As a pharmacist with more than 30 years of clinical experience, I’ve seen many patients misdiagnosed before learning they actually had vestibular migraine. Before we dive into what vestibular migraine is, I want to say something important.
This is not the easiest article for me to write, and I hesitated before tackling it. The reason is simple: there isn’t a single test that definitively diagnoses vestibular migraine. Doctors usually arrive at this diagnosis by exclusion, meaning they run tests to rule out other possible causes first.
Many people who experience what I sometimes call a ‘dizziness migraine’ don’t realize that the spinning or floating sensation can actually be part of the migraine process itself, even when the head pain is mild or completely absent. That’s one reason vestibular migraine is so often missed.
You might read this and think you can simply go ask for a test to confirm whether you have vestibular migraine, but unfortunately it doesn’t work that way. In other words, the symptoms can overlap with many different conditions. Depending on the person, doctors may evaluate things such as:
• Autonomic conditions such as POTS (postural orthostatic tachycardia syndrome). You may be interested in HOW DIZZINESS and POTS repond to choline.
• Persistent dizziness syndromes like PPPD (persistent postural-perceptual dizziness)
s• Neurological causes including rare structural issues like tumors or other abnormalities
So before we go further, I want to be clear: this article is not meant to send you on a wild goose chase.
At the same time, if you’re someone who has struggled with unexplained dizziness, brain fog, visual changes, or balance problems—and all the tests keep coming back “normal”—I want to offer a little hope and possibly a new perspective.
You know me. I don’t shy away from complex topics. Together we’ve tackled some pretty challenging subjects over the years, including MRI contrast safety, sinus fungal balls, small fiber neuropathy, and Lyme disease. So “hard topics” are nothing new around here.
But my goal today is not to overwhelm you.
It’s simply to help you recognize a migraine pattern that many people—and sometimes even doctors—miss.
Now let’s talk about vestibular migraine, what it is, and how to approach it naturally. A vestibular migraine is a neurological condition that affects the brain’s balance system. People may experience dizziness, motion sensitivity, rocking sensations, or a feeling of being off-balance even when head pain is mild or absent. Some describe it as a migraine with vertigo, while others notice visual aura, brain fog, or sudden imbalance that seems to come out of nowhere. Vestibular migraine symptoms can last minutes, hours, or sometimes even days.
And for years I thought (and maybe you thought) that migraines were basically bad pounding headaches, where you need a dark room… and maybe people experiencd nausea or vomiting. That’s the version most people recognize. I’ve never had a migraine, but this is what I think most of us assume.
But over time (through my research and conversations with people who had unrelenting, and unfixable headaches), I’ve learned something surprising: NOT ALL MIGRAINES HURT.
Some migraines show up as dizziness, brain fog, strange visual disturbances, or a floating sensation. Because these symptoms don’t look like the classic pounding headache, they often go unrecognized for years. If you think you have a small lesion, read this article posted on the WEBSITE for the American Migraine Foundation.
Many people describe it to me like this:
“I feel like I’m walking on a boat.”
“My head feels foggy all day.”
“I feel slightly drunk, but I don’t drink.”
When that happens, doctors sometimes diagnose vestibular migraine, a form of migraine that affects the brain’s balance system.
And in my opinion, this condition is dramatically underdiagnosed.
First, What Is a “Regular” Migraine?
A classic migraine usually involves:
• moderate to severe head pain
• throbbing or pulsating sensation
• nausea or vomiting
• sensitivity to light or sound
• worsening with activity
Many people also experience migraine aura, which can include visual disturbances such as shimmering lights, blind spots, or temporary vision loss lasting 20–60 minutes. Migraine is not simply a headache disorder. It is a neurological condition involving brainstem signaling, nerve excitability, and changes in blood vessel behavior in the brain.
Some describe their condition as a “migraine with vertigo,” where balance problems, nausea, and sensitivity to motion appear before or instead of the headache. 
What Is Vestibular Migraine?
Vestibular migraine is a subtype of migraine that affects your vestibular system, which is the part of your brain (and inner ear) that’s responsible for balance and spatial orientation. If you have poor coordination, that could be a sign that there’s something wrong with your vestibular system. So instead of severe head pain like you might expect, the dominant symptoms are more like this:
• dizziness or lightheadedness
• a floating or rocking sensation (or feeling “boaty” as some people call it)
• episodes of vertigo
• imbalance when walking
• motion sensitivity (you can’t go on roller coasters or watch iMax movies, or be spun around)
• pressure in the ears
• brain fog or fatigue
Headache can occur (I’m not saying it never does), but in many people with vestibular migraine it’s surprisingly mild—or sometimes completely absent. That’s one reason doctors miss it, and people end up labeled with something vague like “anxiety” or simply “dizziness.” You guys know how much I hate a misdiagnosis—I feel like I say that almost every week, right?
Interestingly, research published in Frontiers in Neurology reports that vestibular migraine is one of the most common neurological causes of recurrent dizziness, yet it remains widely underdiagnosed.
Where the Term “Vascular Migraine” Fits In
You may also hear the phrase vascular migraine. That’s a little different than “vestibular migraine.”
Historically, scientists believed migraines were primarily caused by changes in brain blood vessels, such as constriction followed by dilation. Because of that theory, migraines were often called “vascular headaches.”
Modern research shows migraine is actually more complex. It involves:
• nerve signaling in the brainstem
• sensory processing pathways
• inflammatory molecules such as CGRP
• changes in blood vessel activity
So while vascular changes are part of migraine, the term vascular migraine is now considered an older descriptive phrase, not a specific diagnosis.
