Vestibular migraine is a migraine-related disorder that causes episodes of vertigo, dizziness, and motion sensitivity that can happen with a headache, before one, or with no headache at all. It is one of the most common causes of recurrent dizziness in adults, and it is frequently mistaken for an inner-ear problem. At Vertigo Atlanta & Physical Therapy, Dr. Jose Crespo DPT uses infrared Video Frenzel assessment to determine if a vestibular migraine is what’s driving your dizziness. We then treat the vestibular symptoms with targeted rehabilitation alongside your broader migraine care.
Vestibular migraine is a form of migraine in which the dominant symptom is dizziness or vertigo rather than headache. During an episode you may feel a spinning or rocking sensation, lightheadedness, unsteadiness, or a strong sensitivity to motion and busy visual environments. These episodes typically last anywhere from five minutes to seventy-two hours, and they can occur with a headache, before or after one, or with no headache at all. That last point is why it is so often missed: many people never connect their dizziness to migraine.
It is one of the most common causes of recurrent spontaneous vertigo in adults, with an estimated lifetime prevalence of roughly one to three percent of the population, and it sits alongside BPPV as a leading reason adults develop episodic vertigo. The diagnosis is made by a pattern: recurring vestibular episodes, a personal history of migraine, and migraine features (such as headache, light and sound sensitivity, or visual aura) showing up during at least half of those episodes, once other causes have been ruled out.
See how we tell vestibular migraine apart from other causes →
Vestibular migraine looks different from person to person and even from episode to episode in the same person. Most presentations fall into three overlapping groups. You do not need all of them, and you do not need a headache, to have vestibular migraine.
The central symptom is a sense of movement that is not really happening, or a feeling of being off balance. It usually comes in episodes rather than constantly.
Migraine symptoms may accompany the dizziness, or may not appear at all during a given episode. Their presence is part of how the diagnosis is confirmed.
Many people with vestibular migraine become highly reactive to movement and to complex visual scenes, both during episodes and between them.
There is no blood test or scan that confirms vestibular migraine. It is diagnosed when recurring episodes of moderate-to-severe vertigo or dizziness (lasting five minutes to seventy-two hours) line up with a history of migraine, with migraine features appearing during at least half of those episodes, and once other vestibular causes have been excluded. That last step is where Dr. Crespo’s assessment matters: the dizziness has to be the migraine kind, not a treatable inner-ear problem wearing the same mask.
Under infrared Video Frenzel lenses, the eye-movement pattern helps separate a central, migraine-related mechanism from a peripheral inner-ear cause such as BPPV. The difference changes the entire treatment plan, so it is worth getting right before any exercises begin.
| Vestibular Migraine | BPPV | PPPD | |
|---|---|---|---|
| Trigger | Migraine triggers (stress, sleep, diet, hormones); often spontaneous | A specific change in head position | Upright posture, motion, busy visual environments |
| Episode length | 5 minutes to 72 hours | Seconds to about a minute per position change | Persistent; present most of the day, most days |
| Tell-tale feature | May include headache, light/sound sensitivity, or visual aura | Brief, intense spinning tied to rolling over or looking up | Constant rocking or swaying that worsens with activity |
| First-line care | Migraine management + vestibular rehab + trigger control | Canalith-repositioning maneuvers (e.g., Epley) | Vestibular rehab, often with CBT and/or medication |
Triggers differ from person to person, and identifying yours is part of treatment. Common ones include:
Part of what Dr. Crespo does is help you connect your episodes to their patterns, so the triggers you can control become part of the plan rather than a mystery.
Vestibular migraine responds best to a combined approach, and no single piece does the whole job. Here is the part Dr. Crespo owns, and where he coordinates with the rest of your care.
Targeted gaze-stabilization, habituation, and balance exercises retrain the brain’s response to motion and reduce the dizziness and visual-motion sensitivity that vestibular migraine creates. Research supports vestibular rehabilitation for migraine-related dizziness, and it works best as part of medical migraine management.
Sleep, hydration, meals, stress, and screen and visual-motion exposure are mapped to your episodes so the factors you can control become part of the plan. This is education and coaching, not a prescription.
