Managing vestibular migraines and their symptoms: a combined approach
Vestibular migraines are another condition we see in the clinic, with close ties to those experiencing vertigo.
A vestibular migraine is a neurological condition characterised by episodes of vertigo and dizziness, often accompanied by migraine symptoms, such as headaches, visual auras and sensitivity to light or sound.
According to Dieterich and Obermann (2016) vestibular migraines are one of the most common causes of recurrent spontaneous vertigo.
Let’s look deeper at vestibular migraines
Vestibular migraines involve episodes of vertigo - sensations of spinning or movement - alongside traditional migraine features.
These episodes can last from 5 minutes to 72 hours and may occur with or without a headache.
Though the causes of vestibular migraines aren’t fully known, patients who present with vestibular migraines usually have a history of motion sensitivity (such as car sickness) since childhood.
It is also believed that vestibular migraines result from overlapping pathways that modulate pain and vestibular inputs into the brain.
*NOTE: Vestibular inputs - or the vestibular system - helps you maintain your sense of balance. It is a sensory system that provides information to the brain about head position, motion and spatial awareness.
Symptoms of vestibular migraines
Common symptoms of vestibular migraines include:
Spontaneous or positional vertigo
Nausea and vomiting
Sensitivity to light (photophobia) and sound (phonophobia)
Visual disturbances or aura
Balance issues
Occasional tinnitus or ear pressure
Our approach to treating vestibular migraines
Unlike BPPV, vestibular migraines do not have a specific treatment approach (such as the Epley’s manoeuvre) to resolve the vertigo associated with them.
We can however have a positive influence on some of the associated symptoms of headache, muscle tension and neck stiffness through manual therapy.
We can also assist with vestibular rehabilitation and lifestyle counselling to help our patients find relief from this condition.
Manual therapy: gentle techniques to improve cervical spine mobility and reduce musculoskeletal tension, particularly in the neck and upper back.
Vestibular rehabilitation: exercises designed to desensitise the vestibular system and improve balance.
Lifestyle counselling: guidance on identifying and managing migraine triggers, such as stress, dietary factors, hormone factors and sleep disturbances.
Home care and exercises for vestibular migraines
At-home care and exercises are helpful for patients to find relief from vestibular migraines and their symptoms.
Between treatments, we encourage patients to keep a diary of when their migraines occur, tracking symptoms and potential triggers.
If appropriate, we will also detail a prescribed exercise plan to help with managing the condition.
This may involve performing vestibular exercises aimed at balance and gaze stabilisation to enhance vestibular function.
Lifestyle modifications may also be encouraged, such as adopting better sleep hygiene, managing stress, avoiding dietary triggers and the like.
Without treatment, vestibular migraines can persist for years, with episodes potentially increasing in frequency and severity.
When to see a specialist doctor
Your GP may refer you to an ENT for accurate diagnosis and to prescribe medication that will help with both the dizziness symptoms as well as the headache pain (combination therapy).
Vestibular migraines can significantly impact quality of life, but with a comprehensive approach - including manual therapy, vestibular rehabilitation and lifestyle modifications - patients often experience substantial relief.
Early intervention and individualised care are key to managing this condition effectively.
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