Vestibular Migraine: How to Manage Dizziness and Headaches Effectively

If you’ve ever felt like the room is spinning, even when you’re sitting still, and then a throbbing headache hits, you might be dealing with vestibular migraine. It’s not just a bad headache or a case of vertigo - it’s both, happening together. And it’s more common than you think. About 1 in 100 people have it, and women are more than three times as likely to be affected as men. Many people suffer for years before getting the right diagnosis, often mistaken for inner ear problems or stress-induced dizziness.

What Exactly Is Vestibular Migraine?

Vestibular migraine (VM) is a neurological condition where the brain’s balance and pain systems get tangled up. You don’t need a headache to have it - about half the time, people get dizzy, unsteady, or feel like they’re on a boat without any head pain. Episodes can last from a few minutes to three days. During an attack, you might feel nauseous, sensitive to light or sound, or see flashing lights or blind spots. Motion, like walking down a busy street or riding in a car, can make it worse.

The brain’s vestibular system - which helps you stay balanced - gets overstimulated during these episodes. This isn’t an ear problem like an infection or fluid buildup. It’s a brain issue, linked to the same wiring that causes classic migraines. Research shows that people with VM often have a family history of migraines, and some carry genetic changes (like CACNA1A mutations) that make their nerves more excitable. This means their brains react too strongly to triggers like stress, sleep loss, or certain foods.

How Is It Diagnosed?

There’s no blood test, scan, or X-ray that confirms vestibular migraine. Doctors rely on a set of clinical rules called the ICHD-3 criteria. To be diagnosed, you need:

• At least five episodes of moderate to severe dizziness lasting 5 minutes to 72 hours
• A current or past history of migraine (with or without aura)
• At least half of your dizziness episodes happen with typical migraine symptoms - like sensitivity to light, nausea, or headache

That’s it. No fancy lab work. But here’s the problem: most general doctors don’t know these criteria. A 2022 study found that 40% of people with VM are misdiagnosed - often as BPPV (a harmless inner ear issue) or Ménière’s disease (a different inner ear disorder). That means you might end up getting ear drops, diuretics, or even surgery that won’t help at all. If you’ve seen multiple specialists and still don’t have answers, ask specifically about vestibular migraine.

What Triggers Your Attacks?

Knowing your triggers is the first step to controlling VM. In a survey of 850 patients, the top triggers were:

• Stress (82%)
• Lack of sleep or irregular sleep (76%)
• Weather changes or barometric pressure shifts (68%)
• Caffeine (54%)
• Alcohol (49%)
• Aged cheeses, processed meats, MSG (38%)

Not everyone reacts to all of these. The key is to track your own patterns. Start a simple diary for 6-8 weeks. Write down:

• When you felt dizzy or had a headache
• What you ate or drank the day before
• How much sleep you got
• Any major stressors or changes in routine

After a few weeks, you’ll likely see patterns. Maybe every time you skip breakfast and drink two coffees, you get dizzy by noon. Or maybe your attacks spike after a long work week. That’s your personalized trigger list. Cut out the big ones first - especially caffeine and sleep disruption. Many patients cut their attack frequency by 35% just by quitting caffeine and fixing their sleep schedule.

How to Stop an Attack When It Hits

When a vestibular migraine attack starts, your goal is to calm the brain down fast. Here’s what actually works:

For Headache Pain:

• Triptans (like sumatriptan): These are migraine-specific drugs. They work for the headache part in about 70% of cases. Take them as soon as you feel the attack coming on - not after it’s full force.
• NSAIDs (ibuprofen, naproxen): Good for milder pain. Take 400-800 mg of ibuprofen early. They’re less effective than triptans but safer for long-term use.

For Dizziness and Nausea:

• Prochlorperazine (5-10 mg): This is the go-to for vertigo. It reduces dizziness in 68% of people within two hours. Available as a pill or suppository.
• Ondansetron (4-8 mg): Great for nausea. Doesn’t help dizziness directly, but makes it bearable.
• Benzodiazepines (like lorazepam): These can help with severe spinning, but only use them once in a while. Long-term use can make your balance worse over time.

Don’t rely on these for daily use. They’re for rescue, not prevention. And always avoid prolonged use of sedatives - they can stop your brain from relearning how to balance properly.

Non-Drug Rescue Tactics:

• Go into a dark, quiet room. Light and noise make symptoms worse.
• Drink 2 liters of water. Dehydration worsens dizziness.
• Stay still. Don’t try to power through it. Rest is medicine here.

