This guide is general information, not medical advice. Medicines and treatments must be prescribed or recommended for you by a doctor or pharmacist. We do not give doses here.
Related guides: Migraine with brainstem aura, Migraine without aura.
What it is
Vestibular migraine is migraine that affects the balance system. It is also called migrainous vertigo or migraine-associated vertigo. Episodes follow the usual migraine pattern, including a recovery stage that can last days.
Figures for how common it is vary depending on how it's defined: The Migraine Trust says about 1 in 10 people with migraine get vertigo, while the National Migraine Centre says up to 4 in 10 have some vertigo or balance problems with their attacks.
Symptoms
- Vertigo: spinning, swaying or tilting
- Dizziness, light-headedness or unsteadiness
- Feeling sick with movement
- Sensitivity to light, sound and movement, and to busy visual places such as supermarkets
- Slowed thinking or memory problems
- Headache, which may come before, during or after the vertigo, or not at all
How long episodes last
Diagnosis usually needs at least 5 episodes of vertigo or dizziness lasting between 5 minutes and 72 hours, with migraine features, such as headache or sensitivity to light and sound, in at least half of them. Some episodes last seconds and some days, but most last hours. Getting up, lying down or turning your head can set them off.
Diagnosis
There's no single test, and hearing and balance tests are usually normal. Doctors rule out other causes such as Ménière's disease, benign positional vertigo (BPPV), vestibular neuritis and persistent postural-perceptual dizziness (PPPD). You may be referred to neurology, ENT or a balance clinic.
Treatment
Treating episodes
GP or pharmacy
Painkillers, triptans or gepants for the headache. Medicines for vertigo, such as prochlorperazine, are only meant for a few days at a time. Used regularly they can stop your balance system recovering.
Preventive medicines
GP or specialist
Usually considered if you have symptoms on more than about 8 days a month. Options include amitriptyline or nortriptyline, propranolol, candesartan and topiramate. Each needs a trial of several weeks. Topiramate must not be used in pregnancy, and anyone who could become pregnant needs highly effective contraception while taking it.
Specialist treatments
Specialist
CGRP medicines, Botox and nerve blocks are sometimes used when other treatments haven't worked.
Vestibular rehabilitation
Physiotherapy
Balance exercises help some people, but they can make symptoms worse while migraine is active, so they work best once migraine is better controlled.
When to get urgent help
Sudden vertigo can occasionally be a sign of a stroke.
Call 999 if you have
- sudden vertigo with slurred speech, double vision, weakness or numbness
- sudden, severe headache with vertigo
- you can't stand or walk
- confusion or a seizure (fit)
Call NHS 111 if
- you have severe vertigo for the first time
- an episode lasts more than 3 days
See your GP if
- you keep having dizzy spells
- episodes stop you working or driving
- your vertigo treatment isn't helping
Work and your workspace
Migraine can count as a disability under the Equality Act 2010 (the Disability Discrimination Act in Northern Ireland) if it has a substantial, long-term effect on your everyday life. Conditions that come and go still count, and the law looks at how you would be without treatment. If it applies, your employer must make reasonable adjustments.
Adjustments that often help
- Working from home to avoid travel on bad days
- No driving, ladders or machinery during episodes
- A desk set-up that limits head turning
- Reduced visual clutter and glare
- Flexible hours and rest breaks
A migraine-friendly workspace
- A chair with good lumbar and neck support
- A desk big enough to put your screen at arm's length
- Screen raised so the top is at eye level
- A flicker-free monitor with an anti-glare or blue-light filter
- Lighting without flicker or glare, and blinds to control daylight
Access to Work can pay towards equipment and support. Acas and Citizens Advice give free advice on your rights.
How The Beyond Pain Foundation can help
If NHS waits are too long, or the help you need is not available to you on the NHS, we may be able to fund:
- A private appointment with a headache or neuro-otology specialist for a faster diagnosis
- Private vestibular rehabilitation once your migraine is under control
- A home-working set-up that limits triggers: a supportive chair with neck support, a large desk so your screen sits straight ahead, and anti-glare screens
- Travel costs to specialist appointments
Every award depends on your situation and the funds we have that month. A letter from your doctor, a headache diary and a written quote all help your application.
Support and sources
The Migraine Trust
Information and support service
Information on every type of migraine, a free information and support service, and advice on treatment and work.
migrainetrust.orgNational Migraine Centre
Charity headache clinic
Specialist appointments in person and online, including routine appointments for a voluntary donation, plus free factsheets.
nationalmigrainecentre.org.ukNHS
Health information
Symptoms, treatment and when to get help with migraine and headache.
nhs.uk/conditions/migraineSources for this guide
Written in our own words from the sources above. Last reviewed: October 2026. Figures can differ between sources; where they do, we give the range.