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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Partly. Vestibular migraine is diagnosed from your history and treated like migraine by video; new vertigo or hearing loss may first need hearing and balance tests in person.
- What it is: a type of migraine in which vertigo, dizziness or unsteadiness are the main symptoms. A headache does not have to come with every attack.
- How common: about 1 in 100 adults has had it, and it is the second most common cause of dizziness. Up to 40% of people with migraine have dizziness or balance problems at some point.
- How long attacks last: from 5 minutes to 72 hours, and tiredness can last up to 3 days afterwards.
- Emergency: call 112 for vertigo with weakness, numbness, slurred speech, double vision, trouble walking, sudden hearing loss, or a sudden, severe headache.
Do not book a video appointment if your vertigo came on with weakness, numbness or tingling, slurred speech, double vision or loss of vision, trouble walking, sudden hearing loss, confusion, or a sudden, severe headache that reached its worst within 5 minutes, especially if this is your first attack. Call 112 or go to an emergency department.
Can an online doctor treat vestibular migraine?
Partly. Vestibular migraine is diagnosed from your history rather than a test, and a doctor can recognise it by video when you have had migraine and the attacks fit. The doctor can treat it like migraine: what to take in an attack, a short course of medicine for severe spinning, a plan for triggers, and preventive medicine when attacks are frequent. New vertigo, or vertigo with hearing loss, may first need hearing and balance tests in person, and some preventive treatments are started by specialists.
How an online consultation helps with vestibular migraine
- A diagnosis from your story: The doctor checks your attacks against the international criteria, which rely on history, not a scan.
- Look-alikes ruled out: BPPV, Ménière’s disease and a mini-stroke can look similar, and the doctor asks the questions that tell them apart.
- A plan for the attack: Migraine treatment taken early, and a short course for severe spinning, without tablets that slow your recovery.
- Fewer attacks: Trigger changes, a diary, and preventive medicine when attacks keep coming.
What the doctor checks in an online vestibular migraine consultation
The doctor asks about the warning signs first, then about your attacks and your migraine history. The doctor asks about:
- Warning signs: weakness, numbness, slurred speech, double vision, trouble walking, sudden hearing loss, or a sudden, severe headache.
- Your migraine history: migraine now or in the past, even decades ago, and migraine in the family.
- The attacks: what the dizziness feels like, how long it lasts, how often it comes, and what sets it off.
- Migraine features in the attacks: headache, sensitivity to light and sound, or a visual aura in at least half of them.
- Your ears: hearing loss, ringing or fullness, and whether hearing returns to normal between attacks.
- Your medicines: what you take for attacks and on how many days a month, contraception, pregnancy plans and other conditions.
Before the call, keep a diary for a few weeks if you can: each attack, how long it lasted, what came with it, what you took, and what you were doing, eating and how you slept beforehand.
What is vestibular migraine?
Vestibular migraine is a type of migraine in which vertigo, dizziness or unsteadiness are often the main symptoms. It used to be called migrainous vertigo, migraine-associated vertigo or migraine-associated dizziness. It is not fully understood, but it probably involves overlapping pathways in the brain that process pain and balance.
How common is it, and who gets it?
In a German population survey, 0.98% of adults had had vestibular migraine, and 0.89% in the past year. It is the second most common cause of dizziness, and was the diagnosis in 6 to 7% of people seen in dizziness clinics and 9% of those seen in migraine clinics. More broadly, NHS balance services estimate that up to 40% of people with migraine have dizziness or balance problems at some point.
- Women are affected more often than men, about 3 times as often, and symptoms may worsen around periods.
- Age: it most often affects adults aged 20 to 50, but it can start at any age.
- Families: it tends to run in families, as migraine does.
- History: nearly everyone with it has had migraine at some point, even if the last headache was decades ago, and many have been prone to motion sickness, such as car sickness, since childhood.
What does a vestibular migraine attack feel like?
