7 Triggers of Vestibular Migraine

There are many types of migraine that don’t always cause a headache and aura. A vestibular migraine is a term used to refer to an episode of vertigo in a person who has a history of migraines. People who experience vertigo often feel like they or the objects around them are moving or spinning around when they are actually not. Vestibular refers to the system present in your inner ear that is in charge of your body’s control. While migraines are typically associated with painful headaches, vestibular migraines are different since the attacks do not usually involve headaches. Many people, though, who get the classic or basilar migraines with auras, also can experience vestibular migraines, but this is not the case for all people. Let us look at what are the triggers for vestibular migraine and how it can be treated.

Vestibular migraine is a type of headache that is characterized by symptoms like vertigo, dizziness, and sensitivity to sound and light. The term vestibular typically refers to the system located in the inner ear, which is responsible for controlling the body’s balance.^{(1, 2, 3, 4)}

According to the World Health Organization (WHO), headache disorders, like vestibular migraine, are one of the most common nervous system disorders, and they affect around 50 percent of all adults all over the world.^{(5, 6)}

Medical experts are not entirely sure about what causes vestibular migraine. Most of the knowledge that is known about the triggers, diagnosis, and treatment of this type of headache is derived from the research carried out to date, but this also does not particularly focus on this condition. However, some experts believe that the abnormal release of chemicals in the brain might play a role in causing vestibular migraines. Women are also at a higher risk of getting vestibular migraines. Doctors also suspect that this type of migraines runs in families, though studies are yet to prove this hereditary link.^{(7, 8, 9)}

However, according to a review of scientific literature carried out in 2017, the research suggested that the leading triggers of vestibular migraine include:⁽¹⁰⁾

• Hormonal changes
• Sleep problems or lack of sleep
• Certain types of foods
• Certain medications
• Dehydration
• Weather changes or changes in barometric pressure
• Stress

Let us take a closer look at the potential triggers of vestibular migraine, how to relieve the symptoms, and when it is time to seek professional medical help.

1. Hormonal Changes

   Hormonal fluctuations, such as those that occur during hormone therapy, menstruation or menopause, are one of the most common triggers of not only migraine but also specifically of vestibular migraine.^{(11, 12)}

   One of the biggest studies carried out on migraine in 2007 found that hormones were a major trigger for nearly 65 percent of the participants in the study.⁽¹³⁾ However, it is essential to keep in mind that these findings were only based on self-reporting done by the participants.

   The primary hormone associated with migraine is estrogen. As per a study done in 2021, both the increase and decrease of estrogen are associated with the development of migraine.⁽¹⁴⁾ When the levels of estrogen fall or rise, it causes various changes in inflammatory markers in the blood along with blood pressure. Both of these are believed to be the triggers for migraine episodes.

2. Sleep Disturbances

   Sleep disturbances include difficulty staying or falling asleep, along with poor sleep quality. These are known triggers for vestibular migraine. According to research done in 2019, people who have vestibular migraine experience a poorer quality of sleep. This, in turn, triggers more frequent episodes of migraine.⁽¹⁵⁾

   Researchers believe that poor quality of sleep or lack of sleep can contribute to the development of migraine as it activates the amygdala and the hypothalamus, both of which cause the changes in the brain that are associated with causing migraine.

   In the long term, the impact of stress from poor sleep on the brain can also cause changes that coincide with a higher frequency of migraines.

3. Certain Types of Foods

   Certain foods are also known to be a big trigger for migraine. These foods are known to act as a trigger for vestibular migraine as well. According to a research review done in 2020, some of the common foods that act as migraine triggers include:⁽¹⁶⁾

   • Alcohol
   • Chocolate
   • Nuts
   • Aspartame
   • Caffeine
   • Citrus fruits
   • Coffee
   • Cheese
   • Dairy
   • Monosodium glutamate (MSG)
   • Processed meats
   • Foods high in fat
   • Foods that contain yeast

   It is believed that certain compounds present in some of these foods, especially phenolic (aromatic) compounds in fruits and alcohol, play a major role in triggering migraine. Many of these compounds interact with different pathways in the brain that are involved in the development of a migraine attack. However, the exact relationship between migraine and food triggers is not completely understood, and further research is still needed.^{(17, 18, 19)}

4. Certain Medications

   There are some types of medications, especially those that change the hormone levels in the body or impact blood vessel dilation, which may also act as a trigger for vestibular migraine as a side effect. Additionally, certain medications may be more prone to causing vestibular migraine if they are consumed too frequently.

   Some medications that may trigger vestibular migraine headaches are as follows:

   • Antidepressants
   • Hormone replacement therapy
   • Analgesics
   • Combination pain relievers
   • Ergotamine
   • Opioids
   • Triptans
   • Oral contraceptives

   There is limited research available on the exact link between these medications and vestibular migraine, and more studies are needed.

5. Weather Changes

   Changes in the weather, such as in temperature or in barometric or atmospheric pressure, are also a significant cause of vestibular migraine. Generally, barometric pressure tends to change very slightly throughout the day. However, it can also fall and rise drastically depending on the current weather. According to a review done in 2021, two studies found an association between dramatic changes in atmospheric pressure with migraine attacks.⁽²⁰⁾ Furthermore, specific weather patterns can also impact the atmosphere’s atomic composition, which may affect various levels of chemicals in the brain that are associated with triggering a migraine.

