Navigating the Storm: Understanding Vestibular Migraine During Migraine Awareness Month

Lisa Brekke, PT, DPT

Board-Certified Clinical Specialist in Neurological Physical Therapy

June is Migraine Awareness Month, a time dedicated to shedding light on the many faces of migraine — a complex neurological condition that affects more than 1 billion people globally. A sub-type of migraine is known as vestibular migraine, a condition where dizziness and balance issues become the biggest complaint, often more than head pain.

What Is Vestibular Migraine?

Vestibular migraine (VM) is a type of migraine that primarily affects the vestibular system, which controls balance and spatial orientation. Unlike the more familiar migraine with intense headache, VM may or may not involve head pain. Instead, its hallmark symptoms include:

• Vertigo (a spinning sensation)

• Unsteadiness or imbalance

• Motion sensitivity

• Nausea

• Brain fog

• Visual disturbances

These episodes can last minutes to hours — or even days, making daily life unpredictable and physically draining.

Who Gets Vestibular Migraine?

Vestibular migraine is more common than many realize, affecting approximately 1–3% of the population, and it tends to occur more frequently in women, often with a history of migraine. Genetics, hormonal shifts, stress, and certain sensory stimuli (like bright lights or strong smells) can all contribute to its onset.

The Diagnosis Dilemma

One of the challenges with VM is that it mimics other inner ear disorders, such as Meniere’s disease or benign paroxysmal positional vertigo (BPPV). There are no definitive tests, which makes diagnosis heavily reliant on clinical history and symptom tracking. Patients may see multiple specialists — from ENTs to neurologists — before receiving a correct diagnosis.

Treatment Options

There is no one-size-fits-all treatment, but management usually involves a combination of lifestyle adjustments, vestibular therapy, and medications, such as:

• Migraine preventatives

• Migraine rescues

• Diet modifications (avoiding common triggers like caffeine, alcohol, or aged cheeses)

• Stress reduction and consistent sleep routines

Many patients also benefit from vestibular rehabilitation therapy (VRT), a specialized form of physical therapy that helps the brain adapt to changes in balance signals.

Living With Vestibular Migraine

The unpredictable nature of vestibular migraine can be isolating and disruptive. It can affect work, social life, and mental health. However, raising awareness is a powerful step in validating experiences and promoting earlier diagnosis and better care.

Migraine Awareness Means Inclusion

As we spotlight migraine during June, it's vital to remember all its forms — including those that don’t always come with a throbbing head. Vestibular migraine can be just as disabling, even if it hides behind a veil of dizziness rather than pain.

Let’s use this month to advocate, educate, and support those navigating the silent spinning world of vestibular migraine.

Have you or someone you know experienced vestibular migraine? Share your story or resources in the comments to help spread awareness.