Today, doctors use more precise terms such as:
• migraine with aura
• chronic migraine
• vestibular migraine
In other words: All migraines involve vascular changes, but not all migraines are vestibular migraines.
Your Personal “Migrenade”
If you’ve followed my work, you’ve probably heard me talk about your migrenade. Migraines usually occur when several triggers combine together.
Everyone’s recipe is different.
In my article
“6 Causes for Migraine Headaches – What’s Your Migrenade?”
I explain how identifying your personal trigger mix can help you reduce migraine frequency. You can read it HERE.
Some common ingredients in the migrenade include:
- Magnesium depletion
- Sleep disruption
- Blood sugar swings (Learn how to control those by reading THIS ARTICLE).
- Hormonal changes
- Dehydration
- Stress or nervous system overload
When enough of those ingredients combine, the brain’s migraine circuits may activate. Sleeping can’t be overemphasized. Do you take sleeping pills?!
The Truth About Ambien: Sleepwalking, Side Effects, and Safer Alternatives
Natural Strategies That May Help a Vestibular Migraine
Migraine brains are often electrically sensitive. Supporting nerve stability and mitochondrial energy can help calm these pathways.
Here are a few natural strategies that many clinicians recommend.
Magnesium
Magnesium helps stabilize nerve signaling and relax blood vessels in the brain.
Low magnesium levels are frequently seen in migraine sufferers. That’s one reason I formulated my magnesium supplement—to provide a well-absorbed form that supports the nervous system.* Are you taking the right kind of magnesium? Some types at the store are useful for osteoporosis and mood, while others are only useful for you if you have constipation. FIND OUT.
Just as an aside, magnesium may also help with other issues:
• improve sleep quality*
• reduce muscle tension*
• help with restless legs*
All of these influence migraine thresholds.
Riboflavin (Vitamin B2)
Riboflavin supports mitochondrial energy production in brain cells. Several clinical trials show that high-dose riboflavin can help reduce migraine frequency. My Mito B Complex includes riboflavin along with other B vitamins that support mitochondrial function and nerve health.
Hydration
The brain is extremely sensitive to fluid balance. Even mild dehydration can trigger vascular changes that contribute to migraine symptoms.
Protect Your Sleep
Migraine brains thrive on routine. Going to bed and waking up at consistent times can significantly reduce migraine activity.
Medications Doctors Sometimes Use
While natural approaches are often the first step, medication may be appropriate when migraine symptoms significantly affect daily life.
Doctors typically prescribe preventive medications, meaning they are taken regularly to stabilize the nervous system.
Common options include:
Beta blockers
Medications such as propranolol or metoprolol help calm nervous system signaling and reduce migraine frequency. If you take a blood pressure drug like one of these, find out how to Replenish 7 Depleted Nutrients from Blood Pressure Medications
Calcium channel blockers
Drugs like verapamil stabilize blood vessel behavior and are sometimes used for migraine patterns that involve dizziness or aura. HERE’S HOW Calcium Channel Blockers work.
Low-dose antidepressants
Medications such as amitriptyline or nortriptyline are sometimes used at low doses to stabilize nerve pathways involved in migraine. If you’re having trouble with your medicine, read this: Do These 12 Supplements Work Better than Antidepressants?
Anti-seizure medications
Certain medications that reduce nerve excitability—such as topiramate or gabapentin—may also help prevent migraines. The following article may interest you next if you can take just 7-8 minutes to read it: Temporal Lobe Seizures a Cause for Weird Smells and Flashing Lights
CGRP-targeting medications (Calcitonin gene-related peptide)
Newer therapies such as Aimovig, Ajovy, Nurtec, and QUILIPTA work by blocking a migraine-related signaling molecule called CGRP. These drugs were developed specifically to help prevent migraines rather than simply treat the pain after it starts. When medication is part of the plan, it’s often most effective when paired with nutritional support and simple lifestyle strategies. Together, these approaches help address the underlying “ingredients” that make up a person’s unique migrenade.
A Final Thought
If you struggle with:
• unexplained dizziness
• brain fog
• visual aura
• head pressure
• balance problems
it may not be “just stress” or “just aging.” It could be vestibular migraine hiding in plain sight. Understanding your personal migrenade—and supporting your brain with the right nutrients and lifestyle habits—can often make a meaningful difference.
And if migraines have been part of your life for a while, my paperback book HEADACHE FREE is still a helpful starting point. While it focuses primarily on traditional migraine patterns, many of the nutritional and lifestyle strategies in that book apply to vestibular migraine as well.
Sometimes the biggest relief comes from realizing you’re not imagining it… and you’re certainly not alone.
You may also find these helpful:
-
Trigeminal Neuralgia – 10 Coping Strategies for Cranial Lightning Bolts!
-
Epilepsy News: 11 Popular Meds Deplete Folate Causing Sadness
-
Expert Insights on Depression, Anxiety, Thyroid, Migraines and Celiac
- Headaches? Time to Get Your Thyroid Checked!
Suzy Cohen, has been a licensed pharmacist for over 30 years and believes the best approach to chronic illness is a combination of natural medicine and conventional. She founded her own dietary supplement company specializing in custom-formulas, some of which have patents. With a special focus on functional medicine, thyroid health and drug nutrient depletion, Suzy is the author of several related books including Thyroid Healthy, Drug Muggers, Diabetes Without Drugs, and a nationally syndicated column.
