vertigo lasting 20 minutes to 12 hours come with hearing loss, ringing and a feeling of fullness in one ear, and the hearing loss is confirmed on a hearing test. In vestibular migraine, spells last from 5 minutes to 3 days, hearing is usually normal, and migraine features such as a headache, a dislike of light and noise, or an aura come with many spells. Some people have features of both, and a hearing test, a neurologist and an ear, nose and throat surgeon can help sort it out. Sudden hearing loss in one ear needs your GP or an emergency department the same day, because treatment is more likely to help when it starts early, and an emergency department if it comes with new dizziness or spinning. Call 000 for dizziness or spinning with double vision, slurred speech, trouble swallowing, numbness, weakness or drooping of the face, an arm or a leg, a sudden loss of vision, sudden trouble standing or walking, a new kind of headache or new neck pain, fainting while sitting, lying down or exercising, without warning or more than once, or fainting if you are over 60, have a heart condition or are injured, chest pain or a racing or irregular heartbeat. A first spell of dizziness or spinning, or a spell unlike your usual ones, needs an emergency department the same day.
What are the strange symptoms of vestibular migraine? +
Besides spinning, people describe a rocking or floating feeling, as if on a boat; the ground tilting or feeling soft; dizziness from moving scenes such as traffic, scrolling or supermarket aisles; a dislike of light, noise or busy patterns; fullness or ringing in the ears; motion sickness; and feeling foggy, tired or unable to concentrate for a while after a spell. These are part of the condition and settle between spells. A sudden loss of hearing in one ear needs your GP or an emergency department the same day, and an emergency department if it comes with new dizziness or spinning. Call 000 for dizziness or spinning with double vision, slurred speech, trouble swallowing, numbness, weakness or drooping of the face, an arm or a leg, a sudden loss of vision, sudden trouble standing or walking, a new kind of headache or new neck pain, fainting while sitting, lying down or exercising, without warning or more than once, or fainting if you are over 60, have a heart condition or are injured, chest pain or a racing or irregular heartbeat, or with a sudden severe headache that reaches its worst within a minute. A first spell of dizziness or spinning, or a spell unlike your usual ones, needs an emergency department the same day. If a doctor has diagnosed vestibular migraine, your usual spells, even sudden or severe ones, do not need 000 on their own; a spell unlike your usual ones, or longer than your usual ones, needs an emergency department the same day, and 000 if it is sudden and severe or comes with double vision, slurred speech, trouble swallowing, a loss of vision, drooping of the face, numbness or weakness, trouble walking, or unsteadiness much worse than in your usual spells.
Does vestibular migraine go away? +
It eases for about half of people, but it can come and go for years. In a German study that followed people for about 9 years, for about half the spells became less frequent, and for the others they carried on as before or became more frequent. Treatment, balance exercises and steady routines help many people have fewer spells. If the dizziness has become daily rather than in spells, persistent postural-perceptual dizziness may have developed, and it has its own treatment, so it is worth asking your doctor about. Call 000 for dizziness or spinning with double vision, slurred speech, trouble swallowing, numbness, weakness or drooping of the face, an arm or a leg, a sudden loss of vision, sudden trouble standing or walking, a new kind of headache or new neck pain, fainting while sitting, lying down or exercising, without warning or more than once, or fainting if you are over 60, have a heart condition or are injured, chest pain or a racing or irregular heartbeat. A spell unlike your usual ones needs an emergency department the same day, and dizziness or a headache that is getting steadily worse over days or weeks needs your GP the same day. If a doctor has diagnosed vestibular migraine, your usual spells, even sudden or severe ones, do not need 000 on their own; a spell unlike your usual ones, or longer than your usual ones, needs an emergency department the same day, and 000 if it is sudden and severe or comes with double vision, slurred speech, trouble swallowing, a loss of vision, drooping of the face, numbness or weakness, trouble walking, or unsteadiness much worse than in your usual spells.
How is vestibular migraine treated? +
Treatment follows the diagnosis. During a spell, keep still somewhere quiet, look at one fixed point, and do not drive until it has fully cleared; treat a headache as you would a migraine, with simple pain relief early at the dose on the pack (if you are pregnant, ask your pharmacist which kind is safe). Your doctor can advise on a medicine for the nausea or the spinning, and on preventive medicines when spells are frequent; there are fewer trials in vestibular migraine itself, so treatment usually follows that of migraine. Balance exercises with a physiotherapist help, especially for unsteadiness between spells, and regular sleep, meals, fluids, exercise and ways to manage stress reduce spells for many people. Keep pain relief to two or three days a week at most. If you are 20 or more weeks pregnant or had a baby in the last 6 weeks, a severe headache, blurred vision or flashing lights needs your maternity unit or an emergency department now. Call 000 for dizziness or spinning with double vision, slurred speech, trouble swallowing, numbness, weakness or drooping of the face, an arm or a leg, a sudden loss of vision, sudden trouble standing or walking, a new kind of headache or new neck pain, fainting while sitting, lying down or exercising, without warning or more than once, or fainting if you are over 60, have a heart condition or are injured, chest pain or a racing or irregular heartbeat, or with a sudden severe headache that reaches its worst within a minute. A first spell of dizziness or spinning, or a spell unlike your usual ones, needs an emergency department the same day.
Related: Migraine overview · Migraine aura · Headache with nausea · Medication overuse headache · Headache with high blood pressure · Headache when standing up · Headache at the back of the head · Cervicogenic headache · Tension headache · Thunderclap headache · Headache diary tool · For GPs