The main symptoms are vertigo, dizziness and unsteadiness. Most people describe spinning, others swaying, and it can be obvious to others, as difficulty walking, or invisible. Other symptoms can include:
- feeling or being sick
- sensitivity to light, noise or movement
- a headache or a feeling of pressure in the head
- a visual aura, such as zigzag lines or flashing lights
- ringing, fullness or brief changes in hearing in the ears
- a floaty or fuzzy feeling, sweating or panic, and tiredness afterwards
A headache does not have to come with every attack, and most people with vestibular migraine do not have the vertigo and the headache at the same time, which is why it is often missed.
What sets the vertigo off?
The spinning can come out of the blue, after a change in head position, during head movements, or in busy surroundings and around moving patterns.
How long does a vestibular migraine last?
By the international definition, an episode lasts from 5 minutes to 72 hours. Many people have attacks lasting hours, but some have spells of seconds that recur, or days. Tiredness can last up to 3 days, and full recovery after an attack can take a few days or longer.
What are the stages of a vestibular migraine?
Like other migraines, an attack can have up to four stages: a warning stage (prodrome), when some people feel ‘off’; an aura, which not everyone has; the main attack; and a recovery stage (postdrome). Not every attack has every stage.
What triggers a vestibular migraine?
Most migraine triggers can set off vestibular migraine. Triggers vary from person to person and can act hours before the attack starts, so a diary is the best way to find yours:
Swipe sideways to compare →
| Type | Common triggers | What helps |
|---|---|---|
| Body and mind | Stress, anxiety, tiredness, irregular or too little sleep, periods and other hormone changes | The same bedtime and waking time every day, including weekends; relaxation or mindfulness |
| Food and drink | Missed meals, not drinking enough, alcohol, caffeine, and some foods such as chocolate, aged cheese or red wine | Regular meals, enough water, less caffeine and alcohol, a food diary |
| Surroundings | Bright, flickering or flashing light, screens, loud noise, strong smells, busy visual scenes | Lower screen brightness, regular breaks, sunglasses |
| Other | Weather changes, travel, muscle tension, some medicines | Planning ahead for travel, and checking new medicines |
Painkillers can become a trigger themselves. Taking triptans or combination painkillers on 10 or more days a month, or paracetamol, aspirin or anti-inflammatory painkillers on 15 or more days, for 3 months or more, can cause medication overuse headache.
How is vestibular migraine diagnosed?
There is no test for vestibular migraine. It is diagnosed from your history, using the criteria of the International Headache Society and the Bárány Society:
- at least 5 episodes of vertigo or dizziness of moderate or severe intensity, each lasting 5 minutes to 72 hours
- migraine now or in the past
- at least half of the episodes come with at least one migraine feature: a migraine-type headache, sensitivity to both light and sound, or a visual aura
- no other diagnosis explains the symptoms better
Hearing and balance tests are usually largely normal, and are used to rule out other causes. If the attacks respond to migraine treatment, that supports the diagnosis.
What can be mistaken for vestibular migraine?
Several conditions look similar, and some can occur alongside vestibular migraine:
Swipe sideways to compare →
| Condition | How it differs | What to do |
|---|---|---|
| Vestibular migraine | Episodes of 5 minutes to 72 hours in someone with migraine; hearing may ring or feel full but does not progress to severe hearing loss | Treat like migraine |
| BPPV | Brief spins set off by changes in head position | A repositioning manoeuvre |
| Ménière’s disease | Attacks of 20 minutes or more with hearing loss confirmed on a hearing test, ringing and fullness in one ear | Hearing tests and an ENT specialist |
| Labyrinthitis or vestibular neuritis | Constant vertigo for days, often after a cold or flu | Usually settles within weeks |
| A mini-stroke (TIA) or stroke | Sudden vertigo with weakness, numbness, slurred speech or double vision | Call 112 |
| Persistent postural-perceptual dizziness (PPPD) | Dizziness lasting at least 3 months | A specialist assessment |
Migraine is more common in people with Ménière’s disease, and the two can overlap. If a hearing test confirms the hearing loss typical of Ménière’s disease, that diagnosis comes first. All causes of spinning are compared on the vertigo page.
Is vestibular migraine dangerous?
