The Mystery of ‘Vestibular Migraine’

Vestibular Migraine

Regular episodes of vertigo (a sensation of whirling and loss of balance – with or without headache or nausea), often leads to a diagnosis of Vestibular Migraine (VM), though it usually takes some time to come to this conclusion, because Vestibular Migraine is only diagnosed after all other possibilities have been ruled out. This is the nature of Vestibular Migraine; inviting mystery and controversy.

The Vestibular System is responsible for our i) sense of balance and ii) awareness of where we are in relation to our surroundings and then iii) coordinating the two.


The cause of VM is unknown, although, despite the logical assumption that a disorder of the Vestibular System is responsible, research does not support this, but suggests that the Brainstem is involved.


This not surprising given that there is widespread agreement that the underlying disorder in Migraine is a sensitised Brainstem.  The possibility that the Brainstem is sensitised in VM is supported by research demonstrating significant improvement in dizziness and motion sickness in migraineurs after taking a ‘triptan’ (the triptans are specific anti-migraine medication which prevents migraine by temporarily DE-sensitising the Brainstem).


Current treatment of VM is problematic; there is no single, preferred preventive medication. Indeed, pharmaceutical management for both acute episodes and prevention is a process of ‘trial and error’, relying heavily on clinical experience. 


Vestibular Migraine episodes are often provoked by head movements. For some, episodes are triggered by moving visual activity such as traffic or movies. Patients are often advised to avoid triggers, however, motion is a part of life; avoiding movement is virtually impossible and an unacceptable option. Furthermore, we are surrounded visual activity!


The assumption that a disorder of the Vestibular System is responsible for VM often leads to treating the Vestibular System – why?  Research shows that the Vestibular System in VM is normal.

Research suggests that the vestibular system is normal in VM; that the Brainstem in VM is sensitised and that neck disorders can sensitise the Brainstem, a disorder of the neck could be responsible for VM… it seems logical that a skilled examination of the neck occurs when investigating VM.


Clinical experience has identified signs and symptoms suggesting that a neck disorder is responsible and these are:

  • a past-history of Migraine or headache
  • VM started within weeks or months of head and /or neck trauma
  • often headache is not a prominent feature, but if headache is present and it is one-sided and/or changes sides between VM episodes or within the same episode
  • associated neck discomfort or stiffness
  • decreased range of movement neck movement
  • symptoms provoked by certain head positions or movements
  • symptoms of short duration and decreasing intensity

Examination of the upper cervical spine could identify the reason for sensitisation of the Brainstem in VM and these disorders can be treated successfully, lessening the impact of, or preventing, VM.  This examination is relatively easy by those skilled and experienced in the Watson Headacheâ Approach.

For further information please call Proactive Physiotherapy 40536222