Vestibular migraine: what should you know?

Episodes may involve spinning, rocking, unsteadiness or discomfort in busy shops and moving vehicles. Nausea, vomiting, light sensitivity, sound sensitivity or a familiar headache pattern can accompany the balance symptoms, although not every feature appears each time. Symptoms can be triggered by irregular sleep, missed meals, stress, hormonal changes, bright screens, strong smells or visually complex movement. A diagnosis is based on the pattern and examination; dizziness by itself does not establish migraine. Other causes, including inner-ear and neurological conditions, may need consideration.

During an episode, sit or lie somewhere quiet and dim, keep your head movements gentle, and sip fluids. Avoid driving until your balance and vision feel normal. Between episodes, regular meals, consistent sleep, hydration and a record of triggers can make patterns easier to recognise. Reduce avoidable glare and take breaks from screens. A clinician can discuss acute and preventive treatment, especially when symptoms disrupt work, study, sleep or ordinary movement.

Seek emergency help for sudden weakness, numbness, facial drooping, speech difficulty, fainting, seizure, new severe imbalance, loss of vision or a sudden extreme headache. Prompt assessment is needed for fever with a stiff neck, repeated vomiting with inability to keep fluids down, or symptoms after a head injury. Arrange a review for a first episode, a major change in pattern, or attacks that are becoming more frequent or disabling.

Does my combination of vertigo, sensory symptoms and headache fit vestibular migraine? What other causes should be checked? Which symptoms should send me to emergency care, and would a diary or specialist referral help?