Vestibular migraine is a migraine disorder: balance tests are usually largely normal, and although hearing can fluctuate, it does not progress to severe hearing loss. The main risk is mistaking something else for it. A mini-stroke can look similar, so a first attack, an attack that is different from your usual ones, or vertigo with weakness, numbness, slurred speech or double vision needs urgent assessment rather than migraine treatment.
Dizziness can also set off anxiety and a physical stress response, which can make the symptoms worse in a cycle. Treating both breaks the cycle: the anxiety page covers what a doctor can do.
Which vestibular migraine treatment might the doctor recommend?
Treatment follows how often the attacks come, how much they disrupt your life, and what you have already tried. This is the framework the doctors use, in line with NICE migraine guidance:
Swipe sideways to compare →
| What you have | Likely first step | Suitable for online care? | When in-person care is needed |
|---|---|---|---|
| Attacks that fit vestibular migraine, in someone with migraine | Migraine treatment taken early, a trigger diary and lifestyle changes | Yes | If attacks change, or new symptoms appear |
| Severe spinning and sickness during an attack | A short course of prochlorperazine or cinnarizine | Yes | If you cannot keep fluids down or stand |
| Frequent or disabling attacks despite trigger changes | A preventive medicine, such as propranolol or amitriptyline, reviewed after 6 months | Yes | If several preventives have not worked: a specialist |
| Painkillers or triptans on 10 or more days a month | A plan to stop the overused medicine, alongside prevention | Yes | If withdrawal is difficult |
| Dizziness between attacks, or that lingers | Vestibular rehabilitation exercises | Partly | For a vestibular physiotherapist |
| New vertigo without a migraine history, or with hearing loss | Hearing and balance tests to rule out other causes | Partly | For the tests and an ENT or audiovestibular specialist |
| Sudden vertigo with weakness, numbness, slurred speech, double vision or a sudden, severe headache | Emergency care | No | Call 112 now |
Dizzy spells and a history of migraine? A doctor can tell you in one consultation whether it fits vestibular migraine and what will help.
See available times →Treatment options for vestibular migraine
There is no cure, but treatment aims to make attacks fewer and milder, and a common goal of prevention is halving the number of attacks. Many people manage well with treatment.
What you can do yourself
- Keep a diary of attacks, sleep, food, stress and medicines to find your triggers.
- Go to bed and get up at the same time every day, including weekends.
- Eat regular meals, drink enough water, and limit caffeine and alcohol.
- Be active: aim for 150 minutes of activity a week, starting gently and building up.
- Take your migraine treatment early in an attack, and carry it with you.
- Keep moving as normally as you can between attacks: avoiding movement can cause other balance problems.
- Use painkillers on no more than 2 days a week, to avoid medication overuse headache.
Exercises that help: vestibular rehabilitation
A vestibular physiotherapist can teach a programme of exercises that help the brain adapt to dizziness and reduce how strong attacks feel. It is not right for everyone: when migraine is very active, the exercises can make symptoms worse for a while, so medicine and lifestyle changes may come first.
Prescription treatment
A prescription is never issued without a consultation. For the attack itself, the doctor may prescribe migraine treatment such as an anti-inflammatory painkiller, a triptan or an anti-sickness medicine, and, for severe spinning and sickness, a short course of prochlorperazine or cinnarizine, to be stopped once the dizziness settles. Taken long term, these slow the brain’s ability to adapt. If attacks are frequent, the doctor may suggest a preventive medicine such as propranolol, amitriptyline or candesartan, and reviews whether you still need it after 6 months. Topiramate is another option, but it must not be used in pregnancy and needs highly effective contraception. Specialists can add flunarizine, CGRP-targeting treatments or botulinum toxin injections. Codeine and other opioids are not recommended for migraine and are never prescribed online. If the doctor prescribes, use the prescription at a pharmacy near you.
What does not help
Anti-sickness tablets taken every day to prevent dizziness. Avoiding movement and busy places altogether. Painkillers on most days of the month. Codeine and other opioids, which can make sickness worse and cause dependence.