Migraine itself is managed medically. Dr. Crespo works alongside the physician or neurologist handling your migraine medication and prevention, so the vestibular rehab and the medical plan pull in the same direction.
These are real infrared recordings from assessments, not stock footage. The eye-movement pattern is one of the clues that tells Dr. Crespo whether dizziness points toward a central, migraine-related mechanism or a peripheral inner-ear problem, which is what determines the right treatment.
The honest answer is encouraging but measured. Published reviews and a systematic review of vestibular rehabilitation for vestibular migraine report that it can reduce vestibular symptoms, dizziness-related disability, and motion sensitivity, with the strongest results when rehabilitation is paired with the physician’s migraine management. The evidence base is smaller and less conclusive than it is for inner-ear disorders such as vestibular neuritis, which is why we describe vestibular therapy here as a well-supported part of the plan rather than a standalone cure.
What that means in practice: vestibular therapy is not symptom masking, and it is not a replacement for migraine treatment. It is the piece that retrains how your brain handles motion, working in the same direction as the medical care managing the migraine itself.
We don’t treat the dizziness in isolation. We treat it next to the migraine plan, so the two reinforce each other.
If vestibular migraine does not fit your pattern, one of these often does. An assessment confirms which.
Dr. Jose Crespo is a Doctor of Physical Therapy specializing in vestibular rehabilitation in Atlanta. Many people with vestibular migraine spend years bouncing between specialists because their dizziness was never connected to migraine. Dr. Crespo makes the mechanism visible with infrared Video Frenzel recording, identifies whether migraine is what is driving your symptoms, and builds vestibular rehabilitation around the finding, working alongside the physician managing your migraine. Every visit is direct, one-on-one care.
The assessment is not a formality. It is the first answer the patient receives.
A vestibular migraine is a form of migraine whose main symptom is dizziness or vertigo rather than headache. Episodes typically last from five minutes to seventy-two hours and can happen with a headache, before or after one, or with no headache at all. It is one of the most common causes of recurrent vertigo in adults.
Yes. This is one of the defining and most confusing features of vestibular migraine. The dizziness, vertigo, and motion sensitivity can occur entirely on their own, which is why the condition is so often mistaken for an inner-ear problem. The diagnosis relies on a personal history of migraine and migraine features (such as light sensitivity or aura) appearing during at least half of the dizziness episodes, not on a headache being present every time.
The pattern is the clue. BPPV produces brief, intense spinning that is triggered by a specific head position, such as rolling over in bed or looking up, and each spell lasts seconds to about a minute. Vestibular migraine produces longer episodes, from minutes to days, that are tied to migraine triggers and may come with headache, light and sound sensitivity, or visual aura. BPPV is treated with repositioning maneuvers; vestibular migraine is treated with migraine management plus vestibular rehabilitation. Dr. Crespo’s infrared assessment helps tell them apart before any treatment begins.
Common triggers include stress (and the let-down after stress), poor or irregular sleep, hormonal changes, dehydration and skipped meals, certain foods and drinks such as aged cheese, red wine, chocolate, and MSG, bright light and loud sound, busy visual environments, and weather changes. Triggers vary from person to person, and identifying yours is part of treatment.
Vestibular migraine responds best to a combined approach: medical migraine management led by your physician, vestibular rehabilitation to reduce the dizziness and motion sensitivity, and trigger and lifestyle management. Dr. Crespo provides the vestibular rehabilitation and trigger education and coordinates with the physician handling your migraine medication. Research supports vestibular therapy for migraine-related dizziness, with the best results when it is paired with medical migraine care.
Often both, in coordination. Migraine itself is a medical diagnosis managed by a physician or neurologist, who handles medication and prevention. A vestibular physical therapist like Dr. Crespo assesses whether your dizziness is migraine-driven or another vestibular cause, then treats the vestibular symptoms with rehabilitation.
Real Google reviews from people who came in dizzy and left with a plan.
Call or request an appointment. Your evaluation records what your eyes are doing, helps separate migraine-related dizziness from an inner-ear cause, and sets a vestibular rehabilitation plan that works alongside your migraine care.