Preventing Attacks Before They Start

If you have more than 4 attacks a month, prevention is not optional - it’s essential. Delaying treatment can lead to your brain becoming hypersensitive, making attacks longer and more frequent. Experts say 30% of people who wait develop chronic dizziness within two years.

First-Line Preventive Medications:

• Propranolol (40-160 mg daily): A beta-blocker. Studies show 62% of patients cut their attacks in half. Common side effects: fatigue, low heart rate.
• Amitriptyline (10-75 mg at night): A tricyclic antidepressant. Works well for both headache and dizziness. Side effects: drowsiness (reported by 65% of users), dry mouth.
• Topiramate (25-100 mg daily): An antiseizure drug. 54% of users see over 50% reduction in attacks. Side effects: brain fog, tingling, weight loss.
• Verapamil (120-240 mg daily): A calcium channel blocker. Good for people who can’t take beta-blockers.

Flunarizine (5-10 mg daily) is widely used in Europe and has strong evidence, but it’s not approved in the U.S. Ask your neurologist if it’s an option.

Supplements That Actually Help:

Many people prefer natural options. The most effective, backed by clinical trials:

• Magnesium (600 mg daily): Helps calm overactive nerves. Often used in combination with other preventives.
• Riboflavin (B2) (400 mg daily): Shown to reduce attack frequency by 40% in the CHARM study.
• Coenzyme Q10 (300 mg daily): Also reduces frequency by 30-40%, with almost no side effects.

Butterbur was once popular, but it’s been pulled from most shelves since 2015 due to liver damage risks. Skip it.

Vestibular Rehabilitation Therapy (VRT)

This is the most underrated tool in vestibular migraine management. VRT isn’t physical therapy for your ears - it’s brain retraining. You do simple, guided exercises that slowly expose your balance system to movement in a controlled way. Over time, your brain learns to ignore false signals.

A 2018 study found that after 8 weeks of VRT, patients improved their dizziness handicap scores by 40%. In a 2020 study, 78% of people who completed 12 sessions reported over 50% symptom reduction. You don’t need to be dizzy to start - even people with mild symptoms benefit.

Find a physical therapist trained in vestibular rehab. You’ll do exercises like:

• Slow head turns while keeping eyes focused
• Walking with head movements
• Balance exercises on foam or one foot

Do them daily. It takes 3-6 months to see full results, but many feel better within weeks. It’s the only treatment that helps your brain adapt long-term.

What Doesn’t Work - and Why

Many people waste time and money on treatments that don’t touch the root cause:

• Diuretics (like hydrochlorothiazide): Used for Ménière’s disease. Only 20% of VM patients respond - they’re useless here.
• Corticosteroids: Help vestibular neuritis (an infection), but only 30% of VM patients improve with them.
• Prolonged benzodiazepines: Can cause dependency and prevent your brain from recovering balance function.
• Ear surgery: If you’ve been misdiagnosed with BPPV or Ménière’s, surgery won’t fix VM. It can make things worse.

These treatments might seem logical - but they’re targeting the wrong system. VM is a brain disorder, not an ear one.

What’s New in 2026?

There’s real progress. In 2023, the FDA approved atogepant, a new preventive drug that targets CGRP (a molecule involved in migraine). In VM patients, it reduced attacks by 56%. Another drug, rimegepant, showed 49% fewer vertigo days in a 2022 trial.

Researchers are also testing non-invasive devices like gammaCore, a handheld device that stimulates the vagus nerve. In a 2021 trial, it cut vertigo by 45%.

And the biggest hope? Blood or brainwave tests that can diagnose VM reliably. Early studies using vestibular-evoked myogenic potentials (VEMPs) are 82% accurate - meaning a simple test might soon replace years of guesswork.

How to Get Started

Here’s your action plan:

1. Start a symptom diary for 6-8 weeks. Track triggers, timing, and severity.
2. Eliminate caffeine and fix your sleep schedule. This alone helps many people.
3. See a neurologist who specializes in headaches or vestibular disorders. Ask if they’re familiar with ICHD-3 criteria.
4. Ask about vestibular rehabilitation. Get a referral to a physical therapist trained in VM.
5. If attacks are frequent, discuss preventive meds. Start with one - don’t stack them.
6. Try magnesium, riboflavin, and CoQ10. They’re safe and often effective.

You don’t have to live with this. With the right approach, 65% of people see major improvement. It takes time, patience, and sometimes trial and error - but you can get your life back.