What Is Vestibular Migraine?
A vestibular migraine is a type of migraine where dizziness and vertigo are the main symptoms, rather than just headache. If you've experienced episodes of spinning sensations, unsteadiness, or dizziness, along with migraine symptoms, you may have vestibular migraines. [1][2]
Unlike typical migraines, where a headache is the primary symptom, vestibular migraines cause recurrent attacks of vertigo (a spinning sensation) or dizziness, which can last anywhere from 5 minutes to 72 hours. These episodes may also occur with or without headache, but they're often accompanied by other migraine features, such as sensitivity to light and sound.[1][3]
How Are Vestibular Migraines Diagnosed?
Your doctor will use specific criteria to diagnose a vestibular migraine. According to the international diagnostic standards, you will need to meet all of the following:[1][3]
At least 5 episodes of vestibular symptoms (i.e., vertigo, dizziness, balance problems) that are moderate to severe in intensity and last anywhere between 5 minutes and 72 hours
A current or past history of migraines (with or without aura)
Migraine features during at least half of your vestibular episodes, which may include:
Headache with typical migraine characteristics (one-sided, pulsating, moderate to severe pain, or worsened by physical activity)
Sensitivity to light and sound (photophobia and phonophobia)
Visual aura (seeing flashing lights, zigzag lines, or blind spots)
Symptoms not better explained by another condition
Evidence-Based Lifestyle Changes That Can Help
Research shows that lifestyle modifications can significantly reduce both dizziness and headache symptoms in vestibular migraines. In fact, studies have found that lifestyle changes can be just as effective as some medications, with fewer side effects.[4]
Sleep: The Most Important Factor
Improving restful sleep appears to be the single most important lifestyle change you can make. In a study of patients with vestibular migraines, those who improved their sleep quality experienced the greatest reductions in both dizziness and headache symptoms..[4] When adjusting your sleeping patterns, try to aim for:
Consistent sleep and wake times, even on weekends
7-9 hours of sleep per night
A cool, dark, quiet bedroom
Avoiding screens for at least an hour before bed
Regular Eating Patterns
Skipping meals is a common trigger for migraine attacks. Research shows that maintaining regular mealtimes can help prevent attacks.[5][6] Aim to:
Eat at consistent times each day
Don't skip meals, especially breakfast
Stay well-hydrated throughout the day
Consider keeping a food diary to identify personal triggers
Exercise
Both aerobic exercise and gentler activities, like yoga, have shown promise for migraine prevention.[5][6] Start slowly and build up gradually:
Aim for 30 minutes of moderate exercise most days of the week
Choose activities you enjoy, whether that’s walking, swimming, cycling, or yoga
Avoid sudden, intense exercise if you're not used to it, as this can trigger attacks
Stress Management
Both high stress and sudden drops in stress (like weekend relaxation after a stressful week) can trigger migraine attacks.[5][6] Consider:
Regular relaxation techniques like deep breathing or meditation
Maintaining a consistent routine, even on weekends
Avoiding dramatic changes in your daily schedule when possible
Consistency Is Key
Research suggests that maintaining a consistent, healthy lifestyle is more important than any single factor. Large disruptions in your daily routine, whether in sleep, meals, or stress levels, are particularly associated with triggering attacks.[6]
How Vestibular Physical Therapy Can Help
Vestibular rehabilitation therapy (VRT) is a specialized form of physical therapy that has been proven effective for vestibular migraines. Recent research shows that VRT can significantly reduce dizziness-related disability and improve balance.[7][8][9]
What Is Vestibular Rehabilitation?
Vestibular rehabilitation involves customized exercises designed to:
Improve balance and reduce fall risk
Decrease dizziness and vertigo symptoms
Retrain your brain to compensate for vestibular dysfunction
Reduce the impact of dizziness on your daily activities
How Does It Work?
