Conditions we treat
Vestibular Migraine
One of the most common causes of recurrent dizziness — and one of the most often missed.
What Is Vestibular Migraine?
Most people think of migraine as a headache. But migraine is really a brain sensitivity disorder, and in some people its main symptom isn't head pain at all — it's dizziness. That's vestibular migraine: episodes of vertigo, dizziness, or unsteadiness driven by the same underlying process as migraine headaches.
The single most important thing to know is this: vestibular migraine often happens without any headache. That's exactly why it's so frequently missed. People don't connect their dizzy spells to migraine because their head doesn't hurt — so the dizziness gets blamed on sinuses, anxiety, or "something with the ears," and goes untreated for years.
Episodes typically last anywhere from a few minutes to several hours, sometimes up to a couple of days. Alongside the dizziness, you may (or may not) notice classic migraine features: sensitivity to light and sound, visual disturbances, nausea, or a headache. Many people with vestibular migraine also have a personal or family history of migraine headaches.
It's also commonly confused with Ménière's disease, because both cause repeated episodes of vertigo — which is one more reason an accurate diagnosis matters.
What It Feels Like
People with vestibular migraine often describe:
- "I get dizzy spells that last hours — sometimes with a headache, sometimes not."
- "Bright lights, busy patterns, and loud places make me dizzy and queasy."
- "I'm so sensitive to motion — car rides, scrolling on my phone, the grocery store all set me off."
- "I've had migraines for years, and now I get vertigo too."
- "Sometimes the room spins; other times I just feel rocking, foggy, or off."
- "It got blamed on my sinuses and my anxiety, but nothing they tried helped."
Between episodes, many people carry a lingering sensitivity to motion and busy visual environments, and a low-grade sense of imbalance.
First Step: Get an Accurate Diagnosis
Vestibular migraine is diagnosed based on your pattern of symptoms and migraine history, and it's primarily managed by a physician — often a neurologist or headache specialist. The foundation of care is reducing how often and how severely the attacks happen, through approaches like identifying and managing triggers, lifestyle strategies (consistent sleep, hydration, and routines), and, when appropriate, medication.
Because vestibular migraine overlaps with several other conditions — Ménière's, BPPV, and PPPD among them — and because it responds to migraine-specific treatment, getting the diagnosis right is the key that unlocks everything else. Vestibular physical therapy works alongside that medical care.
How Vestibular Therapy Helps
Let's be clear about the division of labor: vestibular therapy doesn't stop the migraine attacks themselves — preventing those is the job of medical management and trigger control. But the attacks are only half the story. Many people with vestibular migraine are left with persistent motion sensitivity, visually-triggered dizziness, and unsteadiness between episodes — and that's where vestibular therapy makes a real, well-documented difference:
- Taming motion and visual sensitivity. Through carefully graded habituation, we help your brain become less reactive to the movement and busy visual environments — traffic, stores, screens, patterns — that currently trigger symptoms.
- Reducing visual over-reliance. Vestibular migraine often leaves people overly dependent on their vision for balance, which is why crowded, cluttered spaces feel so destabilizing. We retrain your system to lean on your other balance senses.
- Rebuilding steadiness and confidence. Targeted balance work addresses the between-attack unsteadiness and helps you feel secure on your feet again.
- Treating what's layered on top. Vestibular migraine frequently coexists with — or triggers — BPPV and PPPD, both of which are very treatable. Part of our job is sorting out which of your symptoms belong to which problem so nothing fixable gets missed.
Research supports vestibular rehabilitation as an effective addition to medical management for vestibular migraine, particularly for the chronic dizziness, imbalance, and motion sensitivity that linger between attacks.
What to Expect in Treatment
Evaluation. We start with your history and the pattern of your episodes, then assess your eye movements, inner-ear function, balance, walking, and — importantly — how you respond to motion and visual challenge. We also screen for overlapping, treatable contributors like BPPV.
A coordinated plan. Because medical management leads, we work in step with your physician or neurologist. If your evaluation suggests something needs their attention, we'll help coordinate it.
Your program. You'll get a customized home program centered on habituation, visual-motion desensitization, and balance — introduced gently and progressed gradually. With vestibular migraine especially, we're careful to dose the work so it challenges your system without provoking a flare, and we adjust as we learn how you respond.
Honest expectations. Progress with the between-attack symptoms is usually gradual, built over weeks, and consistency with your program is one of the biggest factors in how well you do.
Vestibular Migraine FAQ
Can I have vestibular migraine without ever getting headaches?
Yes — and it's common. The dizziness can occur with no headache at all, which is the main reason this condition is so often overlooked. A history of migraine (even years ago, or in your family) is an important clue.
How is it different from Ménière's disease?
They look alike — both cause repeated vertigo episodes — but Ménière's typically comes with hearing changes, ringing, and ear fullness, while vestibular migraine tends to bring light/sound sensitivity, visual symptoms, and strong motion sensitivity. They can also coexist or be confused with each other, so an accurate diagnosis is essential.
Will vestibular therapy stop my attacks?
No. Preventing the attacks is handled through medical management and trigger control. Vestibular therapy targets the motion sensitivity, visual dizziness, and imbalance that persist between attacks — which for many people is a large part of the daily burden.
Then is it worth doing?
For most people with lingering between-attack symptoms, yes. Reducing your sensitivity to motion and busy environments, and rebuilding steady balance, can meaningfully improve day-to-day life — and we'll also catch any treatable overlap like BPPV.
I have migraines and now I'm getting vertigo. Are they connected?
Very possibly. New dizziness in someone with a migraine history is a classic vestibular-migraine picture and worth evaluating.
Do I need medication?
That's a question for your physician. Many people benefit from a combination of trigger management, lifestyle strategies, and medication, with vestibular therapy complementing all of it. We're glad to be part of that team.
Do I need a referral to be seen?
No. You can book directly, and for vestibular migraine we'll also make sure you're connected with appropriate medical care.