Vestibular migraine

Vestibular migraine is a form of migraine in which the main symptom is episodes of vertigo or dizziness, lasting anywhere from five minutes to three days, often with little or no headache. It is diagnosed by a physician using criteria from the Bárány Society and the International Headache Society, after other causes of vertigo have been ruled out. Medical management — identifying triggers, lifestyle changes and, when needed, preventive medication — is led by your family doctor or neurologist. Vestibular rehabilitation is a helpful add-on for the motion sensitivity, visual dizziness and imbalance that often linger between episodes. At McKelvie Physiotherapy in Pickering, we assess your dizziness thoroughly, help rule out other inner-ear causes and build a gradual, migraine-friendly exercise program.

What is vestibular migraine?

Vestibular migraine is a type of migraine in which the main symptom is vertigo — a false sense of spinning or movement — or other dizziness, rather than (or as well as) headache. Episodes can last anywhere from five minutes to 72 hours, and many people have dizziness episodes with little or no head pain.

Because the headache is often mild or missing, vestibular migraine is easy to miss. It is diagnosed by a physician using criteria developed by the Bárány Society and the International Headache Society (Lempert et al., 2022). In short, a diagnosis requires:

• repeated episodes of moderate or severe vestibular symptoms lasting five minutes to 72 hours
• a current or past history of migraine
• migraine features — such as a migraine-type headache, sensitivity to light and sound, or a visual aura — during at least half of the episodes
• no other condition that better explains the symptoms

That last point matters: other conditions, such as BPPV or Ménière’s disease, can cause similar symptoms and need to be considered first.

What causes vestibular migraine?

The exact cause isn’t fully understood. Vestibular migraine is thought to involve the same brain mechanisms as other types of migraine, affecting how the brain processes balance, movement and sensory information. It often runs in families, and many people have had migraine headaches earlier in life.

Episodes are often set off by triggers, which vary from person to person. Common ones include:

• poor or irregular sleep
• stress, or the let-down period after stress
• skipped meals or dehydration
• hormonal changes, such as around a menstrual period
• certain foods or drinks
• bright or flickering lights, busy visual environments and motion

What are the symptoms of vestibular migraine?

• Spinning or rocking vertigo that comes in episodes
• Dizziness brought on by head movement, or by busy visual environments such as grocery store aisles, crowds or scrolling screens
• Imbalance or unsteadiness
• Nausea, and sometimes vomiting
• Sensitivity to light, sound or motion
• Headache — before, during or after the dizziness, or not at all
• Visual aura, such as flashing lights or zig-zag lines, in some people

Between episodes, many people feel normal. Others are left with lingering motion sensitivity, visual dizziness or a sense of being off-balance.

How is vestibular migraine treated?

Vestibular migraine is usually managed by a team, and it helps to know who does what.

Your family doctor or neurologist confirms the diagnosis and leads the medical management. This typically includes identifying and managing triggers, lifestyle measures such as regular sleep and meals, and — if episodes are frequent or disabling — medication to treat attacks or prevent them.

A vestibular physiotherapist plays a supporting role. We can help rule out other inner-ear causes of dizziness, such as BPPV, and treat the motion sensitivity, visual dizziness and imbalance that often linger between episodes. Vestibular rehabilitation uses gradual, carefully dosed exercises to help your brain adapt to movement and busy visual environments, along with balance training. A 2026 systematic review found that people with vestibular migraine reported meaningful improvement in dizziness-related disability on average after vestibular rehab — but the studies were quite different from one another, so more high-quality research is needed (El Ahdab et al., 2026).

If we think you need a medical review — for example, to confirm the diagnosis or discuss medication — we’ll tell you.

1. 01

   Assess

   A detailed history of your episodes and triggers, plus an eye-movement and balance assessment with infrared video goggles, to look for other causes such as BPPV.

2. 02

   Plan

   A gradual, migraine-friendly program of habituation, gaze-stability and balance exercises, paced so symptoms stay mild and settle quickly.

3. 03

   Progress

   Steady progression towards the movements and environments that bother you most, with guidance on pacing and on when to check in with your doctor.

Why choose McKelvie Physiotherapy for vestibular migraine?

• Vestibular specialists — our lead physiotherapist holds the Advanced Vestibular Physical Therapist (AVPT) certification.
• Advanced diagnostic technology — we use infrared video goggles (video-oculography) to record eye movements the naked eye can’t see, so your diagnosis is based on evidence, not guesswork.
• A thorough assessment — to help rule out other causes of your dizziness.
• Care that respects migraine — exercises are introduced gradually and adjusted to how you respond.
• One-on-one care in private rooms — a calm setting can make a real difference when you’re sensitive to light, sound and movement.
• Care that comes to you — in person in Pickering, at home across the GTA, or virtually anywhere in Ontario.
• Direct billing to many major insurers — and no referral needed.