Vestibular Migraine Overlaps with other Vestibular Disorders

Background

Vestibular Migraine (VM) is a neurological condition that affects how the brain processes balance and motion signals. It can cause episodes of dizziness, vertigo (spinning), motion sensitivity, imbalance, nausea, and visual discomfort—even without a headache. Because vestibular migraine affects brain regions that interact with the inner ear and eyes, it can mimic or be triggered by other balance disorders. For many patients, the first episode of VM is mistaken for something else.
 

Causes

The underlying cause is believed to be a migraine-related disturbance in the brain’s sensory integration centers. People with vestibular migraine often have a personal or family history of migraine. Triggers can include stress, poor sleep, hormonal changes, diet, sensory overload, or even another vestibular event (such as BPPV or a viral inner ear infection). In some cases, vestibular migraine develops after an injury, illness, or prolonged dizziness from another cause.
 

Treatment

Treatment focuses on reducing the brain’s sensitivity to motion and sensory input. This includes healthy lifestyle practices (consistent sleep, hydration, stress reduction), vestibular rehabilitation exercises, and in some cases, migraine-specific medications. Common preventives include magnesium, riboflavin, CGRP inhibitors, tricyclic antidepressants, or SNRIs. Vestibular symptoms may flare temporarily but often improve over time with the right strategies.
 

Overlap with Other Conditions

Vestibular migraine often looks like or gets triggered by other balance disorders. This can make diagnosis challenging and lead to confusion for both patients and providers.

Benign Paroxysmal Positional Vertigo (BPPV): VM can mimic BPPV with brief, spinning vertigo during head turns. Sometimes, a true BPPV episode (e.g., after rolling in bed) can trigger a migraine flare. Epley maneuvers help with BPPV but not with VM alone.

Unilateral Vestibular Hypofunction (UVH): UVH and VM can both cause imbalance, dizziness, and visual motion sensitivity. UVH comes from damage to one inner ear; VM is brain-based but can flare after inner ear infections or injury. Vestibular testing helps tell them apart.

Bilateral Vestibular Hypofunction (BVH): BVH causes difficulty walking in the dark and bouncing vision with movement. VM can mimic these symptoms during a flare but usually improves between episodes. Some patients with BVH develop VM secondarily, due to sensory overload.

Motion Sickness: Many people with VM have lifelong sensitivity to motion—cars, planes, boats, or scrolling screens. In fact, childhood motion sickness is a common early sign of vestibular migraine risk. These same sensitivities can persist or worsen with VM later in life.

Meniere’s Disease: VM and Meniere’s both cause vertigo, nausea, and ear symptoms like pressure or ringing. Sometimes VM is misdiagnosed as Meniere’s. Migraine can also trigger true Meniere’s attacks in people who have both conditions. Unlike Meniere’s, VM usually doesn’t cause lasting hearing loss.

Persistent Postural-Perceptual Dizziness (PPPD): Vestibular migraine is a common trigger for PPPD, a chronic sensation of rocking or swaying. Even after vertigo resolves, the brain may stay “stuck” in a high-alert state. VM and PPPD often co-exist and respond to similar treatments.

Low Blood Pressure (Orthostatic Hypotension): Both conditions can cause lightheadedness and dizziness when standing up. However, VM is more likely to involve visual sensitivity, motion triggers, or anxiety. A vestibular migraine can also flare if someone is dehydrated or hypotensive.

Stroke or TIA: VM can mimic stroke, especially when it starts suddenly with vertigo, nausea, or imbalance. However, stroke is more likely to cause weakness, slurred speech, or double vision. If there’s any concern for stroke, emergency care is always recommended.