Special situations
Pregnancy and contraception
In pregnancy, paracetamol is the first choice for an attack, and a triptan or an anti-inflammatory painkiller is considered only after discussing the risks; prevention needs specialist advice, and topiramate must not be used. If your attacks include a visual aura, combined hormonal contraception is not routinely recommended: see migraine with aura.
Periods and the menopause
Symptoms may worsen around periods. The hormone headache page covers timing treatment to your cycle.
Driving
Do not drive during an attack, or while vertigo is coming without warning. In the UK, drivers must tell the DVLA about vertigo.
Vestibular migraine while travelling in Europe
Travel stacks triggers: broken sleep, missed meals, dehydration, bright light and busy stations. Keep your medicines in your hand luggage, eat and drink regularly, and plan rest. The same warning signs mean 112 wherever you are.
Children
Mobi Doctor consultations are for adults aged 18 and over. A child who is unwell needs a paediatrician or a local doctor in person, and emergency signs in a child mean 112.
When vestibular migraine is treated online, and when you need in-person care
Treated online: diagnosing vestibular migraine from a clear history in someone with migraine, acute treatment, short courses for severe spinning, trigger and diary plans, preventive medicine and its review, and medication overuse plans.
In-person care: new vertigo without a migraine history, vertigo with hearing loss, hearing and balance tests, vestibular physiotherapy, specialist-only preventive treatments, and any attack with the signs of a stroke.
When to get in-person care
Call 112 or go to an emergency department now for:
- vertigo or a headache with weakness, numbness or tingling in the face, an arm or a leg
- slurred speech, double vision or loss of vision, or trouble walking
- vertigo with sudden hearing loss
- a sudden, severe headache that reaches its worst within 5 minutes (a thunderclap headache)
- a headache with a high temperature and a stiff neck, or a rash that does not fade when a glass is rolled over it
- a headache or vertigo after a head injury
- a seizure, drowsiness or confusion
Get medical advice the same day for:
- your first attack of vertigo, or an attack that is different from your usual ones
- a headache with vomiting, or one made worse by coughing, sneezing, bending down or exercise
- vertigo with being sick, or feeling very sick
- an aura lasting more than an hour
How Mobi Doctor works
- Book a time that suits you: daily 7am–11pm CEST. You can see a doctor over video, usually within 15 minutes. No subscription, and the exact price is shown before you pay.
- Speak to a licensed doctor about your attacks: describe the dizziness, how long it lasts and what comes with it, mention your migraine history and any hearing change, and list what you take.
- Leave with a plan: what to do, what to take and for how long, and which signs mean you should be seen in person. If the doctor prescribes, use the prescription at a pharmacy near you.
No sign-up needed
Not sure it’s vestibular migraine? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
Tap the body — an area or a point — to browse symptoms anywhere
Similar symptoms, different condition? Migraine can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about vestibular migraine
What is vestibular migraine?
A type of migraine in which vertigo, dizziness or unsteadiness are the main symptoms. It used to be called migrainous vertigo or migraine-associated vertigo, and a headache does not have to come with every attack.
What does a vestibular migraine attack feel like?
A vestibular migraine attack usually feels like spinning or swaying, often with feeling sick, sensitivity to light, noise or movement, and sometimes a headache, a visual aura, or ringing or fullness in the ears. Many people feel tired and drained afterwards.
What triggers a vestibular migraine?
The usual migraine triggers: stress, poor or irregular sleep, missed meals, dehydration, alcohol, caffeine, some foods, hormone changes, bright or flickering light, loud noise and weather changes. Head movements and busy visual scenes can set off the spinning.
How can I prevent vestibular migraine attacks?
Keep regular sleep, meals and hydration, limit caffeine and alcohol, manage stress, exercise steadily, and keep a diary to find your triggers, which often include missed meals, poor sleep, hormonal changes, bright or moving visual environments and certain foods; vestibular rehabilitation exercises reduce the dizziness between attacks. If attacks are frequent or disabling, a daily preventive medicine such as propranolol, amitriptyline, topiramate or flunarizine cuts their number, and acute medicines are used sparingly to avoid medication-overuse headache.