   Based on a self-report study done in 2019, a hot and humid climate is also known to trigger migraine episodes.⁽²¹⁾

6. Psychological Stress

   There are numerous factors that can cause psychological stress, especially in the stressful times we live in today. You may experience both minor and major sources of stress, including:

   • Physical or mental health conditions
   • Accidents or injuries
   • Loss

   Stress is a significant trigger for both vestibular migraine and other forms of migraine. In 2007, a study found that nearly 80% of the participants cited stress as being a trigger for their migraine symptoms.⁽¹³⁾

   According to the UK-based National Health Service (NHS), stress is known to be a significant trigger for migraine as it activates certain pathways in the brain. This involves certain nerves, blood vessels, and chemicals.⁽²²⁾ When stress activates the part of the brain known as the hypothalamus, these pathways get activated along with many other brain areas, thus triggering migraine.

Light changes, especially if it involves flashing or bright lights, are another well-known trigger for vestibular and other forms of migraine.

In 2007, the study mentioned above found that around 38 percent of participants found light to be a trigger for their migraine, making it a likely trigger for vestibular migraine as well.⁽¹³⁾

Based on another 2017 study, though, researchers found that apart from being a trigger for migraine, light also impacts how severe the migraine symptoms are.⁽²³⁾ According to this research, it is believed that the connection between the neurons in the eyes and pathways in the brain are associated with the symptoms of migraine.

Although vestibular migraine is categorized under the category of ‘migraine,’ it does not automatically cause a bad headache that is usually associated with migraine.

However, that said, some people with vestibular migraine may very well experience an excruciating throbbing headache.

Vestibular migraine is usually characterized by symptoms of the vestibular system of the body, along with some other commonly known migraine symptoms such as sensitivity to sound and light.

Symptoms of vestibular migraine tend to vary from person to person but usually include the following:

• Dizziness
• Nausea and vomiting
• Loss of balance
• Vertigo caused by motion
• Sensitivity to sound, light, or smell

According to the current diagnostic criteria published in the Frontiers in Neurology Journal, a diagnosis of vestibular migraine needs to have at least five episodes that include vestibular symptoms and last anywhere between five minutes to 72 hours.⁽²⁴⁾

There is still a lot of research going on to look at the effectiveness of the various treatment options for vestibular migraine. However, as per a research review done in 2020, current treatment recommendations for vestibular migraine include several different types of approaches.⁽²⁵⁾ These include:

Dietary and Behavioral Changes: One of the first steps to take to manage vestibular migraine is to reduce your exposure to the biggest trigger of migraine – foods, and beverages. Maintaining a journal in which you note down your symptoms can help you identify the triggers, especially what foods and drinks trigger the symptoms. Identifying your triggers will help you avoid them. If you find that your symptoms are primarily triggered by diet, you should cut out the trigger foods from your diet. However, if your triggers are caused by your lifestyle, such as poor or disturbed sleep, you should take corrective steps to enhance these parts of your life.

Preventive Medications To Prevent Future Episodes: Prophylactic or preventive medications are known to be the most effective treatment option for vestibular migraine. Preventive medications may include valproic acid, beta-blockers, tricyclic antidepressants, topiramate, and lamotrigine. Flunarizine and venlafaxine have also been found to be effective in preventing vestibular migraine.^{(26, 27)}

Medications To Alleviate The Symptoms During Migraine Attacks: No matter how many preventive medications you take and how many triggers you avoid, but it is not always possible to prevent an episode of vestibular migraine. Medication can help alleviate the symptoms of the migraine attack. Medications may include over-the-counter pain medications, steroids, triptans, and antiemetic drugs. Most of the medicines work by reducing the common symptoms of vestibular migraine episodes, including motion sickness, nausea, and dizziness.⁽²⁸⁾

Complementary or Alternative Treatments: According to a 2018 research review, vestibular therapy is an effective complementary treatment for vestibular migraine.⁽²⁹⁾ Neural stimulation and acupuncture have also been found to be helpful, as shown by a 2019 study and a 2020 review.^{(30, 31)}

Treating a condition like vestibular migraine differs from person to person. It is best to consult a headache specialist to discuss the best treatment options for you.

If you are experiencing the symptoms of vestibular migraine, it is best to fix up an appointment with a doctor at the earliest to get an accurate diagnosis. Any primary physician or general physical would be good first consultation. They may further refer you to a neurologist who will conduct a more in-depth examination and design your treatment plan.

Since vestibular migraine can have a huge impact on the quality of your life, early diagnosis and starting treatment are essential.

If your doctor or neurologist diagnoses you with vestibular migraine, they will prescribe medicines that will help alleviate your symptoms during the migraine attacks.

You may also be asked to maintain a log of your migraine triggers so that you can avoid them in the future. In many cases, doctors also prescribe certain preventive medications to prevent future attacks or at least to reduce the frequency of these attacks.

Even though a vestibular migraine is not dangerous, you should still seek medical assistance right away if you experience the following symptoms:

• A headache that quickly gets worse or does not improve with over-the-counter pain relievers
• Neck stiffness
• High fever
• Muscle weakness
• Confusion or decreased awareness
• Changes in speech or vision
• Tingling or numbness
• Convulsions

Vestibular migraine is a type of migraine that is characterized by vestibular symptoms like vertigo and dizziness, along with the classic migraine symptoms. Such type of migraine can be caused by various triggers, including certain types of foods, medications, changes in weather, and hormonal fluctuations. Treatment for vestibular migraine usually involves lifestyle and dietary modifications and medications for symptom relief and prevention.

If you have been experiencing the symptoms of vestibular migraine, maintain a journal of your triggers and when you visit a doctor, take it along to help them diagnose your condition accurately and suggest the appropriate treatment.

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