Maintaining balance is a complex process that requires integration of visual, vestibular, and somatosensory inputs, along with higher-level cognitive processing.

For patients with vestibular dysfunction, impairment within these systems disrupts spatial orientation and stability. Why then, do many patients report episodic vertigo despite normal vestibular testing?

Vestibular Migraine is one explanation for this discrepancy. It is a common and often under diagnosed neurological condition characterized by recurrent episodes of vertigo or dizziness, with or without headache, and frequently accompanied by migraine features such as photophobia, phonophobia, or visual aura.

Despite significant symptoms, standard vestibular testing is often normal, as these assessments primarily measure peripheral function and may not detect transient or centrally mediated dysfunction.

Current evidence suggests that vestibular migraine reflects abnormal sensory integration and altered processing within central vestibular pathways involving the brainstem, cerebellum, and trigeminovascular system.

Proposed mechanisms include cortical spreading depression and increased neuronal excitability, which contribute to disrupted vestibular signaling even in the absence of measurable peripheral deficits.

As a result, diagnosis is largely clinical and based on symptom patterns rather than objective findings, and management focuses on reducing symptom frequency and severity through lifestyle modification, trigger avoidance, pharmacologic therapy, and, in some cases, vestibular rehabilitation.

Have You Heard The News?

The article describes current treatment of Vestibular Migraine as a multimodal approach aimed at reducing attack frequency, severity, and functional impact rather than eliminating a structural vestibular deficit.

Management begins with patient education and lifestyle modification, including regulation of sleep, stress management, regular meals, hydration, and avoidance of individual migraine triggers (such as certain foods, sensory stimuli, or hormonal factors).

Pharmacologic therapy is used for both acute symptom control and prevention, with prophylactic medications similar to those used in migraine management—such as beta-blockers, calcium channel blockers, anticonvulsants, and antidepressants—selected based on patient comorbidities and symptom patterns. In more refractory or frequent cases, newer migraine-targeted therapies may be considered depending on availability and clinical judgment.

Vestibular rehabilitation therapy is also recommended in selected patients to address persistent imbalance, improve vestibular compensation, and reduce motion sensitivity between attacks.

Source: Choi JH, Choi KD, Oh EH, Choi SY. Preventive medical treatment of vestibular migraine: a practical review. Res Vestib Sci. 2025;24(1):20-26. doi: 10.21790/rvs.2024.024

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That's A Fact!

Approximately 55% of patients with migraine experience vestibular symptoms.

Take the First Step Toward Lasting Balance

If you are experiencing unexplained dizziness, vertigo, or balance issues, our specialized team is here to help.

Contact us today to schedule your comprehensive vestibular assessment and start your path toward personalized care and relief.