How long does a vestibular migraine last?
A vestibular migraine episode lasts from 5 minutes to 72 hours by definition, most often hours. Tiredness can last up to 3 days, and full recovery can take a few days or longer.
Can you have vestibular migraine without a headache?
Yes. Attacks can happen without a headache, and most people do not have the vertigo and the headache at the same time. To meet the diagnosis, you must have had migraine at some point, and at least half of the attacks must have a migraine feature.
How do you stop vestibular migraines, and what helps at home?
Find and reduce your triggers with a diary, keep regular sleep and meals, take migraine treatment early in an attack, and use a short course of anti-sickness medicine for severe spinning. If attacks are frequent, preventive medicine aims to halve them.
What can be mistaken for a vestibular migraine?
BPPV, Ménière’s disease, labyrinthitis, vestibular neuritis, persistent postural-perceptual dizziness and a mini-stroke can all look similar, and some can occur alongside vestibular migraine. Hearing loss confirmed on a test points to Ménière’s disease.
What are the 4 stages of vestibular migraine?
A vestibular migraine attack can pass through four stages: a warning stage, or prodrome, with tiredness, yawning, neck stiffness or food cravings hours before; an aura of visual or sensory symptoms, which not everyone has; the main attack of vertigo, dizziness, nausea and sometimes headache; and a recovery stage, or postdrome, of exhaustion and fogginess lasting up to 3 days. Not every attack has every stage, and the vertigo can come without any headache.
Can vestibular migraine be cured?
There is no cure, but treatment works for many people. Trigger changes, early treatment of attacks and preventive medicine make attacks fewer and milder, and vestibular rehabilitation helps lingering dizziness.
Is vestibular migraine dangerous?
It is a migraine disorder, and hearing does not progress to severe loss. The main risk is mistaking a stroke for it: a first attack, an unusual attack, or vertigo with weakness, numbness, slurred speech or double vision needs urgent assessment.
Can you drive with vestibular migraine?
Do not drive during a vestibular migraine attack, in the recovery phase while you feel foggy, or at all while vertigo comes without warning, because a spin at the wheel is as dangerous as fainting. Once attacks are well controlled and predictable, driving is usually fine; in the UK, drivers must tell the DVLA about vertigo, and the doctor can advise you about your licence.
Can an online doctor treat vestibular migraine?
Partly. A doctor can diagnose it from your history by video and treat it like migraine, including prevention. New vertigo or hearing loss may first need hearing and balance tests in person.
- A1.6.6 Vestibular migraine, International Classification of Headache Disorders, 3rd edition (ICHD-3), International Headache Society, 2018.
- Headaches in over 12s: diagnosis and management (CG150), NICE, National Institute for Health and Care Excellence, 2012, updated 2021.
- Could painkillers be causing your headaches?, NICE, National Institute for Health and Care Excellence, 2012.
- Medication overuse guidance, NHS Scotland Right Decisions, neurology headache pathway, 2026.
- Vestibular migraine, NHS Lanarkshire vestibular physiotherapy (UK), updated 14 August 2025.
- Vestibular migraine: patient information, University Hospital Southampton NHS Foundation Trust (UK), reviewed September 2023.
- Vestibular migraine, Johns Hopkins Medicine (US), accessed 15 October 2026.
- Vestibular migraine, The Migraine Trust (UK charity), reviewed September 2026.
- Dizziness: approach to evaluation and management, Muncie HL, Sirmans SM, James E. American Family Physician, 2017.
- Vestibular dysfunction: prevalence, impact and need for targeted treatment, Agrawal Y, Ward BK, Minor LB. Journal of Vestibular Research, 2013.
- Topiramate: referral (pregnancy prevention programme), EMA, European Medicines Agency, updated 23 November 2023.
- Labyrinthitis and vestibular neuritis, NHS, National Health Service (UK), reviewed 6 August 2026.
- Headaches, NHS, National Health Service (UK), reviewed 17 April 2024.
- Vertigo, NHS, National Health Service (UK), reviewed 2 May 2023.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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