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What is Vestibular Migraine?

Vestibular Migraine or Migraine Associated Vertigo (MAV) is a condition which affects the blood supply to the vestibular system and the way the nerves and brain process information from this. When this becomes altered, confusing messages result in the bodies reaction and brain becoming out of sink and symptoms such as vertigo, nausea and headaches result. It is a very complicated condition and while lots of research is being undertaken to try and fully understand it, there is still a lot to do. What is known is the importance of correct diagnosis, appropriate medical management and a compressive physiotherapy rehabilitation programme to gain successful results. Our specialist physiotherapists at are able to provide the support needed with this condition.

Vestibular physiotherapy - passive resetting exercisesAbove: Vestibular physiotherapy - passive resetting exercises

What causes Vestibular Migraine?

Vestibular Migraines work on a similar principle to the classic migraine where restricted blood flow to the brain causes it to not function correctly, producing symptoms such as pain and sensitivity to light.

If you imagine when you reduce the blood supply to your leg, if they stay crossed too long, it causes the muscles to stop working properly and you get pain and pins and needles before it returns to normal once the blood supply returns. The brain produces a similar response when the blood flow is altered except here the wiring system (neural signalling) within it to go wrong until the blood supply is returned. The neural processing and signals within the brain tell our body how to react in different situation.

With Vestibular Migraines the area that controls balance and body awareness are thought to be affected and there is some evidence that chemicals also alter the blood supply to the inner ear which helps control balance.

What are the triggers for a Vestibular Migraine?

There are links with Vestibular Migraine and triggers which you would associate with classic migraines these include:
  • Hormones
  • Weather
  • Food
Having a history of previous migraines, being female and between the ages for 20- 40 are the likeliest group of patients to suffer from Vestibular Migraines.

Vestibular physiotherapy - passive resetting exercisesAbove: Vestibular physiotherapy - passive resetting exercises

What are the symptoms of Vestibular Migraine?

It may sound strange but not everyone diagnosed with Vestibular Migraine will have headaches. The symptoms tend to come in clusters but can be daily and include: It can be quite distressing to have these symptoms until it is understood what is behind the cause. If you have experiencing any of the symptoms above seek out a specialist assessment.

How are Vestibular Migraines diagnosed?

To arrive at a diagnosis of Vestibular Migraine it requires a good history of the condition to be taken along with a battery of tests , of which, no one single test can prove its existence. Possible investigations include:
  • Balance tests
  • Vestibular examination-using various eye, ear and positional tests
  • Examination of the ears
  • Hearing/Audiology tests
  • MRI/CT scans

What is the medical treatment of Vestibular Migraine?

The medical treatment of Vestibular Migraine should be under a neurologist or ear, nose and throat consultant who specialises in vestibular problems. The role of medication is very useful in the early stages along with a review of lifestyle and diet. Medications can include calcium channel blockers, tricyclics, antidepressants, beta-blockers and some anticonvulsant medications. A set diet which takes out the food triggers is employed and can be quite restrictive at first but food groups can be reintroduced at a later date once symptoms have stabilised.

How can physiotherapy help with Vestibular Migraine?

Physiotherapy plays an important role in the treatment of Vestibular Migraine. As the vestibular system is not functioning at the required level a training programme to improve this is used. This makes the system work harder to compensate for these changes.

What physiotherapy will be used to treat Vestibular Migraine?

You will be seen by a specialist physiotherapist at who will complete an assessment which will help to guide you individualised treatment programme. Discussing goals and looking at your lifestyle will also help to decide what approach to use. Some of the treatments use in your physiotherapy sessions may include: Your treatment plan will progress to more challenging activities and exercises as you progress. Treatment with your physiotherapist at will look at all aspects of your lifestyle and all your symptoms and will aim to improve all of these.


Vestibular Migraine or Migraine Associated Vertigo is a complex condition which alters the function of the vestibular system resulting in headaches, vertigo, nausea and balance problems. It can very disabling and have a massive effect on people’s ability to function normally. Getting the diagnosis is the first step to achieving a management programme consisting of medication and physiotherapy rehabilitation. To arrange a specialist assessment by one of our Physiotherapist?s or to get any further information, please call on 0330 088 7800 to book an appointment today. You can also use our online booking system to make an appointment online!

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