Vestibular rehabilitation works through a process called vestibular compensation. Your brain learns to adapt to and compensate for the vestibular dysfunction, reducing symptoms over time.[7] Brain imaging studies have shown that after one month of vestibular rehabilitation, patients experience changes in brain activity in various areas related to balance and spatial orientation.[10]
What to Expect
A typical vestibular rehabilitation program:
Involves individualized exercises tailored to your specific symptoms
Includes exercises you'll do at home between therapy sessions
May include gaze stabilization exercises, balance training, and habituation exercises
Should be supervised by a physical therapist trained in vestibular rehabilitation
Putting It All Together
Managing vestibular migraine often requires a comprehensive approach. Lifestyle modifications and vestibular rehabilitation offer effective, low-risk options that can significantly improve your quality of life.
Start with these steps:
Prioritize sleep: Make improving your sleep quality your first goal
Establish a routine: Keep consistent times for sleeping, eating, and exercise
Ask about vestibular rehabilitation: Talk to your doctor about a referral to a vestibular physical therapist
Keep a diary: Track your symptoms, sleep, meals, and activities to identify your personal patterns
Be patient: Lifestyle changes and vestibular rehabilitation take time to show benefits, typically several weeks to a month.
Remember, vestibular migraine is a real medical condition, and you're not alone. With the right combination of lifestyle modifications, physical therapy, and medical treatment, most patients can significantly reduce their symptoms and improve their quality of life.
When to seek immediate medical attention: If you experience sudden, severe vertigo with new neurological symptoms like double vision, slurred speech, weakness, or difficulty walking, seek emergency care to rule out stroke or other serious conditions.
Think you could benefit from Vestibular Rehab? Schedule your call below. Thank you for reading!
References
Vestibular Migraine: Clinical Aspects and Pathophysiology. Furman JM, Marcus DA, Balaban CD. The Lancet. Neurology. 2013;12(7):706-15. doi:10.1016/S1474-4422(13)70107-8.
Update on Diagnosis and Differential Diagnosis of Vestibular Migraine. Shen Y, Qi X. Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 2022;43(3):1659-1666. doi:10.1007/s10072-022-05872-9.
Clinical Practice Guideline: Ménière's Disease. Basura GJ, Adams ME, Monfared A, et al. Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery. 2020;162(2_suppl):S1-S55. doi:10.1177/0194599820909438.
Effects of Lifestyle Modification on Vestibular Migraine. Roberts RA, Watford KE, Picou EM, et al. Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [And] European Academy of Otology and Neurotology. 2021;42(10):e1537-e1543. doi:10.1097/MAO.0000000000003297.
Lifestyle Factors and Migraine. Seng EK, Martin PR, Houle TT. The Lancet. Neurology. 2022;21(10):911-921. doi:10.1016/S1474-4422(22)00211-3.
Behavioral Management of Episodic Migraine: Maintaining a Healthy Consistent Lifestyle. Seng EK, Gosnell I, Sutton L, Grinberg AS. Current Pain and Headache Reports. 2022;26(3):247-252. doi:10.1007/s11916-022-01023-z.
Outcome of Vestibular Rehabilitation in Vestibular Migraine. Balci B, Akdal G. Journal of Neurology. 2022;269(12):6246-6253. doi:10.1007/s00415-022-11250-4.
The Effect of Vestibular Rehabilitation in the Management of Vestibular Migraine in Adults: A Systematic Review and Meta-Analysis. El Ahdab J, Vilardo M, Ong B, et al. Headache. 2025;. doi:10.1111/head.70002.
Vestibular Rehabilitation Therapy for the Treatment of Vestibular Migraine, and the Impact of Traumatic Brain Injury on Outcome: A Retrospective Study. Stancel-Lewis J, Lau JWL, Male A, et al. Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [And] European Academy of Otology and Neurotology. 2022;43(3):359-367. doi:10.1097/MAO.0000000000003452.
Effect of Vestibular Rehabilitation on Spontaneous Brain Activity in Patients With Vestibular Migraine: A Resting-State Functional Magnetic Resonance Imaging Study. Liu L, Hu X, Zhang Y, et al. Frontiers in Human Neuroscience. 2020;14:227. doi:10.3389/fnhum.2020.00227.